Keratotic papules of palms and soles

A 40-year-old white Caucasian woman presented with a 20-year history of asymptomatic lesions on palmoplantar regions. Physical examination revealed numerous keratotic papules with crateriform holes on the palms (Figure 1) and yellow pits over the areas of soles exposed to pressure (Figure 2). Her father reported the same skin signs but he was less severely affected. The patient displayed no systemic symptoms and chest x-ray and routine laboratory testing showed no alteration. No arsenic exposure was reported. Skin biopsy obtained from a lesion revealed marked orthokeratotic hyperkeratosis with hypergranulosis (Figure 3).