Photo Quiz

Hyperkeratotic Plaques on Hands


Am Fam Physician. 2016 Jun 1;93(11):945-946.

A 10-year-old boy presented with a rash on both hands that had been present for at least several weeks. He had not worn any new gloves or other clothing. He had received a new video game at Christmas about five months prior and had played it for at least three to four hours every day since.

On physical examination, he was not in distress. There were hyperkeratotic plaques on the lateral aspect of both of his index fingers (Figure 1). The lesions were symmetric, lichenified with erosions, and painful. The rest of the dermatologic examination was unremarkable.

Figure 1.


Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Frictional hyperkeratotic hand dermatitis.

B. Irritant contact dermatitis.

C. Palmoplantar keratoderma.

D. Psoriasis.

E. Tinea

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Address correspondence to Efstathios Rallis, MD, PhD, at Reprints are not available from the authors.


show all references

1. Usatine RP, Riojas M. Diagnosis and management of contact dermatitis. Am Fam Physician. 2010;82(3):249–255....

2. Schiller S, Seebode C, Hennies HC, Giehl K, Emmert S. Palmoplantar keratoderma (PPK): acquired and genetic causes of a not so rare disease. J Dtsch Dermatol Ges. 2014;12(9):781–788.

3. Zamiri M, van Steensel M, Munro C. Inherited palmoplantar keratodermas. In: Fitzpatrick TB, Goldsmith LA, eds. Fitzpatrick's Dermatology in General Medicine. 8th ed. New York, NY: McGraw-Hill Medical; 2012:538–550.

4. Rallis E, Kintzoglou S, Verros C. Ustekinumab for rapid treatment of nail psoriasis. Arch Dermatol. 2010;146(11):1315–1316.

5. Schieke SM, Garg A. Superficial fungal infection. In: Fitzpatrick TB, Goldsmith LA, eds. Fitzpatrick's Dermatology in General Medicine. 8th ed. New York, NY: McGraw-Hill Medical; 2012:2277–2327.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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