Case for Diagnosis
Filiform Palmoplantar Papules
Pápulas filiformes palmoplantares
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Hiraldo-Gamero, J. Gordillo Chaves" "autores" => array:2 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Hiraldo-Gamero" "email" => array:2 [ 0 => "alihiraldo@hotmail.com" 1 => "alhiga82@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Gordillo Chaves" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital de Mérida, Badajoz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital de Mérida, Badajoz, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pápulas filiformes palmoplantares" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 708 "Ancho" => 788 "Tamanyo" => 90335 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 78-year-old woman presented lesions on the palms and soles that caused discomfort because they were exposed to constant friction. The lesions had first appeared several years earlier. The patient had a history of osteoarthritis, systemic hypertension, dyslipidemia, and atrial fibrillation. She was on treatment with acenocoumarol, carvedilol, atorvastatin, metamizol, paracetamol, and omeprazole.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed multiple brownish, filiform hyperkeratotic papules measuring only a few millimeters. The lesions were distributed across the entire surface of the palms (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and less densely on the soles.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 2<span class="elsevierStyleHsp" style=""></span>mm punch biopsy that included a complete lesion was taken from one of the patient's palms. Histology revealed a column of parakeratosis in the stratum corneum with underlying focal hypogranulosis and a depressed epidermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Spiny keratoderma or filiform hyperkeratosis of the palms and soles.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">Blood tests with tumor markers, chest radiograph, and abdominal ultrasound were requested. The only relevant findings were hepatic steatosis and the presence of renal cysts. Treatment with 0.1% tretinoin and 40% urea cream obtained a poor results. On further interrogation, the patient reported that several of her relatives had similar problems of “spines” on the hands.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Spiny keratoderma is a rare condition; only around 30 cases have been reported in the literature. Most cases are acquired but there are also familial cases,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> like that of our patient. This skin condition is characterized by the appearance of small, filiform hyperkeratotic lesions distributed across the surface of the palms and/or soles.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The lesions resemble the spines of an old-fashioned music box cylinder.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Although they are usually asymptomatic, the lesions can make manual labor difficult and cause pain on pressure or walking. The condition is chronic and spontaneous remissions are rare.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Spiny keratoderma can be hereditary, with an autosomal dominant inheritance pattern and onset in the second or third decades of life, or sporadic, with onset at a later age. In either case, it is more common in men.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Histologically, spiny keratoderma is characterized by a compact, cornoid lamella–like column of parakeratosis that is clearly separated from the normal stratum corneum and the underlying granular layer is thin or absent.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Like porokeratotic eccrine ostial and dermal duct nevi, the lesions are occasionally associated with hair follicles and acrosyringia.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Spiny keratoderma has been found in association with various diseases, including polycystic kidney and liver disease, Darier disease, tuberculosis, epidermodysplasia verruciformis, and neoplasms. It was originally considered to be a paraneoplastic syndrome, but today, the most widely accepted opinion is that there is no clear association between spiny keratoderma and other diseases. Clinically and histologically, it is considered to be a distinct entity that should not be mistakenly identified as a variant of either punctate keratoderma or porokeratosis, which have respectively been associated with internal and cutaneous malignancies.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The pathogenesis of spiny keratoderma is poorly understood. It has been suggested, on the basis of the keratin patterns found in the column of parakeratosis, that it may be caused by anomalous ectopic hair formation.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Spiny keratoderma has been treated with numerous agents, including topical and oral retinoids, emollients containing salicylic acid, urea, ammonium lactate, propylene glycol, and 5-fluorouracil<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>; the results have been variable.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Hiraldo-Gamero A, Gordillo Chaves J. Pápulas filiformes palmoplantares. Actas Dermosifiliogr. 2013;104:819–820.</p>" ] ] "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 708 "Ancho" => 788 "Tamanyo" => 90335 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 564 "Ancho" => 751 "Tamanyo" => 171533 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin-eosin, original magnification × 4. B, Hematoxylin-eosin, original magnification × 10.