Sporadic Diffuse Palmoplantar Keratoderma in a Pediatric Patient With Early Onset: A Case Report

Palmoplantar keratoderma (PPK) encompasses a heterogeneous group of disorders characterized by hyperkeratosis of palms and soles. Sporadic cases with early childhood onset but no family history represent a diagnostic challenge. In this report, we present a case of an eight-year-old male child who presented with progressive thickening of palmoplantar skin since he was two years old, which progressed with painful fissures, ultimately resulting in restriction of mobility. The clinical examination revealed diffuse, yellow-orange hyperkeratotic plaques with well-demarcated margins and deep fissures over pressure points. On a series of follow-up visits, a complete clinical evaluation coupled with unremarkable laboratory findings ruled out syndromic associations. The diagnosis of sporadic diffuse non-transgradient PPK was made based on the inference of clinical presentation and exclusion of differential diagnoses. Treatment with low-dose acitretin (10 mg twice weekly) combined with topical keratolytic agents over three months resulted in significant clinical improvement, with marked reduction in hyperkeratosis and resolution of painful fissuring. This case highlights the importance of distinguishing isolated PPK from syndromic forms in pediatric patients. Systemic retinoid therapy proved effective in this case of early-onset sporadic PPK, significantly improving the patient's quality of life and mobility.