What is the cause of this woman’s cuplike lesions?

David L. Kaplan, MD—Series Editor

This 50-year-old woman presented with a several-year history of annoying but painless lesions on the insteps of the soles, wrists, and creases of her palms. She is otherwise healthy.

What is the cause of this woman’s cuplike lesions?

  1. Warts
  2. Keratosis punctata
  3. Acrokeratoelastoides lichenoides
  4. Palmar plantar pustulosis
  5. Porokeratosis

Answer on next page.


Answer: Keratosis punctata

Keratosis punctata is classically seen in the skin of the African American population, especially along the natural skin folds and lines. The more common version affects only creases of the palms. These lesions may temporarily respond to topical keratolytics such as urea or salicylic acid. Warts and acrokeratoelastoides usually protrude outwardly rather than the cuplike depressions seen here. There are no pustules, nor are there lesions that have a thin keratotic rim as seen in porokeratosis.