Asymptomatic keratotic papules on the lower limbs

Hyperkeratosis lenticularis perstans (HLP) or Flegel disease is a rare dermatosis of unknown cause, characterized by multiple erythematous hyperkeratotic papules with symmetrical distribution. Treating HLP is challenging because there is no standardized therapy. We describe the case of a 71-year-old light-skinned woman who presented with symmetrical asymptomatic keratotic papules on the dorsal feet, legs, thighs and upper limbs. Histopathological examination showed orthokeratotic hyperkeratosis, hypogranulosis and a band-like inflammatory lymphocytic infiltrate on the dermis, consistent with HLP or Flegel disease.