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Interactive Case Study - August 2026

10-year-old male with chronic hyperkeratotic plaques and periarticular widening of the finger joints
Muhammad "Hamza" Ali 
Taylor Davis, MD 
Kara LeFevre, MD 
 
 
A 10-year-old male with no significant medical history presented with a 3-year history of intermittently pruritic, linear, hyperkeratotic plaques overlying the right 1st MCP joint and left 2nd MCP joint, mild tan hyperpigmentation of the right dorsal hand, and periarticular swelling. There were no reported exposures to harsh chemicals. His parents endorsed a history of frequent hand rubbing. Failed treatments included topical urea, salicylic acid, triamcinolone 0.1% ointment, exfoliation with pumice stone, and liberal moisturization.
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Clinical Photo
Clinical Photo
Biopsy Site (right MCP joint)
Biopsy Site (right MCP joint)
H&E 2x
H&E 2x
H&E 4x
H&E 4x
H&E 10x
H&E 10x
H&E 20x
H&E 20x
Which of the following is the most likely diagnosis?
Juvenile-onset amyopathic dermatomyositis
Knuckle pads
Lichen simplex chronicus
Morphea
Pachydermodactyly
  1. Hanno R, Callen JP. Histopathology of Gottron’s papules. J Cutan Pathol. 1985;12(5):389-94.

  2. Koba S, Misago N, Narisawa Y. Knuckle pads associated with clubbed fingers. J Dermatol. 2007;34(12):838-40.

  3. Dickens R, Adams BB, Mutasim DF. Sports-related pads. Int J Dermatol. 2002;41(5):291-3.

  4. Moshkovich M, Andrade LF, Anderson M, et al. Lichen simplex chronicus: clinical perspectives and emerging therapeutic strategies. Am J Clin Dermatol. 2025;26(6):895-903.

  5. Elston DM, Ferringer T. Psoriasiform and spongiotic dermatitis. In: Ko CJ, High WA, DiCaudo DJ, editors. Dermatopathology. 4th ed. Philadelphia (PA): Elsevier; 2025. p. 181-182.

  6. Papara C, De Luca DA, Bieber K, et al. Morphea: the 2023 update. Front Med. 2023;10:1108623.

  7. Dallos T, Oppl B, Kovacs L, et al. Pachydermodactyly: a review. Curr Rheumatol Rep. 2014;16(9):442.

  8. Hooten NK, Phelan PS, Shalin SC, et al. Unilateral pachydermodactyly in a young female: a rare diagnosis requiring novel clinicopathological correlation. J Cutan Pathol. 2025;52(7):453-458.

  9. Tolis K, Stavropoulos N, Mavrogenis A, et al. Pachydermodactyly: an unknown entity. J Hand Surg Am. 2016;41(8):e239-41.

  10. Dagrosa AT, Fraser LW, Linos KD, et al. Pachydermodactyly associated with extensive computer gaming: a report of three cases. Pediatr Dermatol. 2020;37(5):907-910.

     

  11. Elston DM, Ferringer T. Alterations in collagen and elastin. In: Ko CJ, High WA, DiCaudo DJ, editors. Dermatopathology. 4th ed. Philadelphia (PA): Elsevier; 2025. p. 288-289.

 

Acknowledgements

 

Author Profiles

Muhammad "Hamza" Ali

University of Missouri-Columbia School of Medicine

Muhammad "Hamza" Ali is a 3rd year medical student at the University of Missouri-Columbia School of Medicine. He earned his bachelor's degree in International Studies with a Concentration in Global Environment and Health from the University of Michigan-Ann Arbor.

 

Taylor Davis, MD

University of Missouri-Columbia

Dr. Taylor Davis is a PGY-2 dermatology resident at the University of Missouri. He earned his bachelor’s degree in Physiology and Developmental Biology from Brigham Young University. He then completed medical school at Saint Louis University School of Medicine.

 

Kara LeFevre, MD

University of Missouri-Columbia School of Medicine

Dr. Kara LeFevre is an Associate Professor of Dermatology and Director of Dermatopathology at the University of Missouri where she also practices clinical dermatology with a focus on psoriasis and autoimmune connective tissue diseases. She obtained her medical degree and graduated residency from the University of Missouri, followed by dermatopathology fellowship at the University of California-San Francisco.

 

 

 

 

 

 

 

Question:

 

 

 

 
 

10-year-old male with chronic hyperkeratotic plaques and periarticular widening of the finger joints

Category

Collagen/Elastin Disorders

Description

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