Punctate keratoderma-like lesions on the palms and soles in a patient withchloracne: a new clinical manifestation of dioxin intoxication?

We report what we believe to be a novel skin manifestation of dioxin intoxi cation. A 30-year-old woman with 2,3,7,8-tetrachlorodibenzo-p-dioxin levels of 144,000 pg g(-1) blood fat presented with severe chloracne that affecte d the entire integument. She also exhibited acral granuloma annulare-like l esions and distal onycholysis and, at a later time point, showed signs of h ypertrichosis, as well as brownish-grey hyperpigmentation of the face. In a ddition, she developed punctate keratoderma-like lesions on the palms and s oles. These lesions were negative for human papillomavirus and histological ly characterized by cone-shaped hyperkeratoses invaginating, but not penetr ating, into the dermis. Squamous syringometaplasia of the eccrine glands wa s observed in the immediate vicinity of these lesions. Both clinically and histologically these alterations are essentially indistinguishable from wha t is described as keratosis punctata palmaris et plantaris (KPPP). Although a fortuitous coincidence of chloracne and KPPP cannot be formally excluded , the possibility exists that in our patient toxic levels of dioxin were ca usally involved in this disorder of keratinization.