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J Cutan Pathol 2021 12 26;48(12):1525-1527. Epub 2021 Aug 26.

Department of Dermatology, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain.

Int J Dermatol 2021 Dec 17;60(12):e511-e512. Epub 2021 Aug 17.

Department of Dermatology and Allergology, Philipps-University, Marburg, Germany.

Int J Dermatol 2021 Jan 13;60(1):33-38. Epub 2020 May 13.

Dermatology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Hyperkeratosis lenticularis perstans (HLP), or Flegel's disease (FD), is a rare disorder of keratinization first described in 1958 by Flegel. HLP is characterized by asymptomatic small papules distributed symmetrically on the dorsal feet and lower part of the legs. It typically presents in the fourth or fifth decade of life. Read More

Cutis 2020 03;105(3):123-125

Division of Dermatology, University of Vermont Medical Center, Burlington, USA.

Cutis 2019 Aug;104(2):E37-E38

Department of Dermatology, University of Texas Medical Branch at Galveston, USA.

JAMA Dermatol 2019 Jun;155(6):739-740

Department of Pathology, Hospital General Universitario de Elche, Elche, Spain.

Eur J Dermatol 2019 Feb;29(1):106-107

Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid.

J Dermatol 2019 08 25;46(8):e298-e299. Epub 2019 Feb 25.

Institute of Dermatology, "Santa Maria della Misericordia" University Hospital, Udine, Italy.

J Dtsch Dermatol Ges 2018 Jan;16(1):72-74

Department of Dermatology and Venereology, China-Japan Friendship Hospital, Beijing, China.

J Dtsch Dermatol Ges 2018 Jan 12;16(1):72-73. Epub 2017 Dec 12.

Department of Dermatology and Venereology, China-Japan Friendship Hospital, Beijing, China.

J Am Acad Dermatol 2016 Dec;75(6):e211-e213

Guangdong Provincial Dermatology Hospital, Guangzhou, China. Electronic address:

J Dtsch Dermatol Ges 2016 Apr;14(4):416-8

Servicio de Anatomía Patológica, Hospital San Juan de Dios, Santiago de Chile.

Folia Microbiol (Praha) 2016 Sep 15;61(5):359-63. Epub 2016 Jan 15.

Biology Center, Institute of Parasitology CAS, České Budějovice, Czech Republic.

Determination of the causative agent of erythema-like skin lesions in case of nonspecific superficial perivascular dermatitis was supported by histological examination and led to the latter diagnosis of Hyperkeratosis lenticularis perstans (Flegel disease) in patient. The presence of antibodies against Borrelia burgdorferi in patient serum was confirmed by a routine ELISA method and verified by Western blot technique. Skin biopsy and blood specimens were analyzed by PCR and multilocus sequence analysis (MLSA). Read More

Cutis 2015 Dec;96(6):E5-7

Department of Dermatology, University of Virginia, Charlottesville, USA.

J Clin Pathol 2015 Dec 20;68(12):1011. Epub 2015 Nov 20.

St Johns' Institute of Dermatology, UK.

J Am Acad Dermatol 2015 Aug;73(2):346-8

Hershey, Pennsylvania.

Indian J Dermatol 2013 Mar;58(2):161

Department of Dermatology, Venereology and Leprology, GMERS Medical College, Sola, Ahmedabad, Gujarat, India. E-mail:

J Dermatol Case Rep 2012 Sep;6(3):93-5

Department of Dermatology, Venereology & Leprosy, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram, Wardha, Maharashtra, India - 442102.

Hyperkeratosis lenticularis perstans also known as Flegel's disease is a keratinisation disorder characterized by small keratotic papules with horny scales. Most cases have been reported in Europe with age of presentation between 35 and 60 years. We report a case of a 25-year-old man, who presented with 1-5 mm multiple asymptomatic hyperkeratotic papules of 15 years duration on both legs and hand along with lichenified plaques with Koebner phenomenon in the axillary folds, anticubital and popliteal fossae. Read More

An Bras Dermatol 2011 Jul-Aug;86(4 Suppl 1):S76-7

UNOESC, University of Western Santa Catarina, Joacaba, SC, Brazil.

