Acta Dermato-Venereologica 99-3CompleteContent | Page 32

355 Painless Horny Keratotic Spines on the Palms: A Quiz Caroline DE LORENZI, Gürkan KAYA and Sandrine QUENAN Dermatology and Venereology Department, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, CH-1205 Genève, Switzerland. E-mail: [email protected] A 65-year-old Egyptian man presented to our clinic with a 4-year history of increasing, multiple, painless 1-mm keratotic spiny lesions on his palms (Fig. 1a and b) and fingers (Fig. 1c) exclusively. On examination no other areas of skin involvement were noted. His medical history included diabetes mellitus type 2 controlled with metformin, dyslipidaemia treated with rosuvastatin, and benign prosta- tic hyperplasia treated with a plant-based preparation. His family history was negative for similar lesions or dermato- logical disease. A colonoscopy and fibroscan performed in 2015 showed normal results. The patient currently smokes a pipe every 2 days and works as an engineer. A skin biopsy showed an acanthotic epidermis with elongated rete ridges and thinned granular layer, and a hyperkeratotic column with focal parakeratosis. A peri- vascular, mainly lymphocytic, inflammatory infiltrate was present in the dermis (Fig 2). Multiple tests were performed to rule out a systemic cause and paraneoplastic origin for these acquired lesions. These included complete blood count, as well as hepatic tests, renal function, thyroid-stimulating hormone (TSH), glucose, prostate-specific antigen (PSA) and immunofixa- tion, which were all within normal limits. Chest X-ray and an otolaryngology evaluation were negative for malignancy. Complete resolution was achieved a few weeks after application of a cream containing urea (120 mg/g), tretinoin (0.3 mg/g) and dexpanthenol (10 mg/g). What is your diagnosis? See next page for answer. Fig. 1. (a) Multiple brownish- yellowish filiform keratotic papules on the left palm. (b) Close-up on the filiform keratotic lesions on the palm. (c) Filiform keratotic papules on the fingers. QUIZ SECTION Fig. 2. (a) Haematoxylin and eosin (H&E) original magnification ×5. Acanthotic epidermis with elongated rete ridges and a hyperkeratotic column. Dermis shows a p e r i va s c u l a r, m a i n l y lymphocytic, inflammatory, infiltrate. (b) H&E, original magnification ×20. Epidermis with thinned granular layer and hyperkeratotic column with focal parakeratosis. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3099 Acta Derm Venereol 2019; 99: 355–356