PUVA-related punctate keratoses of the hands and feet

Background: We have observed, in patients undergoing high-dose PUVA treatme nt, a type of keratosis not previously described. The lesions usually occur on the sides of the palms or soles and are clinically distinct. They are g enerally painless and often go unnoticed by patients. Objective: We sought to further characterize these lesions both clinically and histologically. Methods: Patients attending a PUVA clinic were screened for these keratoses . Other PUVA-related complications were recorded. Representative lesions we re photographed, and biopsy specimens were taken. Results: Biopsy specimens were taken from lesions in 10 patients. All had p laque psoriasis and had received high UVA doses (>1000 J/cm(2)) through PUV A therapy. All patients had PUVA-induced keratoses elsewhere, but the numbe r varied greatly between patients. The hand and foot keratoses were well de fined and circular and had a characteristic histologic appearance, with a s harp demarcation between normal and abnormal markedly pale-staining epiderm is. Conclusion: These lesions are a further cutaneous manifestation of prolonge d PUVA therapy.