Acta Dermato-Venereologica Issue No. 97-5 97-5CompleteContent | Page 34

671 Symmetrical Keratotic Papules on the Hands: A Quiz Magdalena ŻYCHOWSKA 1 , Aleksandra BATYCKA-BARAN 1 , Zdzisław WOŹNIAK 2 , Anita HRYNCEWICZ-GWÓŹDŹ 1 and Wojciech BARAN 1 * 1 Department of Dermatology, Venereology and Allergology, and 2 Department of Pathomorphology, Wroclaw Medical University, Chalubinskiego 1, 50-368, Wroclaw, Poland. *E-mail: [email protected] A 4-year-old Caucasian boy with non-consanguineous pa- rents was admitted to the Department of Dermatology for evaluation of asymptomatic keratotic papules on the dorsal aspects of both hands (Fig. 1a). The lesions had developed 2 years prior to hospitalization and had gradually increased in number. Treatment with topical corticosteroids had been ineffective. There was no family history of similar lesions and the boy was otherwise healthy. No abnormalities of the hair, nail or teeth were seen on physical examination. Full blood count, routine biochemical analysis and urinalysis were within normal limits. A 4-mm punch biopsy was performed from lesional skin (Fig. 1b). Orcein staining revealed normal elastic fibres. What is your diagnosis? See next page for answer. Fig. 1. Clinical and histological features. (a) Multiple flesh-coloured, crateriform and confluent papules located symmetrically over metacarpo­ phalangeal and interphalangeal joints. (b) Histopathological image displays orthohyperkeratosis with acanthosis, focal hypergranulosis, scarce lympho­cytic infiltrate in the dermis (haematoxylin and eosin (H&E), original magnification ×100). QUIZ SECTION This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2017 Acta Dermato-Venereologica. doi: 10.2340/00015555-2628 Acta Derm Venereol 2017; 97: 671–672