Watcher’s type of palmoplantar keratoderma

A 51-year-old man reported with progressive thickening of the skin of the hands and feet since the age of 6yrs. It was largely asymptoma c; however, brisk walking caused excessive swea ng, pain, and widening of the fissures on the soles of the feet. He also had scaly raised lesions on legs and knees. His mother, maternal aunt, cousin and nephew had similar lesions. Examination of the soles of feet revealed pronounced thickening of the skin at the bony prominences which was well demarcated. In addition, marked fissuring was obvious. Both palms have similar lesions which were minimal. Nails showed subungual hyperkeratosis and onychogyrophosis. Histopathology from sole showed marked hyperkeratosis, parakeratosis, hypergranulosis, irregular elongation of rete rigdes and dense lymphocytic infilterate in upper dermis & papillary dermis. Pa ent was started on oral acitre n 25mg twice daily and topical 12% salicylic acid with minimal improvement. A rare and unusual case of palmoplantar keratoderma is presented.