Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
Therapy Letters
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor - Observation Letter
doi: 10.4103/ijdvl.IJDVL_546_19
PMID: 32031108

Examination of circumscribed palmar hypokeratosis with line-field confocal optical coherence tomography: Dermoscopic, ultrasonographic and histopathologic correlates

Linda Tognetti1 , Diletta Fiorani2 , Mariano Suppa3 , Elisa Cinotti2 , Margot Fontaine3 , Veronique Del Marmol3 , Pietro Rubegni2 , Jean Luc Perrot4
1 Department of Medical, Dermatology Unit, Surgical and Neuro-Sciences; Department of Medical Biotechnologies, University of Siena, Siena, Italy
2 Department of Medical, Dermatology Unit, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
3 Department of Dermatology, Erasme Hospital, University of Brussels, Brussels, Belgium
4 Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France

Correspondence Address:
Linda Tognetti
Department of Medical, Dermatology Unit, Surgical and Neuro-Sciences, University of Siena, Viale Bracci, Siena 53100
Published: 03-Feb-2020
How to cite this article:
Tognetti L, Fiorani D, Suppa M, Cinotti E, Fontaine M, Marmol VD, Rubegni P, Perrot JL. Examination of circumscribed palmar hypokeratosis with line-field confocal optical coherence tomography: Dermoscopic, ultrasonographic and histopathologic correlates. Indian J Dermatol Venereol Leprol 2020;86:206-208
Copyright: (C)2020 Indian Journal of Dermatology, Venereology, and Leprology


Three women presented with a solitary eroded patch on the thenar eminence of the right hand. One of the patients, aged 37 years, developed the asymptomatic erythematous rounded lesion of 1.5 × 2 cm with clear-cut raised borders about 2 years back [Figure - 1]a. Polarized dermoscopy (Lumenis, Visiomed) highlighted tiny and poorly visible dotted vessels and a vertical cut of the stratum corneum with a moth-eaten border [Figure - 1]b. Examination with a new line field optical coherence tomography (LC-OCT)[1] to a depth of ∼500 μm at the star-like edge revealed a 2/3 reduction in thickness of the stratum corneum [Figure - 1]c confirmed by histopathological examination [Figure - 1]d.

Figure 1: Patient 1: Clinical photograph (a), Polarized dermoscopy ×200 (b), line-field optical coherence tomography (LC-OCT) (c) and histopathologic examination (H and E, ×250) (d). Dermoscopy highlights dotted vessels over an erythematous background, along with and a vertical interruption and a motheaten profile (b). LC-OCT took at the stair-like edge revealed a 2/3 reduction in thickness of the stratum corneum (SC) that appeared as a homogenously and moderately reflective layer, unaltered stratum lucidum (SL) and stratum granulosum (SG) separated by a thin hypo-reflective dark linear space (c). These findings corresponded to the histopathological examination, which confirmed the diagnosis of circumscribed palmar hypokeratosis (d).

Patient 2, aged 57 years, showed an irregularly shaped erythematous lesion of 4.5 × 5 cm with clear-cut and focally scaling edges [Figure - 2]a. She referred cyclic inflammatory episodes with moderate burning sensation in the last 7 years. Polarized dermoscopy 30×, high-frequency ultrasound (HFUS) VEVO MD®, and LC-OCT were performed, followed by the biopsy of the lesion across its edge for histopathological correlation [Figure - 2]b, [Figure - 2]c. LC-OCT revealed in vivo that over the lesion, the SC was almost totally absent, while the stratum lucidum and stratum granulosum were intact [Figure - 2]d, corresponding to histopathology [Figure - 2]e. The same examinations were performed in patient 3, aged 67 years, showing the same dermoscopic and LC-OCT findings of a 2/3 reduction of the SC at lesional edge [Figure - 3].

Figure 2: Patient 2: Clinical photograph (a), polarized dermoscopy ×30 (b), high-frequency ultrasound (HFUS) (c), line-field optical coherence tomography (LC-OCT) (d) and histopathology (H and E, ×25) (e). HFUS revealed an intensely hyper-echogenic normal SC (nSC) with the classic double railway appearance pertaining to the perilesional skin as well as a hyper-echogenic band of pathological SC (pSC) overlying the lesion; moreover, dilated vessels (V) were visible in the papillary dermis (PD) (c). LC-OCT revealed intact stratum lucidum (SL) and sratum granulosum (SG), while the stratum corneum (SC) was almost totally absent; these findings were observed in the histological section (e).
Figure 3: Patient 3: Clinical photograph (a), polarized dermoscopy×30 (b) and LC-OCT (c) taken at lesional border, showing a 2/3 reduction of the stratum corneum (SC).

