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Arch Dermatol. 2008;144(11):1509-1514.

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Diagnosis: Flegel disease, or hyperkeratosis lenticularis perstans (HLP).

MICROSCOPIC FINDINGS AND CLINICAL COURSE

Findings from the biopsy specimen demonstrated a circumscribed focus of lichenoid inflammation associated with atrophy of the stratum spinosum, hypogranulosis, and an overlying sharply circumscribed column of pale-staining orthokeratotic hyperkeratosis. The patient was treated with urea cream, 10%. She was subsequently lost to follow-up.

DISCUSSION

Flegel disease, or HLP, was first described by Flegel¹ in 1958. It is a rare condition arising in the third or fourth decade of life, characterized by asymptomatic keratotic papules on the distal extremities, primarily the feet and legs. Typical lesions are skin-colored to reddish-brown papules surmounted by a horny adherent scale that when removed reveals a saucer-shaped base and pinpoint bleeding. Involvement of the palms, soles, and oral mucosa has been described.

Sporadic and familial cases of HLP have been reported. Familial HLP is thought to be inherited in an autosomal dominant fashion.^2-3 Anecdotal associations include cutaneous tumors,³ gastrointestinal malignant neoplasm,⁴ and endocrine disorders such . . . [Full Text of this Article]

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Arch Dermatol. 2008;144(11):1509-1514.
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