Punctate palmoplantar keratoderma Q82.8

Buschke and Fischer 1910; Brewer 1913

Autosomal dominant inherited palmoplantar keratosis with onset of the disease in adulthood and development of extensive cornu-cutaneum-like horn beds.

Regular autosomal dominant inheritance. Detectable mutations are in the AAGAB gene, which maps to chromosome 15 (15q22.2-15q22.31) (Pohler E et al. 2012, Giehl KA et al. 2012). The gene encodes an alpha- and gamma-adaptin-binding protein.

In 2 Chinese families, another mutation was found on chromosome 8q24 in the COL14A1 gene , which encodes collagen XIV (Bi-Rong G et al. 2012; see also under Collagens).

Varying inter- and intrafamilial penetrance. Mostly occurring from puberty onwards, but also partially described in childhood.

Palmoplantar, progressive. No transgrediens (hyperkeratoses do not extend beyond palmae and plantae).

Symmetrical appearance of multiple wart-like horn papules, pinhead-sized to lentil-sized in shorter stand duration, that are dented in the center. Over the years, cherry-sized, isolated or even aggregated prominent horn nodules may develop, which may confluence to form misshapen wart-like beds. This may result in a cornu cutaneum-like aspect. There is usually pressure dolence on walking. Nail dystrophies are occasionally present. Spontaneous remissions are usually not observed. The phenotype may vary considerably interfamilially.

Enormous ortohyperkeratosis with pronounced hypergranulosis as well as massive elongation of the rectal ridges. Vent-like ascending of the acrosyringea through the overlying horny masses. No inflammatory infiltrate.

• Verrucae plantares
• Porokeratosis plantaris, palmaris et disseminata
• Callus
• syphilitic clavi
• dyskeratosis follicularis
• Psoriasis vulgaris with participation of Palmae and Plantae
• Psoriasis palmaris et plantaris
• Paraneoplastic acrokeratosis (with manifestation in adulthood; see figure)

Usually not necessary. Disturbing hyperkeratoses may be removed mechanically, if necessary surgical intervention. Topically, emollients and keratinolytics prove to be helpful. Systemic therapy with retinoids(acitretin, alitretinoin) is possible and leads to improvements. However, therapeutic success can only be achieved with permanent treatment.

No spontaneous remission.

A possible association with cancer is described. It is assumed that an increased EGFR-signaling, which can be detected in AAGAB-deficiency, could be causal. In particular, lymphomas, malignancies of the kidney, breast and gastrointestinal tract have been described.

1. Bodemer C et al. (2021) Treatment of hereditary palmoplantar keratoderma: a review by analysis of the literature. Br J Dermatol. 184:393-400.
2. Guo BR et al. (2012) Exome sequencing identifies a COL14A1 mutation in a large Chinese pedigree with punctate palmoplantar keratoderma. J Med Genet 49:563-568.
3. Has C et al. (2016) Palmoplantar keratodermas: clinical and genetic aspects. J Dtsch Dermatol Ges 14:123-39; quiz 140.
4. Klein B et al (2021) Palmoplantar papules. N Engl J Med 384:1447.
5. Müller CSI et al (2010) Keratosis palmoplantaris papulosa seu maculosa Buschke-Fischer-Brauer. Akt Dermatol 36: 480-483
6. Seebode C, Schiller S et al (2014) Skin lesions of the hands and feet. Dermatol 65: 499-512
7. Zhang XJ et al.(2004) Identification of a locus for punctate palmoplantar keratodermas at chromosome 8q24.13-8q24.21. J Invest Dermatol 122:1121-1125.