Circumscribed palmar hypokeratosis is a rare benign epidermal malformation, usually appearing on palms and soles, with about 50 cases described. The exact physiopathology is still unknown: the late onset of disease and the peculiar body site suggest a causative role for the repetitive local micro-traumatism in predisposed subjects.[2] Clinically, the differential diagnosis is essentially with a solitary roundish patch of Bowen disease and porokeratosis of Mibelli of the hand. However, Bowen disease is usually localized on the dorsum of the hand/fingers, has a dry erythemato-squamous surface with no raised white border and show peculiar dermoscopic features (i.e., glomerular vessels, dry scales, surface, small brown globules or structureless gray to brown pigmentation).[3] porokeratosis of Mibelli [Figure - 4] typically appears at pre-tibial surface or dorsal surface of the hands as a roundish patch with skin-colored/whitish center surrounded by a double “white track” scaling collarette with a brownish pigmentation in the inner side.[3] LC-OCT examination of he raised edge can help differentiating CPH form porokeratosis of Mibelli of the head [Figure - 4]a, leg [Figure - 4]b and ankle [Figure - 4]c.

Figure 4: Porokeratosis of Mibelli of the forehead (a), lower leg (b) and ankle (c): clinical photographs, polarized dermoscopy ×20 and line-field optical coherence tomography (LC-OCT). Under dermoscopy, the central atrophic epidermis shows white pink-whitish areas or red dots corresponding to enlarged capillary vessels. LC-OCT reveals the structure of the raised edge, where a thin column of tightly packed parakeratotic cells within a keratin-filled epidermal invagination (i.e, cornoid lamella), overlying an area of dyskeratotic and vacuolated cells.

In addition, histopathological examination of CPH can be affected by artefacts occurred during slide preparation and/or staining. To avoid biopsy, noninvasive imaging tool including dermoscopy,[2] ultrasound[4] and OCT[5] were employed. The different dermoscopic features here observed are likely due to the different degree of thinning of the stratum corneum and of trauma-induced inflammation. HFUS was able to detect the stair-like interruption of the stratum corneum in both patients, showing an abrupt change of double to single entrance echo in the transition part, with a higher definition compared with cases examined with 20-MHz US.[4] Compared with standard OCT imaging,[5] LC-OCT imaging was able to reveal different level of stratum corneum reduction, with a stair-like vertical cut.[1] On the contrary, the oblique exfoliation of the stratum corneum usually seen in histologic section is likely to be due to stretching during slide preparation and fixation. Moreover, LC-OCT examination of porokeratosis of Mibelli cases highlighted a lower scaling edge than in CPH and a thinned atrophic epidermis and evident collagen bundles in the center of the lesion. Thus, LC-OCT could be proposed as an easy and rapid noninvasive technique to obtain real-time images, closely resembling a virtual biopsy section.[1]

Declaration of patient consent

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

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

Dubois A, Levecq O, Azimani H, Siret D, Barut A, Suppa M, et al. Line-field confocal optical coherence tomography for high-resolution noninvasive imaging of skin tumors. J Biomed Opt 2018; 23:1-9.
[Google Scholar]
Vilas Boas da Silva PT, Rodríguez-Lomba E, Avilés-Izquierdo JA, Ciudad-Blanco C, Suárez-Fernández R. Dermoscopic features of circumscribed palmar hypokeratosis. JAMA Dermatol 2017; 153:609-11.
[Google Scholar]
Lallas A, Errichetti E. Miscellaneous inflammatory diseases. In: Lallas A, Errichetti E, Ioannides D, editors. Dermoscopy in General Dermatology. 1st ed. Boca Raton: CRC Press; 2018.
[Google Scholar]
Polańska A, Bowszyc-Dmochowska M, Żaba R, Adamski Z, Pazdrowski J, Dańczak-Pazdrowska A, et al. High-frequency ultrasonography (20 MHz) in circumscribed palmar hypokeratosis – New observations. Arch Med Sci 2016; 12:1389-91.
[Google Scholar]
Abignano G, Kapadia A, Lettieri G, Goodfield M, Emery P, McGonagle D, et al. Use of optical coherence tomography for the diagnosis of preclinical lesions of circumscribed palmar hypokeratosis. Clin Exp Dermatol 2017; 42:192-5.
[Google Scholar]

Fulltext Views

PDF downloads
Show Sections