Dept. of Dermatology - University of Iowa College of Medicine

Dermatology Differential Diagnosis by Morphology

Scaly and Hyperkeratotic Lesions

Follicular

Punctate Palms / Soles

Patchy Palms / Soles

Diffuse Palms / Soles

Vascular Keratoses

Exfoliative Erythroderma
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Follicular Hyperkeratotic Lesions

  1. Keratosis pilaris
    • Physiologic
    • Ichthyotic
    • Phrynoderma
  2. Pityriasis rubra pilaris - PRP - More: #2, #3, #4, #5, #6.
  3. Keratosis follicularis cantagiosa of Brooke (Epidemic Acne)
  4. Keratosis spinulosa - Lichen spinulosa
  5. Keratosis pilaris atrophicans
    • Keratosis pilaris atrophicans faciei
    • Atrophoderma vermiculata
    • Keratosis pilaris decalvans
  6. Kyrle's disease - Hyperkeratosis follicularis et parafollicularis
  7. Follicular pityriasis rosea
  8. Elastosis perforans serpiginosa
  9. Follicular syphiloderm
  10. Lichen plano pilaris
  11. Lichen scrofulosorum

Punctate Hyperkeratosis of the Palms and Soles

  1. Psoriasis (occasional)
  2. Chronic contact dermatitis (variable distribution)
  3. Corns and Calluses
  4. Verrucae
  5. Reiter's syndrome
  6. Arsemical keratoses
  7. Asbestos heratoses
  8. Localized epithelial nevus
  9. Pityriasis rosea (unusual)
  10. Trichophytosis
  11. "Cancer" keratoses (especially thenar and hypothenar)
  12. Genodermatoses:
    • Keratosis palmaris et plantaris
      • Punctate keratoderma (without other symptoms)
      • Striate keratoderma (without other symptoms)
      • Disseminate keratoderma with corneal atrophy
      • Circumscribed keratoderma (childhood onset)
    • Superficial actinic disseminated porokeratosis
    • Acrokeratosis verruciformis of Hopf
    • Darier's disease - Keratosis follicularis
    • Icthyoses
  13. Very Rare
    • Naegli's syndrome (1 Swiss family)
    • Keratosis circumscripta (Nigerian children)

Patchy Hyperkeratosis of the Palms and Soles

  1. Syphilis - Lues - Yaws (Secondary stage)
  2. Psoriasis
  3. Pachyonychia congenita (Pressure sites, 2-3 years old)
  4. Lichen planus (lesions elsewhere - usually)

Diffuse Hyperkeratosis of the Palms and Soles

  1. Chronic contact dermatitis
  2. Trichophytosis
  3. Pityriasis rubra pilaris - PRP - More: #2, #3, #4, #5, #6.
  4. Keratoderma climacterum
  5. Lichen simplex
  6. Chronic arsenic keratosis
  7. Syphilis - Lues - Yaws (Tertiary stage)
  8. Ichthyosiform reactions to systemic disease:
    • Hypothyroidism
    • Leprosy
    • Neoplasms - breast
    • Multiple Myeloma
    • Lymphoma
  9. Genodermatosis
    • Keratosis palmaris et plantaris
      • Diffuse - Tylosis (Infants)
      • Keratoderma with esophageal carcinoma
      • Mutilating keratoderm
      • Progressive keratoderma
      • Mal de Meleda
      • Papillon-Lefevre syndrome
      • Polykeratosis
      • Hydrotic ectodermal dysplasia
      • Dyskeratosis congenita
      • Congenital ichthyoses

Vascular Keratotic Lesions

  1. Angiokeratoma corporis diffusum (Fabry's disease)
  2. Angiokeratoma of Mibelli (Hands and feet)
  3. Angiokeratoma circumscriptum (Usually on the legs)
  4. Angiokeratoma of Fordyce (Scrotum)

Exfoliative Erythroderma

  1. Psoriasis
  2. Pityriasis rubra pilaris - PRP - More: #2, #3, #4, #5, #6.
  3. Atopic Dermatitis
  4. Erythrodermic Reticulosis
  5. Drug Eruption - Esp. heavy metals.
  6. Seborrheic dermatitis
  7. Sulzberger - Garbe syndrome

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June, 1996
Dept. of Dermatology / University of Iowa /
Last updated November 12, 1996