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Acral keratotic graft versus host disease simulating warts

A 53‐year‐old man experienced persistent oral graft versus host disease after receiving an HLA‐matched allogeneic stem cell peripheral blood transplant for chronic myeloid leukaemia. Twelve months post‐transplant, multiple keratotic lesions resembling warts developed on his fingers, on his palms and on the soles of his feet. Skin biopsy showed a lichenoid reaction under a hyperplastic and hyperkeratotic epidermis lacking signs of papillomavirus infection. The lesions partially regressed when the patient’s oral prednisone was increased. This instance of acral keratotic lesions may represent an unusual expression of chronic graft versus host disease; however, the the hydroxychloroquine which had been used for 8 months to control the patient’s oral graft versus host disease cannot be excluded as a cofactor.