case_images: PMC5726709_01
case_images: Hands and feet of the patient 1. A Bilateral symmetrical
  diffuse planter waxy yellowish hyperkeratosis of the feet, more severe
  in pressure sites, less severe in the plantar arch, and associated with
  deep fissures and cracks all over the sole. B
  Asymmetrically striate and focal hyperkeratosis in both palmar surfaces
  without significant nail changes
case_images: abd-92-05-s1-0154-g01.jpg
case_images: PMC5726709_01_abd-92-05-s1-0154-g01.jpg
case_images: f1
case_images: On examination, the female patient (case 1) showed bilateral symmetrical diffuse plantar waxy yellowish hyperkeratosis, associated with deep fissures and cracks all over the sole (Figure 1). The hyperkeratosis was asymmetrically striate and focal in both palmer surfaces (Figure 1).
case_images: Hands and feet of the patient 2. A - Bilateral symmetrical
  diffuse waxy yellowish hyperkeratosis with cracks in both plantar
  aspects of the soles. B - Warty papules on the knuckles of
  the dorsal aspect of the big toes. Note the dystrophic nail changes in
  the form of onychographosis (hyperkeratotic and grossly thickened nail
  plates) which was more severe in both big toes, but less severe in the
  small toes. C - Bilateral asymmetrical hyperkeratosis in
  the form of punctate keratoderma and focal warty keratotic papules in
  the palmar surface of the fingers, mainly against the interphalangeal
  and metacarpophalangeal joints. D - Deformed nails of both
  hands (non-specific nail changes)
case_images: abd-92-05-s1-0154-g02.jpg
case_images: PMC5726709_02_abd-92-05-s1-0154-g02.jpg
case_images: f2
case_images: Bilateral asymmetrical hyperkeratosis was present at the palmar surface of the fingers (Figure 2). The nails in the same patient were deformed (Figure 2).
case_images: Hands and feet of the patient 3. A - Soles and toes with
  characteristics similar to patient 2 (see fig. 2 for description). B - Hyperkeratotic
  projections onto normal skin at the medial aspect of big toe and first
  web space. C - Bilateral asymmetrical hyperkeratosis in the
  form of warty keratotic papules in the palmar surface of both hands and
  fingers
case_images: abd-92-05-s1-0154-g03.jpg
case_images: PMC5726709_02_abd-92-05-s1-0154-g03.jpg
case_images: f3
case_images: In case 3, the edge of the keratoderma consisted of hyperkeratotic projections onto normal skin and bilateral asymmetrical hyperkeratosis was noticed on both hands and fingers (Figure 3).
case_images: PMC5726709_02
case_images: Hands and feet of the patient 2. A - Bilateral symmetrical
  diffuse waxy yellowish hyperkeratosis with cracks in both plantar
  aspects of the soles. B - Warty papules on the knuckles of
  the dorsal aspect of the big toes. Note the dystrophic nail changes in
  the form of onychographosis (hyperkeratotic and grossly thickened nail
  plates) which was more severe in both big toes, but less severe in the
  small toes. C - Bilateral asymmetrical hyperkeratosis in
  the form of punctate keratoderma and focal warty keratotic papules in
  the palmar surface of the fingers, mainly against the interphalangeal
  and metacarpophalangeal joints. D - Deformed nails of both
  hands (non-specific nail changes)
case_images: abd-92-05-s1-0154-g02.jpg
case_images: PMC5726709_02_abd-92-05-s1-0154-g02.jpg
case_images: f2
case_images: Bilateral asymmetrical hyperkeratosis was present at the palmar surface of the fingers (Figure 2). The nails in the same patient were deformed (Figure 2).
case_images: Hands and feet of the patient 3. A - Soles and toes with
  characteristics similar to patient 2 (see fig. 2 for description). B - Hyperkeratotic
  projections onto normal skin at the medial aspect of big toe and first
  web space. C - Bilateral asymmetrical hyperkeratosis in the
  form of warty keratotic papules in the palmar surface of both hands and
  fingers
case_images: abd-92-05-s1-0154-g03.jpg
case_images: PMC5726709_02_abd-92-05-s1-0154-g03.jpg
case_images: f3
case_images: In case 3, the edge of the keratoderma consisted of hyperkeratotic projections onto normal skin and bilateral asymmetrical hyperkeratosis was noticed on both hands and fingers (Figure 3).