Cases for Diagnosis
Keratotic Plaques on the Hands
Placas queratósicas en manos
J. Alonso-González
, M. Ginarte, J. Toribio
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Departamento de Dermatología, Complejo Hospitalario Universitario, Facultad de Medicina, Santiago de Compostela, Spain
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"apellidos" => "Toribio" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Departamento de Dermatología, Complejo Hospitalario Universitario, Facultad de Medicina, Santiago de Compostela, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Placas queratósicas en manos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 677 "Ancho" => 950 "Tamanyo" => 241909 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin-eosin, original magnification ×100. B, Orcein, original magnification ×250. C, Orcein, original magnification ×400.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">The patient, a 14-year-old boy with no relevant personal or family history, presented with asymptomatic lesions on both hands that had first appeared approximately 1 year earlier. He had received treatment with topical corticosteroids on several occasions. The lesions had improved somewhat during each round of treatment, only to worsen again after the medication was withdrawn.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed yellowish-white keratotic plaques with well-defined borders on the dorsum of the right hand and on the lateral sides of the proximal phalanges of both hands (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, A and B). A larger plaque with similar characteristics was located on the right thenar eminence, stretching around to the lateral edge of the hand (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The patient had no other lesions.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathology revealed marked orthokeratotic hyperkeratosis and mild epidermal acanthosis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). Orcein staining revealed a reduction (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B) and fragmentation (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>C) of the elastic fibers in the dermis.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Acrokeratoelastoidosis of Costa.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">Due to the benign nature of the condition and the absence of symptoms, the patient was given no treatment.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">First described by Costa<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in 1953, acrokeratoelastoidosis (AKE) is a rare entity that can be either sporadic or familial. Autosomal dominant and autosomal recessive inheritance patterns have been described, as well as a possible linkage to chromosome 2.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In most cases, onset occurs before the age of 20 years,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and the disease exhibits no clear predilection for race or sex.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The lesions are small, translucent, yellowish-white papules measuring 2 to 4<span class="elsevierStyleHsp" style=""></span>mm. They can be round or polygonal, have a flat or umbilicated surface, and are often keratotic. The most characteristic locations are the thenar and hypothenar eminences and the dorsal and lateral aspects of the fingers and toes.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2-5</span></a> The lesions typically occur across the areas where the dorsal and plantar or the dorsal and palmar surfaces meet.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> On the dorsa of the feet, the papules tend to merge into plaques<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> that can extend as far as the anterior aspect of the legs; lesions rarely occur on the soles of the feet.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The lesions are usually asymptomatic, although pruritus<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and pain caused by fissuring have been reported.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Hyperhidrosis is a common but variable finding.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Histology reveals epidermal acanthosis with orthokeratotic hyperkeratosis. In the dermis, a reduction and fragmentation of elastic fibers (elastorrhexis) is observed.