Flegel's disease, also known as hyperkeratosis lenticularis perstans, is a rare skin disease characterized by small reddish-brown asymptomatic hyperkeratotic papules usually located on the lower extremities. The histopathological features are hyperorthokeratosis, epidermal atrophy and band-like inflammatory infiltrate in the superficial dermis. Treatment is generally ineffective. Read More

Actas Dermosifiliogr 2009 Mar;100(2):157-9

Acta Dermatovenerol Croat 2009 ;17(1):16-9

Department of Anatomic Pathology, Hospital El Bierzo, Spain.

We present a case of hyperkeratosis lenticularis perstans (Flegel's disease) in a 71-year-old-woman. Apart from all the typical morphological features of the disease, we evidenced mounds of parakeratosis that contained neutrophils, alternating with other strata of the horny layers in which no infiltrate was seen. Such a pattern has been described in association with diseases that show a periodic clinical pattern of presentation with periods of exacerbations and remissions. Read More

Arch Dermatol 2008 Nov;144(11):1509-14

University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada.

Int J Dermatol 2008 Nov;47 Suppl 1:38-41

Department of Dermatology, and Maastricht University Center for Molecular Dermatology, University Medical Center Maastricht, The Netherlands.

Flegel's disease, also known as hyperkeratosis lenticularis perstans, is a rare skin disease characterized by small, red-brown, hyperkeratotic, papules that are usually located on the lower extremities. The diagnosis is based on the clinical appearance in association with the typical histologic features of orthohyperkeratosis and a subepidermal band-like infiltrate. Treatment is difficult and rarely fully effective. Read More

Am J Dermatopathol 2006 Apr;28(2):122-6

Department of Dermatology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.

A case of hyperkeratosis lenticularis perstans (Flegel's disease) was studied histopathologically comparing early and old lesions. The age of the lesions were judged by both the patient's history and direct observation. The histopathologic and immunophenotypic features of a new lesion were essentially in accordance with previous findings. Read More

Wien Klin Wochenschr 2004 ;116 Suppl 2:78-80

Department of Dermatology, Maribor Teaching Hospital, Maribor, Slovenia.

An 82-year-old female presented with an 11-year history of multiple, symmetrically disseminated hyperkeratotic red-brown papules 3-5 mm in diameter on the dorsal aspects of the upper and lower extremities. The eruption first appeared on the dorsa of the feet and on the lower parts of the legs. During the last few years, the lesions extended gradually to the upper part of the legs and thighs, also disseminating over the trunk. Read More

Clin Exp Dermatol 2003 May;28(3):339-40

Department of Dermatology, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK.

Med Trop (Mars) 2002 ;62(1):85-8

Service de Dermatologie, Hôpital d'Instruction des Armées Alphonse Laveran, BP 50, 13998 Marseille Armées, France.

This report describes the case of a 33-year-old black woman who presented atypical hyperkeratosis. Atypical features included location on the dorsum of the foot and presence of punctate pits. The lesion was classified as intermediate between keratosis punctata of the palmar creases and focal acral hyperkeratosis. Read More

Dermatology 2001 ;202(3):255-8

Department of Dermatology, Eberhard Karl University, Tübingen, Germany.

Hyperkeratosis lenticularis perstans (HLP) or Flegel's disease is a rare dermatosis characterized by asymptomatic hyperkeratotic papules predominantly located on the lower extremities. Lesional and non-lesional epidermis samples were studied by light- and electron-microscopic examination. The main ultrastructural finding was the presence of structurally altered Odland bodies/membrane-coating granules. Read More

Hautarzt 2001 Mar;52(3):231-5

Klinik und Poliklinik für Dermatologie und Venerologie der Universität Rostock, Augustenstrasse 80, 18055 Rostock.

A case report of hyperkeratosis lenticularis perstans (Flegel) is presented. The disease is characterized clinically, histologically and with electron microscope. The evolution of the disease since Flegel described it 40 years ago is considered, with emphasis on etiology, pathogenesis and unanswered questions. Read More

Hautarzt 2000 Jan;51(1):31-5

Univ.-Hautklinik Münster.

Hyperkeratosis lenticularis perstans (Flegel's disease) is a rare but clinically and histologically highly characteristic genodermatosis. We report on new immunohistochemical and ultrastructural findings suggesting a complex disorder of epidermal differentiation. In this context, a good response to calcipotriol, a synthetic vitamin D3 derivative is of particular interest. Read More