Painless Horny Keratotic Spines on the Palms: A Quiz.

Abstract

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 prostatic hyperplasia treated with a plant-based preparation. His family history was negative for similar lesions or dermatological 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 perivascular, 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 immunofixation, 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).