Palmoplantar Red Hyperkeratosis

Abstract

Clinical differential diagnosis of palmoplantar red hyperkeratosis includes palmoplantar plaque psoriasis, chronic hand dermatitis, “chronic hyperkeratotic eczema (CHE),” and tinea. Rarely a patient with the above clinical presentation may have mycosis fungoides and much more rarely a paraneoplastic disorder.

Palmoplantar plaque psoriasis may not reveal the characteristic findings seen in plaques psoriasis elsewhere. Tinea is suspected in the presence of neutrophils in the horny layer, and the diagnosis may be confirmed by special stains. Chronic hand dermatitis may reveal the findings of irritant dermatitis and spongiotic dermatitis. CHE demonstrates hyperkeratosis, usually compact, acanthosis, and generally no or mild spongiosis. Palmoplantar mycosis fungoides may be missed histologically if there is severe spongiosis.