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Images in Clinical Practice
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doi:
10.4103/ijdvl.IJDVL_1095_19
pmid:
32969354
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Circumscribed acral hypokeratosis: A benign localized lesion in the palm

Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Corresponding author:Dr. Daniel Rizo-Potau, Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain. rizo@clinic.cat
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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Rizo-Potau D, Marti-Marti I, Martin-Ortega E. Circumscribed acral hypokeratosis: A benign localized lesion in the palm. Indian J Dermatol Venereol Leprol 2020;1-2.

Circumscribed acral hypokeratosis is a benign entity, usually presenting in middle-aged women, over the thenar or hypothenar eminences (less frequently in the soles) as an asymptomatic depressed pink plaque with well-defined borders [Figure 1].1 Dermoscopy shows regularly distributed white dots (which we have described as rosettes) which appear to correspond to the acrosyringium [Figure 2].2 Histologic examination shows an abrupt stair-like thinning of the horny layer. Although no clear etiology has been determined for circumscribed acral hypokeratosis, it has been proposed to be a localized acquired genodermatosis of keratinocytes secondary to repeated trauma or other noxious exposition.3,4 Even though it is usually benign in its course, there are a few reports of premalignant transformation in the elderly.5 Treatment options in such cases include cryotherapy, topical fluorouracil or calcipotriol, ablative laser or surgery, with variable results.3,4 Circumscribed acral hypokeratosis is an underdiagnosed dermatosis and it should be included in the differential diagnosis of well-defined erosive lesions of the palms and the soles.

Figure 1:: Circumscribed acral hypokeratosis: depressed pink plaque with well-defined borders
Figure 2:: Circumscribed acral hypokeratosis: regularly distributed white rosettes in a pink background (Dermlite DL200 HR polarized light mode, ×10)

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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  2. , , , , . Dermoscopic features of circumscribed palmar hypokeratosis. JAMA Dermatol. 2017;153:609-11.
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  5. , , , . Premalignant circumscribed palmar hypokeratosis: A new form of circumscribed palmar hypokeratosis? Case report and literature review. Dermatology. 2010;220:143-6.
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