title: Comparative study of high-resolution multifrequency ultrasound of the plantar skin in patients with various types of hereditary palmoplantar keratoderma.
abstract: BACKGROUND
  High-variable-frequency ultrasound is used as an imaging tool for various cutaneous disorders. We utilized this tool in pachyonychia congenita (PC) patients, who typically present with plantar hyperkeratosis and often severely debilitating pain, compared to patients with epidermolytic palmoplantar keratoderma (EPPK) and mal de Meleda (MDM).
  
  
  OBJECTIVE
  To ascertain the feasibility of ultrasound technology for the diagnosis of PC.
  
  
  METHODS
  The study included a total of 16 patients, 7 with PC, 5 with EPPK and 4 with MDM, who underwent ultrasound examination of the plantar skin with high-resolution multifrequency ultrasound equipment.
  
  
  RESULTS
  Ultrasound scans performed over the proximal and distal plantar foot calluses in PC patients demonstrated hyperechoic dots and lines within the epidermis compatible with hyperkeratosis, engorged varicose veins in the dermis and an anechoic layer interposed between the epidermis and the dermis, corresponding to blister fluid below the calluses. In contrast to PC patients, patients with MDM and EPPK demonstrated no blisters.
  
  
  CONCLUSIONS
  PC patients, as opposed to a group of patients with MDM and EPPK, displayed subepidermal blistering beneath their calluses. This finding may help in the diagnosis of PC and in partially explaining plantar pain as part of PC symptomatology.
authors.affiliation: Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Goldberg
authors.forename: E
authors.initials: E
authors.lastname: Sprecher
authors.forename: M E
authors.initials: ME
authors.lastname: Schwartz
authors.forename: D
authors.initials: D
authors.lastname: Gaitini
mesh_terms: D000293:Adolescent; D000328:Adult; D001768:Blister / Q000150:complications / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005528:Foot / Q000098:blood supply / Q000000981:diagnostic imaging; D006801:Humans; D007645:Keratoderma, Palmoplantar / Q000000981:diagnostic imaging*; D053546:Keratoderma, Palmoplantar, Epidermolytic / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D053549:Pachyonychia Congenita / Q000150:complications / Q000000981:diagnostic imaging*; D010146:Pain / Q000209:etiology; D012867:Skin / Q000098:blood supply / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000379:methods; D014648:Varicose Veins / Q000000981:diagnostic imaging; D055815:Young Adult