International Journal of Dermatology 2005, 44, 664–667 © 2004 The International Society of Dermatology 664 Blackwell Publishing, Ltd. Oxford, UK IJD International Journal of Dermatology 1365-4632 Blackwell Publishing Ltd, 2004 45 Morphology Multiple minute digitate hyperkeratoses Guarneri et al. Multiple minute digitate hyperkeratoses Claudio Guarneri, MD, Fabrizio Guarneri, MD, PhD, Mario Vaccaro, MD, PhD, Francesco Borgia, MD, PhD, and Serafinella P. Cannavò, MD From the University of Messina – Institute of Dermatology, Policlinico Universitario, Messina, Italy Correspondence Mario Vaccaro, MD, PhD Institute of Dermatology Policlinico Universitario Via Consolare Valeria Gazzi 98125 Messina Italy E-mail: mario.vaccaro@unime.it Case Report A 29-year-old woman presented with an asymptomatic erup- tion on her trunk, which first appeared at the age of 23 years and gradually progressed to involve the chest and arms. Clinical examination revealed hundreds of asymmetrically distributed multiple minute dome-shaped keratotic papules (Fig. 1a) associated with tiny, spiked, whitish-gray keratotic projections measuring 1–2 mm in length and not related to follicular orifices (Fig. 2a). The skin surrounding the lesions was normal. The face, palm and soles were also not involved. She had no personal history of X-ray exposure, relevant drug ingestion or application, inflammatory skin diseases and Figure 1 (a) Small, dome-shaped hyperkeratotic papules over the shoulder. (b) Histological view: compact orthokeratotic stratum corneum, with acanthosis and a mild lymphocytic infiltrate in the upper dermis