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A rare and unusual hyperkeratotic disorder
  1. Amna Ahmad1,
  2. Iskander H Chaudhry1,
  3. Alistair Robson2
  1. 1Department of Histopathology, Manchester Royal Infirmary, UK
  2. 2St Johns’ Institute of Dermatology, UK
  1. Correspondence to Iskander H Chaudhry, Department of Histopathology, Manchester Royal Infirmary, UK; i.h.chaudhry01{at}

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Clinical question

A 78-year-old female presented with a pruritic rash on her legs for many years. A biopsy was taken from the right leg. Review the high-quality, interactive digital Aperio slide at and consider your diagnosis.

What is your diagnosis?

  1. Atrophic lichen planus

  2. Hyperkeratosis lenticularis perstans

  3. Lichenoid drug reaction

  4. Lichenoid keratosis

  5. Porokeratosis



Hyperkeratosis lenticularis perstans (‘Flegel's disease’) is a rare genodermatosis that was first described in 1958.1 Although there is no sex or racial predilection, most of the cases have been described in white Europeans. It develops in mid to late adult life and in some cases has an …

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