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Queratodermia espinosa palmar: a propósito de un caso" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Guhl" 1 => "R. Goiriza" 2 => "E. Vargasa" 3 => "J. Fraga" 4 => "A. García-Díeza" 5 => "J. 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Mateu Puchades" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Piel" "fecha" => "2004" "volumen" => "19" "paginaInicial" => "215" "paginaFinal" => "216" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spiky keratotic projections on the palms and fingers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Grillo" 1 => "B. Pérez-García" 2 => "C. González-García" 3 => "S. Vano-Galván" 4 => "P. Jaén-Olasolo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatol Online J" "fecha" => "2012" "volumen" => "15" "paginaInicial" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20040258" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hiperqueratosis filiforme paraqueratósica palmar sin malignidad subyacente" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Pérez-Pérez" 1 => "C. Peteiro" 2 => "J. Sánchez-Aguilar Toribio" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2007" "volumen" => "98" "paginaInicial" => "420" "paginaFinal" => "424" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17663932" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000009/v1_201310240051/S1578219013002138/v1_201310240051/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000009/v1_201310240051/S1578219013002138/v1_201310240051/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013002138?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 20 | 13 | 33 |
| 2024 October | 98 | 48 | 146 |
| 2024 September | 105 | 33 | 138 |
| 2024 August | 115 | 65 | 180 |
| 2024 July | 73 | 47 | 120 |
| 2024 June | 103 | 41 | 144 |
| 2024 May | 75 | 44 | 119 |
| 2024 April | 76 | 19 | 95 |
| 2024 March | 86 | 28 | 114 |
| 2024 February | 82 | 38 | 120 |
| 2024 January | 45 | 31 | 76 |
| 2023 December | 56 | 20 | 76 |
| 2023 November | 72 | 24 | 96 |
| 2023 October | 53 | 35 | 88 |
| 2023 September | 84 | 32 | 116 |
| 2023 August | 53 | 25 | 78 |
| 2023 July | 55 | 38 | 93 |
| 2023 June | 72 | 26 | 98 |
| 2023 May | 68 | 26 | 94 |
| 2023 April | 63 | 18 | 81 |
| 2023 March | 57 | 31 | 88 |
| 2023 February | 41 | 23 | 64 |
| 2023 January | 48 | 27 | 75 |
| 2022 December | 55 | 39 | 94 |
| 2022 November | 25 | 33 | 58 |
| 2022 October | 31 | 27 | 58 |
| 2022 September | 34 | 45 | 79 |
| 2022 August | 33 | 49 | 82 |
| 2022 July | 37 | 42 | 79 |
| 2022 June | 22 | 40 | 62 |
| 2022 May | 47 | 44 | 91 |
| 2022 April | 50 | 37 | 87 |
| 2022 March | 45 | 51 | 96 |
| 2022 February | 40 | 31 | 71 |
| 2022 January | 36 | 30 | 66 |
| 2021 December | 53 | 43 | 96 |
| 2021 November | 68 | 33 | 101 |
| 2021 October | 47 | 46 | 93 |
| 2021 September | 49 | 49 | 98 |
| 2021 August | 45 | 27 | 72 |
| 2021 July | 54 | 31 | 85 |
| 2021 June | 57 | 34 | 91 |
| 2021 May | 53 | 35 | 88 |
| 2021 April | 79 | 61 | 140 |
| 2021 March | 71 | 27 | 98 |
| 2021 February | 73 | 35 | 108 |
| 2021 January | 37 | 22 | 59 |
| 2020 December | 34 | 19 | 53 |
| 2020 November | 37 | 12 | 49 |
| 2020 October | 22 | 13 | 35 |
| 2020 September | 36 | 15 | 51 |
| 2020 August | 28 | 16 | 44 |
| 2020 July | 24 | 14 | 38 |
| 2020 June | 29 | 23 | 52 |
| 2020 May | 22 | 31 | 53 |
| 2020 April | 35 | 19 | 54 |
| 2020 March | 33 | 18 | 51 |
| 2020 February | 3 | 6 | 9 |
| 2020 January | 0 | 1 | 1 |
| 2019 December | 0 | 2 | 2 |
| 2019 November | 0 | 1 | 1 |
| 2019 October | 0 | 1 | 1 |
| 2019 September | 0 | 6 | 6 |
| 2019 August | 0 | 7 | 7 |
| 2019 July | 0 | 22 | 22 |
| 2019 June | 0 | 15 | 15 |
| 2019 May | 2 | 17 | 19 |
| 2019 April | 0 | 15 | 15 |
| 2019 March | 0 | 7 | 7 |
| 2019 February | 0 | 5 | 5 |
| 2019 January | 0 | 3 | 3 |
| 2018 December | 2 | 6 | 8 |
| 2018 November | 1 | 2 | 3 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 4 | 0 | 4 |
| 2018 May | 0 | 2 | 2 |
| 2018 March | 3 | 8 | 11 |
| 2018 February | 42 | 2 | 44 |
| 2018 January | 44 | 5 | 49 |
| 2017 December | 47 | 6 | 53 |
| 2017 November | 35 | 2 | 37 |
| 2017 October | 46 | 18 | 64 |
| 2017 September | 46 | 13 | 59 |
| 2017 August | 78 | 12 | 90 |
| 2017 July | 52 | 11 | 63 |
| 2017 June | 100 | 28 | 128 |
| 2017 May | 77 | 19 | 96 |
| 2017 April | 64 | 8 | 72 |
| 2017 March | 72 | 9 | 81 |
| 2017 February | 34 | 28 | 62 |
| 2017 January | 36 | 32 | 68 |
| 2016 December | 53 | 6 | 59 |
| 2016 November | 61 | 19 | 80 |
| 2016 October | 125 | 24 | 149 |
| 2016 September | 189 | 6 | 195 |
| 2016 August | 159 | 13 | 172 |
| 2016 July | 80 | 10 | 90 |
| 2016 June | 7 | 10 | 17 |
| 2016 May | 5 | 10 | 15 |
| 2016 April | 6 | 23 | 29 |
| 2016 March | 8 | 19 | 27 |
| 2016 February | 13 | 26 | 39 |
| 2016 January | 14 | 18 | 32 |
| 2015 December | 6 | 18 | 24 |
| 2015 November | 7 | 18 | 25 |
| 2015 October | 2 | 16 | 18 |
| 2015 September | 4 | 9 | 13 |
| 2015 August | 4 | 4 | 8 |
| 2015 July | 92 | 4 | 96 |
| 2015 June | 57 | 5 | 62 |
| 2015 May | 57 | 0 | 57 |
| 2015 April | 54 | 3 | 57 |
| 2015 March | 37 | 2 | 39 |
| 2015 February | 45 | 4 | 49 |
| 2015 January | 39 | 1 | 40 |
| 2014 December | 45 | 4 | 49 |
| 2014 November | 28 | 1 | 29 |
| 2014 October | 42 | 5 | 47 |
| 2014 September | 30 | 2 | 32 |
| 2014 August | 21 | 3 | 24 |
| 2014 July | 28 | 4 | 32 |
| 2014 June | 44 | 1 | 45 |
| 2014 May | 44 | 7 | 51 |
| 2014 April | 30 | 2 | 32 |
| 2014 March | 49 | 4 | 53 |
| 2014 February | 24 | 5 | 29 |
| 2014 January | 24 | 2 | 26 |
| 2013 December | 27 | 4 | 31 |
| 2013 November | 14 | 2 | 16 |
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