Congenital circumscribed plantar hypokeratosis

A Case of Circumscribed Palmar or Plantar Hypokeratosis and a Mini-review of the Literature

ABSTRACT

Circumscribed palmar or plantar hypokeratosis (CPPH) is a new dermatologic disorder that firstly defined Pérez A et al in 2002. Since that time, further cases of CPPH have been reported by different authors in different countries. We report a 69-year-old Turkish woman who presented with asymptomatic, erythematous patches on the thenar region of the left hand and on the second left finger. Skin biopsy showed histological features of CPPH. In this article, it was emphasized that CPPH may be seen more frequently than expected and the clinical and pathological features of this disease with suspected malignant transformation should be known.

Circumscribed palmoplantar hypokeratosis

Circumscribed palmoplantar hypokeratosis (CPH) is a rare acquired dermatosis first described in 2002. It affects mostly the thenar or hypothenar eminences of the palm of middle-aged or elderly women and manifests clinically with sharply limited, annular erythematous plaques with a depressed surface, rimmed by a slightly raised, keratotic border. Microscopically, circumscribed palmoplantar hypokeratosis shows a sharp decrease of the horny layer thickness, with few, if any, associated changes (parakeratosis, dermal inflammation). Despite a characteristic clinical and microscopic aspect, the disease remains poorly known, as does its pathogenesis, even if several hypotheses have been proposed (clonal epidermal malformation, disorder of epidermal differentiation/keratinization and/or desquamation, human papillomavirus- or trauma-induced disease). Several therapies have been proposed with varying results, the best ones achieved with surgical excision; however, because the disease is benign, intervention is optional. © 2020 Elsevier Inc. All rights reserved.

Cutaneous Manifestations of COVID-19: An Evidence-Based Review

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has affected 18 million people and killed over 690,000 patients. Although this virus primarily causes respiratory symptoms, an increasing number of cutaneous manifestations associated with this disease have been reported.

OBJECTIVE

The aim of this review was to collate and categorize the dermatologic findings reported in patients with COVID-19 and identify specific lesions that may facilitate diagnosis and prognostication.

METHODS

An evidence-based review of the PubMed database was conducted on 14 May, 2020 using the search terms "Covid-19 skin," "Covid-19 rash," "Covid-19 exanthem," and "Covid-19 chilblains." Peer-reviewed publications containing original COVID-19 patient cases and a discussion of the associated cutaneous findings were included in the analysis.

RESULTS

The literature search identified 115 records, of which 34 publications describing 996 patients with dermatologic conditions were included. Case reports (n = 15), case series (n = 13), and observational prospective studies (n = 4) were the most common publication types. Acral lesions resembling pseudo-chilblains were the most frequent lesion identified (40.4% of cases), appearing in young adults (mean age, 23.2 years) after the onset of extracutaneous COVID-19 symptoms (55/100 patients). Erythematous maculopapular rashes affected 21.3% of patients, most frequently impacting middle-aged adults (mean age, 53.2 years) and occurring at the same time as non-cutaneous symptoms (110/187 patients). Vesicular rashes affected 13.0% of patients, appearing in middle-aged adults (mean age, 48.3 years) after the onset of other symptoms (52/84 patients). Urticarial rashes affected 10.9% of patients, appearing in adults (mean age, 38.3 years) and occurring at the same time as non-cutaneous symptoms (46/78 patients). Vascular rashes resembling livedo or purpura were uncommon (4% of cases), appearing in elderly patients (mean age, 77.5 years) and occurring at the same time as non-cutaneous COVID-19 symptoms (18/29 patients). Erythema multiforme-like eruptions, although infrequent (3.7% of cases), affected mostly children (mean age, 12.2 years).

CONCLUSIONS

Vesicular rashes may suggest an initial diagnosis of COVID-19, acral lesions may be most appropriate for epidemiological uses, and vascular rashes may be a useful prognostic marker for severe disease. As a potential correlate to disease severity, prognosis, or infectibility, it is critical that all healthcare professionals be well versed in these increasingly common cutaneous manifestations of COVID-19.