Painful thickening of the soles: importance of keeping a wide differential

Acquired plantar keratoderma refers to the hyperkeratotic plaques on the soles of the feet, which can result from a variety of underlying conditions. Psoriasis, allergic or irritant contact dermatitis and eczema are several causes of acquired plantar psoriasis. This case report describes a female patient in her 50s with plantar keratoderma, initially attributed to psoriasis that was recalcitrant to systemic treatments. Subsequent evaluation suggested the possibility of contact dermatitis triggered by footwear. Allergen avoidance and supportive management led to clinical improvement. This case highlights the critical importance of considering environmental irritants and allergens in the evaluation and management of refractory acquired keratoderma.