By Gary M. White, MD
Punctate keratoderma, aka Hereditary Palmoplantar Keratoderma, Papulosa Variant is an uncommon chronic condition of the palms and soles characterized by keratotic papules and nodules.
- Inheritance is autosomal dominant or sporadic.
- Rarely, isolated cases of late onset have been associated with internal neoplasia, e.g. bronchial carcinoma [CED 1994;19;139].
- Mutations in the AAGAB gene on 15q, which encodes the alpha- and gamma-adaptin-binding protein p34 have been identified [Acta Derm Venereol 2016; 96: 468–472].
- See also spiny keratoderma, which is similar, but lesions are smaller.
Discrete, keratotic papules, limited to the palms, soles and volar aspects of the fingers occurs in punctate keratoderma. These changes typically occur at puberty, but may have a later onset.
- Pare down individual lesions
- Topical keratolytics, e.g 20-40% urea-containing cream may help.
- An oral retinoid, e.g. acitretin, is rarely needed but may be successful if given chronically [JAAD 1983;8;700].
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