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November 1987

Facial Papules and Nodules, Thyroid Goiter, and Acral Keratoses

Author Affiliations

University of Louisville

Arch Dermatol. 1987;123(11):1561-1562. doi:10.1001/archderm.1987.01660350174037

REPORT OF A CASE  A 62-year-old man had thyroid goiter (Fig 1) of approximately ten years' duration. There were no signs or symptoms of hyperthyroidism or hypothyroidism. In addition, multiple facial lesions had developed slowly over a 15-year period. The patient was in good health except for symptoms of prostatism. Family history was not contributory.Physical examination disclosed the following abnormalities: a large head, bilateral conjunctival pterygia, buccal papillomas, fissured tongue, large thyroid goiter without nodules, enlarged prostate, and dull intelligence. Cutaneous examination revealed multiple papules and nodules, particularly in the centrofacial area (Fig 2). Some of the lesions contained a central keratotic plug or horn. On the hands and distal forearms, keratotic wartlike lesions were present (Fig 3). On the left heel a much larger keratotic lesion was noted. A large, soft, pedunculated molluscum fibrosum was present in the left side of the groin.Examination of a skin biopsy specimen from

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