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Acquired/secondary  Keratodermas Genetic/primary
(genodermatoses)
 Keratodermas
(if you don't find it here, see ref.8)

palmoplantar ectodermal dysplasia (PED)
(keratoderma + oral, hair, nail, dental, auditory, neural abnormalities)

Follicular pattern:

  1. acne comedone: simple keratin & sebum plug of nearly whole follicle
  2. keratosis follicularis:
    • keratosis pilaris (KP): more bluntly spiky infundibular plugs
      • with scarring:
        1. keratosis pilaris atrophicans faciei
        2. atrophoderma vermiculata
        3. keratosis pilaris decalvans
        4. perforating disease in association with renal failure
    • keratosis spinulosa: more finely spiky infundibular plugs
      • lichen spinulosa or spinulosus: keratosis spinulosa with follicular lichenoid chronic inflammation
      • lichen scrofulosorum: keratosis spinulosa with follicular granulomatous chronic inflammation
  3. Paraneoplastic keratoderma
  4. perforating folliculitis: rolled up thin hair into follicle, with debris & degenerated elastic fibers & chronic inflammatory cells
  5. Pityriasis rubra pilaris (PRP): sebaceous atrophy & granular layer loss at shoulders of follicular ostium; chronic inflammation & telangiectasia. Can cause makedly thickened palmar hyperkeratosis12.
  6. keratosis follicularis cantagiosa of Brooke (epidemic acne)
  7. follicular pityriasis rosea
  8. follicular syphiloderm
  9. lupus erythematosus with follicular plugging
  10. lichen planopilaris (variant of  lichen planus)
  11. keratosis pilaris of phrynoderma type: due to adult vitamin A deficit & morphology like keratosis spinulosa
  12. LS & A with follicular plugging
  13. pellagra with follicular horny spines like keratosis follicularis plus enlarged sebaceous glands (lesions especially of central face)
  14. hyperkeratosis lenticularis perstans

Other miscellaneous:

  1. infectious diseases:
    1. fungal dermatosis: Tinea pedis
    2. Tuberculosis: verrucosa cutis & lichen scrofulosorum
    3. Norwegian scabies
    4. Secondary syphilis
    5. Reiter's syndrome
    6. gonorrheal keratoderma blenorrhagicum
    7. Human papillomavirus
    8. AIDS
  2. chronic acral dermatitis (elevated IgE)
  3. Xeroderma (dry skin)
  4. "Eczema"...especially chronic & hard to cure of hands & feet
  5. Lichen planus
  6. Psoriasis
  7. contact dermatitis
  8. neurodermatitis
  9. Grover's disease: with acantholytic hyperkeratosis
  10. Grover-like coincidental pinpoint, minute lesions seen in skin specimens with other entities [S-04-1550; S-04-2666, especially actinic keratosis S-04-7889B, S-04-8081]
  11. Epidermolytic hyperkeratosis-like coincidental pinpoint, minute lesions seen in skin specimens with other entities. [S-05-9246]

Punctate (small lesions) palms/soles, acquired:

  1. porokeratosis plantaris discreta
  2. Paraneoplastic keratoderma
  3. Psoriasis
  4. Chronic contact
  5. corns & calluses
  6. Verrucae
  7. Reiter's syndrome
  8. Arsenical keratoses
  9. Asbestos keratoses
  10. Localized epidermal nevus
  11. Pityriasis rosea (rare)
  12. Trichophytosis

Patchy (bigger lesions) palms/soles, acquired:

  1. Corns (clavus) & Callus
  2. Climacteric keratoderma
  3. Vesicular palmoplantar eczema
  4. Hyperkeratotic palmar [spongiotic] eczema (hyperkeratotic dermatitis of palms; tylotic exzema; circumscribed palmar keratoderma)
  5. Secondary syphilis or yaws
  6. Psoriasis
  7. Lichen planus

Diffuse palms/soles, acquired:

  1. Chronic contact
  2. psoriasis
  3. idiopathic erythroderma: elevated serum IgE levels, dermatopathic lymphadenopathy, & marked palmar plantar keratoderma.
  4. Trichophytosis (fungus)
  5. Climacteric (older age related) keratoderma
  6. Lichen simplex
  7. Arsenical keratosis
  8. tertiary syphilis or yaws
  9. icthyosiform reactions associated with systemic disease:
    1. hypothyroidism
    2. hyperparathyroidism
    3. lupus (SLE)
    4. sarcoidosis
    5. leprosy
    6. paraneoplastic (cancer associated...breast; esophagus)
    7. myeloma (malignancy)
    8. lymphoma (malignancy)

Vascular ("blood-blister") keratoses:

  1. simple blood blister: a pinch, suction, or friction caused lens of intra-epidermal blood (S10-13476) with little or no associated hyperplasia or hyperkeratosis (can rarely accumulate a jell or mucous like component as in a seroma [L10-3799]). Talon noir is a "black heel", an extreme blood blister due to shearing forces; there are many lesser lesions of the feet (post-traumatic cutaneous intracorneal blood") which might bring melanoma to mind.
  2. angiokeratoma: raised papillary dermal capillary or vascular lesions with associated epidermal hyperplasia & hyperkeratosis.
    • angiokeratoma circumscriptum: very rare & as plaques upper & lower limbs children.
    • angiokeratoma of Fordyce: scrotum, penile, vulvar.
    • angiokeratoma of Mibelli: warty acral papules children & adolescents.
    • angiokeratoma corporis diffusum: bathing-trunk area, symmetrical clusters of red papules & may be associated with Anderson-Fabry disease.
    • sporadic angiokeratoma: more often legs & not syndromic.

