Diagnosis: keratosis punctata of the palmar creases
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 (Figure 3) that evolve into discreet conical pits (Figure 4).1,2 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.”1
The lesions of KPPC characteristically are 1 to 5 mm in diameter, sharply defined hyperkeratotic pits that occur in the flexural creases of the hands, both on the palms and volar surfaces of the fingers. KPPC has also referred to as keratotic pits of the palmar creases, punctate keratoses of the palmar creases, keratoderma punctata, hyperkeratosis penetrans, lenticular atrophia of the palmar creases, and hyperkeratosis punctata of the palmar creases.
FIGURE 3
Close-up of a “plug”
FIGURE 4
Close-up of a “pit”
Distinguishing KPPC from KPPP
KPPC has also been regarded as a variant of keratosis punctata palmaris et plantaris (KPPP).3,4 KPPP and KPPC share some similarities with respect to the size and number of lesions per palm, probable exacerbation by trauma, and predilection for occurring in those of Afro-Caribbean descent.1,3,4
Historically, there has been some confusion in distinguishing KPPC from KPPP—in fact, it is possible for the 2 conditions to occur simultaneously. The papular lesions of KPPP tend to occur over the entire palm, volar wrist, and medial aspects of the feet. These entities differ in age at onset, prevalence, symptoms, and prognosis.