Kulkarni KP, Kaur S
Department of Pediatrics, PGIMER, Chandigarh.

Address for Correspondence: Ketan P Kulkarni, Department of Pediatrics, PGIMER, Chandigarh, India. Email: ketanprasadkulkarni@gmail.com

A 4 year old male child presented with thickening of palmaer and plantaer surfaces of hands and feet respectively, since 2 years of age. He had painful fissures on the palmer surface with consequent limitation of activities of daily living. There was no history of any affected family member with similar complaints. The rest of the skin was unaffected. There was no evidence of any systemic involvement in the form of periodontitis, alopecia, neurological involvement, mental retardation, nail anomalies, polydactyly, syndactyly, clubbing of fingers or dwarfism. The rest of the systemic examination was within normal limits.

Thus, the child had isolated and sporadic palmoplantar keratosis. Palmoplantar keratoderma (PPK) constitutes a heterogeneous group of inherited as well as acquired disorders characterized by thickening of the palms and the soles of affected individuals (1,2). In diffuse PPK there is uniform involvement of the palmoplantar surface. This pattern is usually evident within the first few months of life. Keratin 1 and keratin 9 mutations have been reported in these patients (3). The diagnosis is largely clinical, especially in a resource limited setting. The solitary nature of presentation in the index patient precludes assessment of inheritance pattern and may have occurred due to sporadic mutations in the keratin genes.

Treatment includes salicylic acid, 50% propylene glycol in water under plastic occlusion several nights per week, and lactic acid- and urea-containing creams and lotions; all have been shown to be helpful. Patients with isolated PPK usually have a benign clinical course.