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Medical Professionals Reference (MPR)Clinical Challenge: Skin Thickening on Soles

Inherited palmoplantar keratoderma, acquired palmoplantar keratoderma, mosaic plantar verrucae, or pitted keratolysis?

A 45-year-old construction worker with a 20-year history of painful foot “calluses” presents with worsening symptoms unresponsive to over-the-counter treatments. The patient has a family history of similar conditions and is currently on hydrochlorothiazide for hypertension. Physical examination reveals hyperkeratosis, scaling, and superficial fissures on the soles, along with mild scaling and xerosis of the palms.

Palmoplantar keratoderma (PPK) is not just a single condition but a group of disorders that can be inherited or acquired. Molecular genetic analysis has increasingly played a role in its classification, offering new avenues for targeted treatment.

Possible Diagnoses:
  1. Inherited Palmoplantar Keratoderma: This condition often presents with localized or generalized areas of hyperkeratosis on the palms and soles. It can be inherited in an autosomal dominant or recessive manner and may be associated with systemic abnormalities like hearing loss and dental anomalies.
  2. Acquired Palmoplantar Keratoderma: This form of keratoderma may be idiopathic or associated with inflammatory skin conditions such as psoriasis and pityriasis rubra pilaris. It may also be linked to underlying malignancies.
  3. Mosaic Plantar Verrucae: Characterized by multiple, often painful, warts on the soles of the feet. Unlike keratodermas, this condition is caused by human papillomavirus (HPV) infection.
  4. Pitted Keratolysis: This condition is bacterial in origin and manifests as small, shallow, and malodorous pits on the soles of the feet.

Based on the patient’s history, symptoms, and physical examination, what is your diagnosis?

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