Kristina R. Burke, MD, CPT, MC, USA; George W. Turiansky, MD, COL, MC, USA


Dermatology Nursing 

In This Article


Physical examination revealed round, well-demarcated, slightly erythematous, keratotic plaques 0.5–6.5 cm in size over the affected areas. A raised hyperkeratotic border containing a thread-like groove in some areas was noted along the periphery of the lesions (see Figure 1).

Figure 1.

Well-demarcated, slightly erythematous, keratotic plaques located on the right heal. A raised, hyperkeratotic border containing a threadlike groove is seen along the periphery of the lesions.

Shave biopsies of the right shin and left heel lesions (site indicated by arrow in Figure 2) demonstrated a parakeratotic column (cornoid lamella) pointing away from the center of the lesion noted in an invagination of the epidermis and which corresponded to the raised hyperkeratotic edges of the clinical lesions. Irregularly arranged, dyskeratotic keratinocytes were present at the base of the column. The granular layer of the epidermis was absent at the base of the parakeratotic column.

Figure 2.

Arrow indicates site of skin biopsy.


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