Punctate Porokeratosis Presenting as Multiple Hyperkeratotic Papules on the Bilateral Hands: A Case Report

Punctate porokeratosis (PK) is a rare variant of PK characterized by small, keratotic papules on the palms and soles. It may occur in adolescence or early adulthood, and it is diagnosed mainly based on the histopathological findings of a cornoid lamella. In this report, we described a case with atypically larger papules and distinct dermoscopic features.

A 36-year-old woman presented with a 1-year history of asymptomatic hyperkeratotic papules on both hands. Physical examination showed multiple, discrete, translucent, hyperkeratotic papules measuring 2-8 mm in diameter (larger than the classic papules of 1-2 mm in diameter) on the palms and fingers. Dermoscopic examination revealed a light red background with yellowish-white scales and irregular vascular structures, whereas the typical "double-track" sign was absent.

Histopathological examination is essential for diagnosing punctate PK, particularly in cases where lesions are unusually large or dermoscopic presentations are atypical.