By Gary M. White, MD
Spiny keratoderma is an uncommon condition in which numerous keratinaceous spines occur on the palms and soles. One study suggests that SK represents an ectopic hair formation of the palms and soles [JCP 1999;26;25]. Rarely, it may occur post radiation (PICK--post irradiation conical keratoses).
See also punctate keratoderma, a similar condition in which the lesions are larger.
Bilateral spines like an old fashioned music box strictly on the volar hands and feet are characteristic. Onset is from puberty to old age. Half of the cases are sporadic and half are familial. A very small percentage of these cases may be uninherited and paraneoplastic, i.e. associated with a neoplasm. One case of linear lesions presumably following Blaschko's lines has been reported [PD 2016;33/322].
There is no cure. One may attempt to reduce the prominence of the keratotic spines using a topical keratolytic, e.g. 40% urea cream QD.
This elderly gentlemen had a bit of an overlap of spiny keratoderma with some smaller lesions of punctate keratoderma
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