Abstract Punctate porokeratosis is a rare variant of porokeratosis, presenting as small, hyperkeratotic papules with a raised border over the palms and soles, usually during adolescence. Dermoscopy typically reveals a keratinous rim corresponding to the cornoid lamella, while histopathology confirms the diagnosis with features such as parakeratosis overlying an absent granular layer. Differentiation from conditions like Porokeratotic Eccrine Ostial and Dermal Duct Nevus, arsenical keratosis, spiny keratoderma, and verruca is essential due to overlapping clinical features. A novel dermoscopic finding of a Chinese letter-like pattern, previously described in pigmentary disorders, is highlighted in this report as a potential diagnostic clue for punctate porokeratosis. Noninvasive tools like dermoscopy and histological evaluation remain central to diagnosis, and treatment includes topical agents, phototherapy, and procedural options targeting abnormal keratinization and clonal proliferation. We report a case of a 29-year-old male with unilateral punctate porokeratosis of the palm, where dermoscopy revealed the distinctive Chinese letter-like pattern, aiding in its diagnosis and differentiation.
Saravanan et al. (Wed,) studied this question.