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

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.