Ulcerating plantar keratoderma in association with systemic lupus erythematosus

This report highlights the finding of ulcerative plantar keratoderma in two patients with systemic lupus erythematosus (SLE). Both patients suffered f rom painful plantar ulcerations and fissures; in one patient there was diff use desquamation over the entire plantar surface, while the other patient's lesions were focal and accentuated over weight-bearing surfaces. Other eti ologies for keratoderma including papulosquamoua disease, contact dermatiti s, tinea and primary keratodermas were excluded. Both patients were resista nt to multiple topical therapies including super-potent topical corticoster oids, vitamin D analogues and retinoids, but did report moderate relief wit h hydrocolloid dressings applied over super-potent topical corticosteroids and pressure off-loading measures. Lupus-associated keratoderma can be recu rrent and recalcitrant to treatment, often necessitating aggressive, therap y and particular attention to advanced wound care methodologies. While not a specific cutaneous sign of lupus, it should be recognized as a cause for considerable morbidity.