The gross, light microscopic, and ultrastructural findings in a 55 year old
man was striate keratoderma are presented. There was no family history of
the disease. The lesions developed in his late teens and early adult years,
and consisted of progressively worsening, raised, hyperkeratotic, linear p
laques on the palm and volar surface of the third and fifth fingers bilater
ally. There were also painful callosities on both heels, and thick, raised
plaques on the heels and lateral plantar surfaces. The epidermis was papill
omatous and acanthotic, with marked orthokeratosis, minimal parakeratosis,
and a very thickened granular layer. No epidermolysis was seen. Electron mi
croscopy showed increased tonofibrils in the stratum spinosum arranged in w
avy, parallel bundles and a granular layer in which normal Odland bodies we
re present. However, the keratohyaline granules were large, with rounded bo
rders and a striped, alternating, dark and light content characteristic of
composite granules. There was diminished contact of the granules with tonof
ibrils. The transition to the stratum corneum was abrupt. The ultrastructur
al and genetic features of keratodermas, with special emphasis on the stria
te type, are reviewed.