Case and Research Letters
Multiple Epidermolytic Acanthomas on the Scrotum: What Genital Pruritus Can Reveal
Acantomas epidermolíticos múltiples del escroto: Lo que el prurito genital puede esconder
P. García-Martínez
, L. Curto-Barredo, R. Rovira-López, R.M. Pujol
Corresponding author
Servicio Dermatología, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
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Eritema escrotal difuso. Pápulas aisladas de pequeño tamaño. (b). Detalle de las lesiones: múltiples pápulas hiperqueratósicas escrotales. (c). Acantoma epidermolítico: acantosis irregular con hiperqueratosis ortoqueratósica y papilomatosis (hematoxilina-eosina ×<span class="elsevierStyleHsp" style=""></span>40). (d). Detalle del aumento del número de gránulos de queratohialina en el estrato granuloso y acantólisis focal (hematoxilina-eosina ×<span class="elsevierStyleHsp" style=""></span>400).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. García-Martínez, L. Curto-Barredo, R. Rovira-López, R.M. Pujol" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "García-Martínez" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Curto-Barredo" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Rovira-López" ] 3 => array:2 [ "nombre" => "R.M." 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García-Martínez, L. Curto-Barredo, R. Rovira-López, R.M. Pujol" "autores" => array:4 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "García-Martínez" "email" => array:1 [ 0 => "pablogmh@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Curto-Barredo" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Rovira-López" ] 3 => array:2 [ "nombre" => "R.M." "apellidos" => "Pujol" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio Dermatología, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Acantomas epidermolíticos múltiples del escroto: Lo que el prurito genital puede esconder" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1712 "Ancho" => 2336 "Tamanyo" => 845494 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Diffuse scrotal erythema and small, isolated papules. B, Detail of the lesions: multiple hyperkeratotic scrotal papules. C, Epidermolytic acanthoma: irregular acanthosis with orthokeratotic hyperkeratosis and papillomatosis. Hematoxylin and eosin (H&E), original magnification<span class="elsevierStyleHsp" style=""></span>×40. D, Detail of the increased number of keratohyalin granules in the stratum granulosum and focal acantholysis. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×400.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Epidermolytic acanthoma (EA) is a rare benign lesion described by Shapiro and Baraf<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> in 1970. It typically presents clinically as a solitary, asymptomatic verrucous papule. Histologically, there is an epidermal proliferation (acanthoma) with epidermolytic hyperkeratosis, without the concomitant presence of signs suggestive of other cutaneous tumors. The presence of multiple EAs in the genital and perigenital region is an individualized variant with well-defined clinical and pathologic characteristics.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 49-year-old man with no past medical history of interest, reported the progressive appearance over the previous 18 months of multiple pruritic papules on his scrotum.</p><p id="par0015" class="elsevierStylePara elsevierViewall">He denied any triggering factors such as trauma or high-risk sexual behavior. Physical examination revealed the presence of numerous, small (2-4<span class="elsevierStyleHsp" style=""></span>mm), well-defined papules of whitish color and with a verrucous surface lying on a background of mild erythema (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, A and B). Histology of one of the lesions showed an acanthotic epidermis with intense orthokeratotic hyperkeratosis with hypergranulosis and papillomatosis. Abundant large keratohyalin granules were observed in the stratum granulosum, associated with vacuolar cell degeneration and edema, giving rise to focal separation in the upper third of the epidermis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, C and D). No histopathological changes suggestive of human papillomavirus (HPV) infection were present, and immunohistochemistry with anti-HPV antibodies was negative.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Treatment with 0.1% pimecrolimus cream was prescribed for the pruritus, and the lesions were then treated using cryotherapy, causing increased discomfort. A slight improvement was observed at the following visit, with reduced erythema and pruritus, and the lesions treated with cryotherapy had resolved.</p><p id="par0025" class="elsevierStylePara elsevierViewall">EA is a benign and usually asymptomatic tumor that typically presents in adult individuals. It has been described as a solitary lesion, though occasionally it can present with multiple lesions that may be localized or widespread. The solitary forms can arise at any site, whereas multiple or widespread lesions appear to preferentially affect the genitocrural region.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Clinically, multiple genital EA lesions present as numerous, flat or verrucous, skin-colored or whitish papules on the scrotum, vulva, perineum, or occasionally perianal region. The lesions can be asymptomatic or produce a variable degree of pruritus, causing scratching and persistence of the condition. The differential diagnosis includes other diseases more prevalent in the genital region, such as condyloma acuminatum, bowenoid papulosis, and molluscum contagiosum.