PMC4809450_01
Initial physical examination. Bilateral palms and plantar feet show significant rugose thickening and brownish-yellow hyperpigmentation.
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Examination found rugose thickening and brownish-yellow hyperpigmentation with enhanced dermatoglyphics on the bilateral palms and plantar feet (Fig 1), symmetric tan velvety hyperpigmented plaques on the bilateral neck folds, and digital clubbing.
Palmar biopsy specimen shows hyperkeratosis and papillomatosis with thin suprapapillary plates. (Hematoxylin-eosin stain; original magnification: x100.)
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Skin biopsies of the palms and neck folds showed papillomatosis of the epidermis, hyperkeratosis, and thin suprapapillary plates, consistent with the clinical diagnoses of TP and AN (Fig 2).
Decreased thickening and rugosity of bilateral palms and feet after immunosuppressive therapy and pulmonary transplant.
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Marked decrease in skin thickness of both palms and improvement in the digital clubbing has been observed after transplant (Fig 3) while on an immunosuppressive regimen of prednisone, mycophenolate mofetil, and tacrolimus.