Differential Diagnosis of Keratodermas

Differential Diagnosis of Hyperkeratosis of palms and soles (Keratodermas)

Porokeratosis Mantoux (Sometimes hereditary, sometimes not. Appears at a more advanced age with pinhead-sized, white, hard hyperkeratoses. They can be removed without any bleeding, but recur)

Hereditary Keratodermas

Mal de Meleda (The hyperkeratosis extends beyond the sides of the palms and soles onto the wrists and ankles. Hyperidrosis, Subungual keratoses, Psoriasiomorph plaques on elbows and knees)

Papillon - Lefevre Syndrome (Periodontal Disease and premature loss of Teeth)

Unna - Thost Disease (Yellow-Brown thick Hyperkeratosis, stricktly confined to the palms and soles)

Hereditary Epidermolytic Palmoplantar Keratoderma of Voerner (It can be differentiated by the presence of granular degeneration in the malpighian layer)

Mutilating Keratoderma (Ainhum and loss of digits. Sometimes, Hyperidrosis, Nail changes, Hypogonadism, Inner ear Deafness)

Brauer's Keratoderma (Scattered hyperkeratotic verrucosities on the palms and soles)

Bronauer - Fuhs Keratoderma (Hyperkeratosis in bands)

Richner - Hanhart Syndrome with Tyrosinemia (Punctiform or ribbon-shaped, clavus-like, painful keratoses, favoring the fingertips, Dystrophy of the Cornea, Mental retardation, Multiple lipomatas, Subungual keratoses)

Progressive Keratoderma or Greither's Syndrome (Dominant trait, resembles to Meleda, involves elbows-knees. Appears in childhood and at the age of about 55 years, tends to regress)

Punctate Keratoderma of Buschke - Fischer type (Numerous hard, horny Papules, round or oval, over the palms and soles, including digits. No associated defectswith the exception of Nail dystrophies)

Dermatopathia Pigmentosa Reticularis (Universal pigmentation, beggining at age 2 years, Onychodystrophy, Punctate Hyperkeratosis of Palms and Soles)

Porokeratosis Palmaris et Plantaris Disseminata (Inherited, usually appears in early 20s. Wartlike, porokeratotic lesions on the palms and soles and later on other areas)

Keratosis Pilaris Decalvans (Inherited, it begins in infancy or early childhood on the Nose, Cheeks, Limbs, Neck. Follicular Papules, Scarring alopecia, Palmoplantar Hyperkeratosis, Atopy, Photophobia, Deafness, Physical and Mental Retardation)


Acquired and Symptomatic Keratodermas

Climacteric Keratoderma


Lichen Planus

Hyperkeratotic Eczema

Pityriasis Rubra Pilaris (Usually with painful fissuring)


Secondary Syphilis (Indurated Papules, may persist until the third stage)


Gonorrhoea (In septicemia. Small, hard hyperkeratoses, or more diffuse in geographic patterns)

Reiter's Disease - Keratoderma Blenorrhagicum

"Cancer" keratoses (Punctate pearly Papules, especially on thenar and hypothenar eminences)

Howel - Evans Syndrome (Rare condition that may precede a Carcinoma of Esophagus)


Chronic Arsenic Poisoning

Hydroxyurea (Plantar Keratoderma)

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