Pediatric Annals

Case Challenges 

An 11-year-old Girl with Knuckle Plaques

Stephanie Christen-Zaech, MD; Sarah L. Chamlin, MD

  • Pediatric Annals. 2007;36(8)
  • Posted August 1, 2007

Abstract

Editor’s note: Each month, this department features a discussion of an unusual diagnosis in genetics, radiology, or dermatology. A description and images are presented, with the diagnosis and an explanation of how the diagnosis was determined following. As always, your comments are welcome.

An 11-year-old girl presented with a 4-year history of asymptomatic plaques over her knuckles. She denied trauma to the affected areas. Her review of systems including fatigue, muscle weakness, or sun sensitivity revealed no abnormalities. Past medical history and family history were unremarkable. She was treated with emollients and over-the-counter strength hydrocortisone without any improvement in the appearance or thickness of the plaques. Physical examination revealed hyperkeratotic lichenified erythematous and hypopigmented plaques over the proximal interphalangeal joints of all 10 fingers. She had no involvement of the toes, no palmoplantar keratoderma, and no nailfold telangiectasia. A skin biopsy specimen was obtained from a lesion on the right index finger. Histopathologic examination of the skin section showed hyperkeratosis and acanthosis without signs of inflammation.

Abstract

Editor’s note: Each month, this department features a discussion of an unusual diagnosis in genetics, radiology, or dermatology. A description and images are presented, with the diagnosis and an explanation of how the diagnosis was determined following. As always, your comments are welcome.

An 11-year-old girl presented with a 4-year history of asymptomatic plaques over her knuckles. She denied trauma to the affected areas. Her review of systems including fatigue, muscle weakness, or sun sensitivity revealed no abnormalities. Past medical history and family history were unremarkable. She was treated with emollients and over-the-counter strength hydrocortisone without any improvement in the appearance or thickness of the plaques. Physical examination revealed hyperkeratotic lichenified erythematous and hypopigmented plaques over the proximal interphalangeal joints of all 10 fingers. She had no involvement of the toes, no palmoplantar keratoderma, and no nailfold telangiectasia. A skin biopsy specimen was obtained from a lesion on the right index finger. Histopathologic examination of the skin section showed hyperkeratosis and acanthosis without signs of inflammation.

Editor’s note: Each month, this department features a discussion of an unusual diagnosis in genetics, radiology, or dermatology. A description and images are presented, with the diagnosis and an explanation of how the diagnosis was determined following. As always, your comments are welcome.

An 11-year-old girl presented with a 4-year history of asymptomatic plaques over her knuckles. She denied trauma to the affected areas. Her review of systems including fatigue, muscle weakness, or sun sensitivity revealed no abnormalities. Past medical history and family history were unremarkable. She was treated with emollients and over-the-counter strength hydrocortisone without any improvement in the appearance or thickness of the plaques. Physical examination revealed hyperkeratotic lichenified erythematous and hypopigmented plaques over the proximal interphalangeal joints of all 10 fingers. She had no involvement of the toes, no palmoplantar keratoderma, and no nailfold telangiectasia. A skin biopsy specimen was obtained from a lesion on the right index finger. Histopathologic examination of the skin section showed hyperkeratosis and acanthosis without signs of inflammation.

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