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2-4</span></a> In some cases, these changes in the skin can only be observed by electron microscopy.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The cause of AKE is unknown,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a> but electron microscopic studies of patients with AKE have revealed fibroblasts containing dense cytoplasmic granules and an absence of extracellular fibers. These findings support the hypothesis that the underlying disease process is the inhibition of elastic fiber synthesis by fibroblasts.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Key conditions that should be considered in the differential diagnosis include other marginal acrokeratodermas such as focal acral hyperkeratosis, degenerative collagenous plaques of the hands, keratoelastoidosis marginalis of the hands, and lenticular acral keratosis in laundry workers. Diagnosis is established on the basis of clinical findings and histologic examination of the lesions.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Treatment is generally unnecessary, as the lesions are usually asymptomatic. Of the treatments used to date—dapsone, methotrexate, topical salicylic acid, topical capsaicin,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> liquid nitrogen, oral and topical corticosteroids, and erbium:YAG laser treatment—oral retinoid treatment is the only one likely to lead to any improvement; it should be noted, however, that the lesions recur after discontinuation of the treatment.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Alonso-González J, et al. Placas queratósicas en manos. Actas Dermosifiliogr.2012;103:327-8.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 416 "Ancho" => 974 "Tamanyo" => 63310 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 555 "Ancho" => 375 "Tamanyo" => 34257 ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 677 "Ancho" => 950 "Tamanyo" => 241909 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin-eosin, original magnification ×100. B, Orcein, original magnification ×250. C, Orcein, original magnification ×400.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acrokeratoelastoidosis (a hitherto undescribed skin disease)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "O.G. 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Glaser" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "2002" "volumen" => "19" "paginaInicial" => "320" "paginaFinal" => "322" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12220276" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acroqueratodermias marginales" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. De la Torre" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Piel" "fecha" => "2004" "volumen" => "19" "paginaInicial" => "294" "paginaFinal" => "302" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acrokeratoelastoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.A. Bogle" 1 => "L.Y. Hwang" 2 => "J.A. Tschen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2002" "volumen" => "47" "paginaInicial" => "448" "paginaFinal" => "451" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12196760" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acroqueratoelastoidosis dolorosa de localización atípica. Tratamiento con capsaicina tópica" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Robayna" 1 => "R. de Lucas" 2 => "F. Rubio" 3 => "I. Buron" 4 => "M. Mayor" 5 => "J. Calvo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Cutan Ibero Lat Am" "fecha" => "1997" "volumen" => "25" "paginaInicial" => "160" "paginaFinal" => "162" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000004/v1_201304241303/S1578219012001515/v1_201304241303/en/main.assets" "Apartado" => array:4 [ "identificador" => "6171" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cases for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000004/v1_201304241303/S1578219012001515/v1_201304241303/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012001515?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 18 | 9 | 27 |
| 2024 Octubre | 167 | 41 | 208 |
| 2024 Septiembre | 170 | 19 | 189 |
| 2024 Agosto | 192 | 58 | 250 |
| 2024 Julio | 151 | 30 | 181 |
| 2024 Junio | 155 | 43 | 198 |
| 2024 Mayo | 133 | 36 | 169 |
