Hyperkeratosis Lenticularis Perstans (Flegel Disease) Clinical Presentation

Updated: Nov 11, 2021
  • Author: Daniel Roling, MD; Chief Editor: William D James, MD  more...
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Small keratotic papules typically begin to develop symmetrically on the lower extremities (see the images below).

Clinical photograph of the upper thigh showing num Clinical photograph of the upper thigh showing numerous red-brown papules with sparing of the inguinal crease.
A higher-powered view of the patient seen in the p A higher-powered view of the patient seen in the previous image. Photograph of the upper thigh demonstrates 1- to 4-mm, noncoalescing keratotic papules.

Papules spread proximally at a slow rate. Hyperkeratosis lenticularis perstans usually is an asymptomatic condition.


Physical Examination

Small, red-brown, hyperkeratotic, 1-5 mm papules on the lower extremities are the most frequent and characteristic presentation of hyperkeratosis lenticularis perstans. [4, 5] Involvement of the eyes, ear pinnae, arms, axillae, palms, soles, and the oral mucosa has been reported, although these reports are rare. Involvement of the trunk has been reported but remains an unusual variant. [6, 7, 8]

Dermatoscopic findings suggest a brown, structureless center with peripheral scaly, white areas enhanced by polarized light. [9]

Removal of the scale reveals a bright-red base, often with pinpoint bleeding. A localized unilateral variant has been reported. [10, 11] The trunk tends to be spared; absence of axial lesions is characteristic.



To date, the causes of hyperkeratosis lenticularis perstans (Flegel disease) are unknown. Some authors suggest that exposure to the sun may be involved.