Abstract
A 45-year-old man from Tonga was noted to have thick, scaly skin on both feet. He reported a 20-year history of painful calluses and fissures on the soles, as well as nail thickening and intermittent white patches in the oral cavity. On physical examination, there was thick, yellow-colored hyperkeratotic scale projecting from the plantar aspects of both feet (Fig 1), hypertrophic nail dystrophy, and wedge-shaped subungual hyperkeratosis (Fig 2).
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