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Hyperkeratosis Lenticularis Perstans: Case Report of a Rare Entity

Indian Journal of Dermatology
Medknow Publications
Publication Date
DOI: 10.4103/0019-5154.108092
  • E-Correspondence
  • Biology
  • Medicine


Sir, A 22-year-old female patient presented with complains of gradually increasing asymptomatic skin lesions all over body for last 2 years. On examination, multiple, tiny, discrete, erythrmatous, scaly, folliculo-papular, bilaterally symmetrical lesions were present all over her body, except face and scalp [Figures 1-4]. Lesions were dense on distal extremities as compared to proximal extremities and trunk. Few discrete lesions were present on palms and soles also. Skin lesions were asymptomatic, only occasional pruritus was reported by patient. Nail and mucosa were unaffected. Lesions started on distal extremities and gradually spread proximally. Patient applied various topical medicines including topical steroids, moisturizers etc., without significant improvement. Figure 1 Discrete, follicular papular lesions on dorsa of feet Figure 2 Similar lesions on forearms Figure 3 Lesions on thighs Figure 4 Few lesions of similar morphology on trunk Patient was unmarried and healthy, had no history of any drug taken. Her menstrual periods were normal. She had history of regular hair removal only from extremities by waxing since the age of 14 years. She had no history of tuberculosis or any other major illness in past. No other family member had history of similar lesions. Her complete blood count, blood sugar level, thyroid function tests, and X-ray chest were normal. Skin biopsy showed dense, focal hyperkeratosis and parakeratosis, absent granular layer, acanthosis, and upper dermal lymphocytic infiltrate in a band-like manner. Changes showed sharp demarcation from normal skin, which showed basket weave hyperkeratosis [Figure 5]. Clinical and histo-pathological correlation confirmed the diagnosis of hyperkeratosis lenticularis perstans (HLP) or Flegel's disease. Figure 5 Histopathology showing b

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