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Histologically there is a compact hyperkeratosis. Vacuolar degeneration of keratinocytes is observed in the granular layer and stratum spinosum of the epidermis, together with the presence of cytoplasmic amphophilic material and numerous basophilic bodies similar to keratohyalin and amorphous eosinophilic bodies of the trichohyalin type.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The etiopathogenesis of EA is unknown. Some potential triggers have been identified, including viral infections, UV exposure, immunosuppression, and recurrent trauma (scratching).<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5–7</span></a> Mutations in the keratin K1 and K10 genes have been reported in isolated cases, and there has been no evidence of the presence or participation of HPV in the majority of cases studied.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Multiple asymptomatic EA does not require treatment. However, certain topical keratolytic treatments (lactic, salicylic, or glycolic acid) have been found to be effective in some cases, as have more aggressive treatments, such as curettage, cryotherapy, and carbon dioxide laser. Low-potency topical corticosteroids can be useful in cases with pruritus, and the use of calcineurin inhibitors has also recently been described.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Multiple anogenital EA is a clinical variant of EA that can present with persistent genital pruritus and must be included in the differential diagnosis of multiple papular genital lesions. The characteristic histological findings of EA make skin biopsy useful to confirm the diagnosis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Martínez P, Curto-Barredo L, Rovira-López R, Pujol RM. Acantomas epidermolíticos múltiples del escroto: lo que el prurito genital puede esconder. Actas Dermosifiliogr. 2018;109:81–82.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1712 "Ancho" => 2336 "Tamanyo" => 845494 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Diffuse scrotal erythema and small, isolated papules. B, Detail of the lesions: multiple hyperkeratotic scrotal papules. C, Epidermolytic acanthoma: irregular acanthosis with orthokeratotic hyperkeratosis and papillomatosis. Hematoxylin and eosin (H&E), original magnification<span class="elsevierStyleHsp" style=""></span>×40. D, Detail of the increased number of keratohyalin granules in the stratum granulosum and focal acantholysis. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×400.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Isolated epidermolytic acanthoma. A solitary tumor showing granular degeneration" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Shapiro" 1 => "C.S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 17 | 19 | 36 |
| 2024 October | 189 | 89 | 278 |
| 2024 September | 276 | 58 | 334 |
| 2024 August | 333 | 91 | 424 |
| 2024 July | 246 | 85 | 331 |
| 2024 June | 233 | 71 | 304 |
| 2024 May | 186 | 47 | 233 |
| 2024 April | 161 | 30 | 191 |
| 2024 March | 213 | 41 | 254 |
| 2024 February | 316 | 76 | 392 |
| 2024 January | 246 | 41 | 287 |
| 2023 December | 327 | 19 | 346 |
| 2023 November | 300 | 34 | 334 |
| 2023 October | 273 | 45 | 318 |
| 2023 September | 268 | 44 | 312 |
| 2023 August | 157 | 29 | 186 |
| 2023 July | 165 | 53 | 218 |
| 2023 June | 135 | 31 | 166 |
| 2023 May | 117 | 52 | 169 |
| 2023 April | 141 | 36 | 177 |
| 2023 March | 156 | 38 | 194 |
| 2023 February | 128 | 43 | 171 |
| 2023 January | 145 | 54 | 199 |
| 2022 December | 149 | 51 | 200 |
| 2022 November | 92 | 46 | 138 |
| 2022 October | 96 | 51 | 147 |
| 2022 September | 102 | 68 | 170 |
| 2022 August | 88 | 44 | 132 |
| 2022 July | 104 | 42 | 146 |
| 2022 June | 86 | 41 | 127 |
| 2022 May | 162 | 52 | 214 |
| 2022 April | 203 | 68 | 271 |
| 2022 March | 196 | 61 | 257 |
| 2022 February | 200 | 53 | 253 |
| 2022 January | 290 | 69 | 359 |
| 2021 December | 149 | 54 | 203 |
| 2021 November | 155 | 47 | 202 |
| 2021 October | 214 | 72 | 286 |
| 2021 September | 157 | 55 | 212 |
| 2021 August | 185 | 81 | 266 |
| 2021 July | 160 | 46 | 206 |
| 2021 June | 242 | 38 | 280 |
| 2021 May | 183 | 59 | 242 |
| 2021 April | 431 | 109 | 540 |
| 2021 March | 244 | 44 | 288 |
| 2021 February | 198 | 34 | 232 |
| 2021 January | 151 | 28 | 179 |
| 2020 December | 126 | 28 | 154 |
| 2020 November | 166 | 25 | 191 |
| 2020 October | 98 | 29 | 127 |
| 2020 September | 105 | 21 | 126 |
| 2020 August | 130 | 25 | 155 |
| 2020 July | 104 | 26 | 130 |
| 2020 June | 100 | 44 | 144 |
| 2020 May | 87 | 19 | 106 |
| 2020 April | 27 | 15 | 42 |
| 2020 March | 26 | 21 | 47 |
| 2020 February | 3 | 0 | 3 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 4 | 0 | 4 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 August | 2 | 0 | 2 |
| 2019 July | 6 | 0 | 6 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 6 | 0 | 6 |
| 2019 April | 2 | 0 | 2 |
| 2019 March | 2 | 0 | 2 |
| 2018 December | 4 | 0 | 4 |
| 2018 November | 1 | 0 | 1 |
| 2018 September | 5 | 0 | 5 |
| 2018 February | 86 | 25 | 111 |
| 2018 January | 264 | 34 | 298 |
| 2017 December | 10 | 19 | 29 |
Show all