Exfoliative erythrodermas (red & peeling skin), acquired:

  1. Psoriasis
  2. Pityriasis rubra pilaris (PRP)
  3. Atopic dermatitis
  4. Erythrodermic reticulosis:
    1. Mycosis fungoides
    2. Sezary syndrome
    3. Epidermotrophic lymphomas and leukemias
  5. Drug eruption (esp. heavy metals)
  6. Seborrheic dermatitis
  7. Sulzberger-Garbe syndrome

Follicular pattern:

  1. keratosis follicularis (very common & like spikey goosebumps): physiologic & ichthyotic...simple keratotic plug of infundibulum.

    • keratosis pilaris: more bluntly spikey infundibular plugs

    • keratosis spinulosa: more finely spikey infundibular plugs

  2. lichen pilaris sue spinulosa (lichen spinulosa)

  3. porokeratosis (PPPD)

  4. elastosis perforans serpiginosa

  5. dyskeratosis follicularis (Morbus-Darier's disease or Darier-White disease): acantholytic hyperkeratosis (chest & back) of infundibular epithelium with keratotic plug

  6. keratosis pilaris atrophicans

    1. k. p. a. faciei

    2. atrophoderma vermiculata

    3. k. p. decalvans

  7. Kyrle's disease (hyperkeratosis follicularis et parafollicularis in cutem penetrans)

  8. ulerythema ophrygenes: follicular plugging, redness & atrophy, and may begin in childhood in lateral eyebrows (plugs, absent sebaceous glands, dermal chronic inflammation & fibrosis.

Other miscellaneous:

  1. Epidermodysplasia verruciformis
  2. nevoid lesions of epidermolytic hyperkeratosis (very tiny foci of this reaction pattern are not at all uncommon in skin specimens removed for other reasons)
  3. Epidermolysis bullosa herpetiformis
  4. Ichthyosis vulgaris (hyperkeratosis with absent granular layer)
    • ICE syndrome
  5. X-linked ichthyosis (hyperkeratosis with granular layer present)

  6. Lamellar ichthyosis (hyperkeratosis & granular layer usually present and some variable acanthosis0

  7. erythrokeratoderma variabilis
  8. elastosis perforans serpiginosa
  9. epidermolytic hyperkeratosis (large keratohyaline granules, vacuolated keratinocytes in superficial epidermis)
  10. ichthyosis  & various chondrodysplasias
  11. Refsum's (ichthyosis) syndrome
  12. see ref. 8

Punctate palms/soles, congenital:

  1. keratosis palmaris et plantaris
    1. punctate keratoderma
    2. striate keratoderma
    3. disseminated keratoderma with corneal atrophy
    4. childhood onset circumscribed keratoderma
  2. superficial actinic disseminated porokeratosis
  3. acrokeratosis verruciformis of Hopf
  4. Darier's disease
  5. the ichtyoses (see above)
  6. Naegli's syndrome
  7. keratosis circumscripta in Nigerian children

Patchy palms/soles, congenital:

  1. ?

Diffuse palms/soles,congenital:

  1. Tylosis in infants
  2. mutilating keratoderma
  3. progressive keratoderma
  4. Mal de Meleda
  5. Papillon-Lefevre syndrome
  6. polykeratosis
  7. hydrotic ectodermal dysplasia
  8. dyskeratosis congenita
  9. congenital ichthyosis (see above)

Vascular ("blood-blister") keratoses:

  1. angiokeratoma corporis diffusum (Fabry's disease)
  2. angiokeratoma of Mibelli (hands and feet) "telangiectatic warts"

Erythroderma, v:

  1. Congenital (sometimes bullous)  ichthyosiform erythroderma
    • CHILD syndrome
    • KID syndrome
    • Dorfman-Chanarin syndrome
    • Sjogren-Larsson (Rud's) syndrome
    • epidermolytic hyperkeratosis9
  2. erythrokeratoderma variabilis (patchy hyperkeratosis and areas of erythema).
  3. targetoid lesions of "genodermatose en Cocardes"
  4. migratory polycyclic erythema and scaling of "ichthyosis linearis circumflexa"
  1. pachyonychia congenita (pressure sites palms & soles)
  2. acquired pachyonychia [as with S-02-11582]
  3. etc.[S-03-9336]