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Hi All. I am seeing a patient with a cluster of soft, fleshy lumps in the PMAs of both feet. They can be debrided without pain or haemorrhage. They become covered in flat callus after a time and are uncomfortable at that time. She is concerned as they appear to be growing in number in the last 6 months. Her dermatologist suggests they are keratoderma but I wanted to check with others' experience of this condition. Previously, I have reserved my use of this term for harder, more plaque-like growths. I appreciate your thoughts.

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Hi Moose,

Difficult to offer an opinion without a pic, but with a little more history we may be able to help.

What is the age and occupation of the pt? Meds, etc.

Are the lesions confined to both feet or does she have anhidrosis/eczema type hands too?

Localised keratoderma may present similary to diffuse hyperkeratosis and are often inherited as autosomal dominant, ie genetic. Both congenital and acquired forms of keratoderma can present in isolation or as part of a syndrome/other pathology. One type of acquired is keratoderma climactericum (‘Climacteric’ is used to describe the time around or preceding menopause) and is associated with obesity and hypertension. Aetiology is unknown, although endocrine factors would obviously play a part.

You say that the lesions are not `plaque-like`. At the start of the disorder, mild keratoses are sharply circumscribed and these gradually increase in size, forming scales and coalesce resulting in the diffuse hyperkeratosis presentation.

Dave attached some good docs on this here.

Cheers,
Bel

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If...

The patient is female ~ 50 yoa with normal BMI. The lesions affect only the feet. The lesions are sharply circumscribed and, after the removal of overlying callus, would not be palpable to the touch - ie not nodular in texture. I do have a pic but can't see how to upload it without a URL. Sorry.

Go to tinypic.com and upload your picture and then paste the resulting code into the text area on your pod arean reply.

Regards Dave

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