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Department of Dermatology, Huashan Hospital, Fudan University, Shanghai 200040, China

A 20-year-old girl was admitted to our institute for malformation of extremities.The skin lesions began with erythema on and thickening,desquamation of the palms and soles when she was 2,then gradually aggravated and onychoptosis occurred on the index finger of the left hand with a painless ulcer on it when she was 12.Physical examination revealed a drumstick-like hypertrophy of thumbs,shortening of the index finger,honeycomb-like depression on the extensor aspect of middle finger,dark red keratinized macula symmetrically located on the extensor aspect of all finger joints,keratinization and thickening on the toes with yellowish scale and tyloma-like thickened and keratinized plaque on the pedes.No lesions were pruritic.The palms folded with difficulty.She was diagnosed as mutilating palmoplantar keratoderma according to laboratory,radiological and histopathological examination.Oral acitretin(lOmg,once daily) with topical antifugal and antibiotic agents was effective for this patient.She is still in follow-up.