Hyperkeratosis palmoplantar with palmar crease hyperkeratosis
Overview
A condition characterized by thickening of the skin on the palms of the hands and soles of the feet. The condition is associated with a risk of developing esophageal cancer which increases with age.
Causes
KPPC is rarely seen in Caucasians. Of 1001 white patients examined for palmar lesions, none fulfilled the diagnostic criteria for KPPC. In a study of 534 patients, Weiss et al discovered cases— all in African American patients and representing 3.1% of this racial group.8 The cause of KPPC is unknown. No medications have been implicated, and it has been difficult to link it to a virus. Although some authors have suggested that KPPC represents flexural calluses related to manual labor, lesions also occur in patients without this history. There is no association between KPPC and arsenical agents or syphilis.
Diagnosis
Keratosis punctata of the palmar creases (KPPC) is a benign, largely asymptomatic condition of the hands, seen almost exclusively those with African ancestry. KPPC presents as small keratotic papules that evolve into discreet conical pits1,2 Although KPPC is not a novel or rare condition among African Americans, it is not found in standard dermatology texts used by primary care physicians. However, reference to KPPC may be found in ethnic dermatology texts, including reference to it as “a common normal finding in the black palm.”
Prognosis
The patient was reassured by the explanation of the condition and chose to try a keratolytic/emollient agent, Lac-Hydrin, for symptomatic recurrences. At her last visit for another health issue, she has reported this to be helpful.
Treatment
The mainstay of therapy is informing the patient of the benign nature of the diagnosis and avoiding unnecessary and unhelpful therapies and diagnostic modalities. Therapy with keratolytic agents or systemic retinoids may temporarily improve symptoms of KPPC.