Focal acral hyperkeratosis is a rare skin disorder, initially described by Dowd et al., which is sporadic or inherited in an autosomal dominant way. Clinically, the condition presents with small yellowish to white papules located on lateral aspects of the hands and feet. Histopathological alterations are limited to the epidermis and there are no changes in the elastic fibers of the dermis. In this case report, a 14-year-old girl had a two-year history of persistent, asymptomatic, multiple papules along the border of the hands and feet. A histologic section of papules from the left hand and foot showed marked hyperkeratosis and hypergranulosis of epidermis.
Adolescent ; Dermis ; Elastic Tissue ; Epidermis ; Female ; Foot ; Hand ; Humans ; Skin

BACKGROUND: In the Korean healthcare system, medical care for HIV patients was provided by a few university affiliated hospitals. Access to these tertiary hospitals by homeless people living with HIV was difficult due to socioeconomic reasons. Consequently, proper treatment for homeless subjects living with HIV was not delivered in a timely manner. This study compares the degree of disease progression of HIV infection/AIDS between homeless and non-homeless patient groups. MATERIALS AND METHODS: Out of 605 HIV/AIDS patients who visited the Center for Infectious Disease, National Medical Center, Seoul, Korea from August 2003 to May 2010, 295 subjects were included for this study. Referred cases (n=310) were excluded. The study subjects were further classified into three socioeconomic groups: National Health Insurance beneficiaries, Medical Aids beneficiaries, and the homeless. Status of HIV/AIDS disease progress was evaluated by peripheral blood CD4 cell count and the presence of AIDS defining illnesses at the first visit. RESULTS: There were 220 National Health Insurance beneficiaries (male 94.1%), 45 Medical Aids beneficiaries (male 88.9%), and 30 homeless people (male 96.7%). CD4 cell counts of the homeless (median: 119/microL, interquartile range: 44-383/microL) were significantly lower than those of the National Health Insurance beneficiaries (median: 267/microL, interquartile range: 159-397/microL; P=0.024). In addition, the proportion of patients whose CD4 cell counts <200/microL was significantly higher in homeless subjects (53.3%) compared to those in the National Health Insurance beneficiaries (27.3%) and the Medical Aids beneficiaries (28.9%) (P=0.004; P=0.033 respectively). Also, the frequency of AIDS defining illnesses was higher in the homeless (73.3%) than for those in other groups (the Health Insurance beneficiaries: 24.5%; the Medical Aids beneficiaries: 40.0%) (P<0.001; P<0.005 respectively). CONCLUSIONS: Homeless people living with HIV tend to seek medical care in far advanced stage, which may attribute to poor prognoses. More organized and strategic interventions are necessary to find and treat homeless people living with HIV at the early stage.
Acquired Immunodeficiency Syndrome ; CD4 Lymphocyte Count ; Communicable Diseases ; Delivery of Health Care ; Disease Progression ; HIV ; Homeless Persons ; Humans ; Insurance, Health ; Korea ; National Health Programs ; Prognosis ; Tertiary Care Centers