Symmetrical Keratoderma On The Palms, Soles And Elbows Associated With Acute Hepatitis B Viral Infection

Abstract

HB virus is well-known to cause several skin manifestations. We present an unusual case of keratoderma associated with acute hepatitis B. Hepatitis B antigens were detected in a 24-year-old Japanese woman as part of a regular health examination. Three weeks later, she felt common cold-like symptoms, and noticed eruption of her palms and soles. Clinical examination showed well-circumscribed erythematous hyperkeratosis on the palms and soles, with partial extension into the dorsal aspect of her hands and feet. In addition, she had well-demarcated erythematous hyperkeratotic plaques on both elbows. Histopathology obtained from the right palm showed hyperkeratosis, acanthosis, and focal parakeratosis without granular degeneration. We consider that the keratoderma appeared in our patient must be related to acute hepatitis B virus infection. The differential diagnosis of our case was made for acquired PPK (APPK), hereditary PPK (HPPK), PSE, PRP, and psoriasis inverse. The most plausible diagnosis of keratoderma in our case is PRP, because PRP has reported to be precipitated with viral infections including hepatitis A and C. Another possibility is APPK associated with hepatitis B.