Punctate Porokeratosis Presenting as Multiple Hyperkeratotic Papules on the Bilateral Hands: A Case Report

Introduction: Punctate porokeratosis (PK) is a rare variant of porokeratosis characterized by small, keratotic papules on the palms and soles. It may occur in adolescence or early adulthood, and it is diagnosed mainly based on the histopathological findings of a cornoid lamella. In this report, we described a case with atypically larger papules and distinct dermoscopic features. Case Presentation: A 36-year-old woman presented with a one-year history of asymptomatic, hyperkeratotic papules on both hands. Physical examination revealed multiple, discrete, translucent, hyperkeratotic papules measuring 2–8 mm in diameter (larger than the classic papules that are 1–2 mm in diameter)​ on the palms and fingers. Dermoscopic examinations showed a light red background with yellowish-white scales and irregular vascular structures, but the typical “double-track” sign was absent. Conclusion: Histopathological examination is essential for diagnosing punctate porokeratosis, particularly in cases where lesions are unusually large or dermoscopic presentations are atypical.