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JAMA Pediatrics Clinical Challenge
May 2015

Follicular Rash on the Knees and Hyperkeratotic Palms: A Difficult Diagnosis

Author Affiliations
  • 1Department of Pediatrics, Winthrop University Hospital, Mineola, New York
  • 2Virginia Commonwealth University School of Medicine, Richmond
  • 3Department of Dermatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
JAMA Pediatr. 2015;169(5):491-492. doi:10.1001/jamapediatrics.2014.3327

A healthy 7-year-old girl presented with a 2-month history of an itchy rash on her elbows, knees, hands, and feet. The patient was otherwise healthy with normal development and growth. She had no other medical problems and was not taking any medications. The rash started as small pink bumps on her knees and elbows, spreading to her hands and feet and progressively thickening. The patient’s history was otherwise unremarkable; she had no pets, had no recent travel outside the United States, and her vaccinations were up to date.

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