Intended for healthcare professionals

Endgames Case Review

A case of generalised papules

BMJ 2017; 357 doi: (Published 29 June 2017) Cite this as: BMJ 2017;357:j2912
  1. Valencia Long, medical officer,
  2. Henry Foong, consultant
  1. National Skin Centre, Singapore
  1. Correspondence to V Long valencialong{at}

A 75 year old man who lived in a nursing home complained of itching and a rash that had lasted for four months. The man had experienced a traumatic cervical cord injury six months earlier and had sensory impairment but no other substantial medical history. On examination, he had markedly thickened crusts and hyperkeratosis on his hands and feet bilaterally, with involvement of his finger and toe web spaces (fig 1, fig 2). There were excoriated erythematous papules over his trunk and axillae (fig 3) and erythematous papules or nodules on his glans penis. A fungal scrape was performed and this was negative for fungal elements.

Fig 1

Thickened crusts in the digits and palm

Fig 2

Crusts in the toe web spaces

Fig 3

Excoriated erythematous papules …

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