| 2024 Abril | 125 | 25 | 150 |
| 2024 Marzo | 129 | 33 | 162 |
| 2024 Febrero | 146 | 33 | 179 |
| 2024 Enero | 128 | 38 | 166 |
| 2023 Diciembre | 121 | 25 | 146 |
| 2023 Noviembre | 103 | 18 | 121 |
| 2023 Octubre | 103 | 32 | 135 |
| 2023 Septiembre | 102 | 27 | 129 |
| 2023 Agosto | 77 | 13 | 90 |
| 2023 Julio | 112 | 42 | 154 |
| 2023 Junio | 92 | 33 | 125 |
| 2023 Mayo | 92 | 17 | 109 |
| 2023 Abril | 89 | 24 | 113 |
| 2023 Marzo | 79 | 27 | 106 |
| 2023 Febrero | 70 | 27 | 97 |
| 2023 Enero | 51 | 32 | 83 |
| 2022 Diciembre | 68 | 43 | 111 |
| 2022 Noviembre | 34 | 44 | 78 |
| 2022 Octubre | 33 | 32 | 65 |
| 2022 Septiembre | 34 | 51 | 85 |
| 2022 Agosto | 36 | 27 | 63 |
| 2022 Julio | 29 | 37 | 66 |
| 2022 Junio | 31 | 24 | 55 |
| 2022 Mayo | 79 | 43 | 122 |
| 2022 Abril | 133 | 54 | 187 |
| 2022 Marzo | 124 | 53 | 177 |
| 2022 Febrero | 107 | 40 | 147 |
| 2022 Enero | 142 | 40 | 182 |
| 2021 Diciembre | 88 | 43 | 131 |
| 2021 Noviembre | 117 | 50 | 167 |
| 2021 Octubre | 77 | 63 | 140 |
| 2021 Septiembre | 80 | 44 | 124 |
| 2021 Agosto | 68 | 35 | 103 |
| 2021 Julio | 63 | 28 | 91 |
| 2021 Junio | 73 | 46 | 119 |
| 2021 Mayo | 74 | 35 | 109 |
| 2021 Abril | 168 | 36 | 204 |
| 2021 Marzo | 138 | 28 | 166 |
| 2021 Febrero | 104 | 33 | 137 |
| 2021 Enero | 85 | 23 | 108 |
| 2020 Diciembre | 62 | 17 | 79 |
| 2020 Noviembre | 46 | 24 | 70 |
| 2020 Octubre | 56 | 12 | 68 |
| 2020 Septiembre | 47 | 12 | 59 |
| 2020 Agosto | 47 | 24 | 71 |
| 2020 Julio | 42 | 18 | 60 |
| 2020 Junio | 51 | 37 | 88 |
| 2020 Mayo | 47 | 19 | 66 |
| 2020 Abril | 41 | 23 | 64 |
| 2020 Marzo | 45 | 23 | 68 |
| 2020 Febrero | 5 | 0 | 5 |
| 2020 Enero | 4 | 2 | 6 |
| 2019 Diciembre | 4 | 12 | 16 |
| 2019 Noviembre | 4 | 8 | 12 |
| 2019 Octubre | 0 | 9 | 9 |
| 2019 Septiembre | 4 | 14 | 18 |
| 2019 Agosto | 4 | 9 | 13 |
| 2019 Julio | 4 | 24 | 28 |
| 2019 Junio | 4 | 25 | 29 |
| 2019 Mayo | 7 | 70 | 77 |
| 2019 Abril | 2 | 50 | 52 |
| 2019 Marzo | 0 | 8 | 8 |
| 2019 Febrero | 2 | 10 | 12 |
| 2019 Enero | 0 | 5 | 5 |
| 2018 Diciembre | 2 | 13 | 15 |
| 2018 Noviembre | 5 | 6 | 11 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 6 | 9 | 15 |
| 2018 Agosto | 0 | 8 | 8 |
| 2018 Julio | 0 | 7 | 7 |
| 2018 Junio | 0 | 8 | 8 |
| 2018 Mayo | 0 | 5 | 5 |
| 2018 Abril | 0 | 6 | 6 |
| 2018 Marzo | 21 | 7 | 28 |
| 2018 Febrero | 102 | 15 | 117 |
| 2018 Enero | 79 | 9 | 88 |
| 2017 Diciembre | 97 | 11 | 108 |
| 2017 Noviembre | 71 | 12 | 83 |
| 2017 Octubre | 66 | 10 | 76 |
| 2017 Septiembre | 56 | 16 | 72 |
| 2017 Agosto | 55 | 18 | 73 |
| 2017 Julio | 45 | 9 | 54 |
| 2017 Junio | 66 | 13 | 79 |
| 2017 Mayo | 78 | 11 | 89 |
| 2017 Abril | 57 | 8 | 65 |
| 2017 Marzo | 53 | 25 | 78 |
| 2017 Febrero | 77 | 17 | 94 |
| 2017 Enero | 45 | 11 | 56 |
| 2016 Diciembre | 56 | 8 | 64 |
| 2016 Noviembre | 95 | 6 | 101 |
| 2016 Octubre | 116 | 11 | 127 |
| 2016 Septiembre | 243 | 17 | 260 |
| 2016 Agosto | 181 | 9 | 190 |
| 2016 Julio | 63 | 11 | 74 |
| 2016 Junio | 16 | 13 | 29 |
| 2016 Mayo | 6 | 7 | 13 |
| 2016 Abril | 5 | 10 | 15 |
| 2016 Marzo | 7 | 7 | 14 |
| 2016 Febrero | 5 | 11 | 16 |
| 2016 Enero | 9 | 3 | 12 |
| 2015 Diciembre | 6 | 1 | 7 |
| 2015 Noviembre | 19 | 6 | 25 |
| 2015 Octubre | 18 | 1 | 19 |
| 2015 Septiembre | 11 | 9 | 20 |
| 2015 Agosto | 10 | 5 | 15 |
| 2015 Julio | 73 | 5 | 78 |
| 2015 Junio | 85 | 6 | 91 |
| 2015 Mayo | 94 | 11 | 105 |
| 2015 Abril | 89 | 18 | 107 |
| 2015 Marzo | 84 | 13 | 97 |
| 2015 Febrero | 65 | 15 | 80 |
| 2015 Enero | 73 | 17 | 90 |
| 2014 Diciembre | 75 | 7 | 82 |
| 2014 Noviembre | 63 | 13 | 76 |
| 2014 Octubre | 105 | 18 | 123 |
| 2014 Septiembre | 79 | 9 | 88 |
| 2014 Agosto | 92 | 21 | 113 |
| 2014 Julio | 115 | 20 | 135 |
| 2014 Junio | 111 | 12 | 123 |
| 2014 Mayo | 136 | 25 | 161 |
| 2014 Abril | 41 | 2 | 43 |
| 2014 Marzo | 39 | 4 | 43 |
| 2014 Febrero | 33 | 8 | 41 |
| 2014 Enero | 28 | 6 | 34 |
| 2013 Diciembre | 41 | 11 | 52 |
| 2013 Noviembre | 34 | 5 | 39 |
| 2013 Octubre | 19 | 2 | 21 |
| 2013 Septiembre | 22 | 4 | 26 |
| 2013 Agosto | 33 | 3 | 36 |
| 2013 Julio | 16 | 8 | 24 |
| 2013 Junio | 15 | 10 | 25 |
| 2013 Mayo | 18 | 11 | 29 |
| 2013 Abril | 21 | 6 | 27 |
| 2013 Marzo | 22 | 11 | 33 |
| 2013 Febrero | 29 | 4 | 33 |
| 2013 Enero | 37 | 6 | 43 |
| 2012 Diciembre | 18 | 4 | 22 |
| 2012 Agosto | 0 | 1 | 1 |
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