KERATODERMIA CRIB RATA 



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In the tropics we have met with leprotic and syphihtic hyper ^ 

 keratoses, as well as with those connected with hchen planus. We 

 have also seen ichthyosis, pityriasis rubra pilaris, and keratosis 

 palmaris et plantaris, and several other forms; but of all these, 

 three forms must receive a little further notice — viz. : — 



1. Keratodermia cribrata. 



2. Acanthokeratodermia praecornufaciens. 



3. Keratoma plant are sulcatum. 



KERATODERMIA CRIBRATA. 



Synonym. — Keratodermia punctata. 



Definition. — It is a localized non-follicular hyperkeratosis of the 

 hands and feet, appearing in post-uterine life, in which the hyper- 

 keratosic area is riddled with little pits caused by the shedding of 

 little corn-like projections. 



Remarks. — In the tropics it was first described by Castellani and 

 then by Chalmers. 



etiology. — It seems that it is in some way associated with 

 yaws or syphilis (congenital or acquired), probably by changes 

 effected in the metabolism, and not by the action of their 

 parasites. 



Pathological Histology. — The essential points are a mild chronic 

 inflammation of the dermis and a hyperkeratosis of the sweat orifices, 

 leading to the formation of corn-like projections, which are freed 

 laterally and finally all round, and then fall out, leaving a 

 depression. 



Symptomatology. — The palms of the hands or soles of the feet 

 may show hyperkeratosis associated with slight itching. In the 

 hyperkeratosic area there are many corn-like bodies, some of which 

 have fallen out and left depressions. The condition is very 

 chronic. 



Diagnosis. — -The bilaterally symmetrical hyperkeratosis of the 

 palms or soles, with the pits in the thickened areas and the corn- 

 like bodies, are characteristic. 



Treatment. — Nothing is known to permanently benefit the 

 condition. 



ACANTHOKERATODERMIA PRAECORNUFACIENS. 



This is an acanthokeratodermia characterized by the formation 

 of thickened patches of epidermis in the palms of the hands and soles 

 of the feet, which may (in the latter situation) become cracked and 

 fissured and break down, forming painful sores, which prevent the 

 patient from walking. Sometimes they are associated with a 

 thickening of the horny layer of the nail-bed, thus giving rise to a 

 peculiar elevation of the nail called by Unna hyperkeratosis subun- 

 gualis. Most patients have been affected with syphihs, but the 

 specific organisms cannot be found in the lesions, and antisyphilitic 



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