Multiple minute digitate hyperkeratosis: 10 years from Caccetta's algorithm. A case report and narrative review

To date, the clinical appearance and histological features of multiple minute digitate hyperkeratosis have been well characterized. However, there is no consensus on its treatment. After a comprehensive search of the databases MEDLINE, EMBASE, Web of Science, and the Cochrane Library and Database of Systematic Reviews, we have summarized the available clinical evidence regarding the therapeutic approaches already reported for this entity since its first description in 1967. Additional publications were identified within the references of retrieved papers. Sixty-five articles have been revised, resulting in a total of 73 compatible cases. The histopathological features and different classifications used through history have also been considered, updating and completing the available knowledge. Ultimately, we propose topical treatment with 5 % 5-fluorouracil formulated with 10 % salicylic acid as a potential treatment that has been used successfully in a 51-year-old woman at our facility. Further research in form of prospective or comparative studies is encouraged for a better conceptualization of the therapeutics of this disease.

Multiple Minute Digitate Hyperkeratosis: 10 Jahre nach Caccettas Algorithmus. Fallbericht und narrative Übersicht

Das klinische Erscheinungsbild und die histologischen Merkmale der Multiple Minute Digitate Hyperkeratosis sind bereits gut charakterisiert. Es besteht jedoch kein Konsens über die Behandlung dieser Erkrankung. Nach einer umfassenden Recherche in den Datenbanken MEDLINE, EMBASE, Web of Science und der Cochrane Library and Database of Systematic Reviews haben wir die vorliegenden klinischen Daten zu den therapeutischen Ansätzen zusammengefasst, die für diese Entität seit ihrer Erstbeschreibung im Jahr 1967 publiziert wurden. Zusätzliche Veröffentlichungen wurden in den Referenzen der gefundenen Artikel identifiziert. Fünfundsechzig Artikel wurden durchgesehen, sodass sich insgesamt 73 kompatible Fälle ergaben. Die histopathologischen Merkmale und die verschiedenen Klassifizierungen, die im Laufe der Zeit verwendet wurden, wurden ebenfalls berücksichtigt. Letztendlich schlagen wir die topische Behandlung mit 5% 5‐Fluorouracil in Kombination mit 10% Salicylsäure als eine mögliche Behandlung vor, die bei einer 51‐jährigen Frau in unserer Einrichtung erfolgreich angewendet wurde. Weitere Forschung in Form von prospektiven oder vergleichenden Studien werden empfohlen, um ein besseres Konzept für die Therapie dieser Krankheit zu entwickeln.

Spiny keratoderma: A review of case reports and histopathological descriptions

Spiny keratoderma (SpK) is a rare skin condition characterized by spine-like papules on the palms and soles. The condition is identified under several names such as "music box spine keratosis" and "palmoplantar filiform hyperkeratosis," creating ambiguity in the diagnostic and histopathologic features of the disease. In this study, we reviewed 84 cases of SpK to examine patient demographics, medical history, clinical and histopathological descriptions, and sporadic versus hereditary onset. Notably, the most used histopathological terms were "parakeratosis" and "hypogranulosis," and the most used clinical terms were "spine" and "hyperpigmented." The average age at presentation was 60.1 years with the majority of cases in males. Only 29.8% of cases were associated with a family history of SpK and underlying malignancies were present in 28.6% of cases. This review investigates the frequency of histopathologic and clinical terms used to describe SpK to provide insight into the clinical and histopathological characteristics of this rarely reported condition.

Spiny keratoderma: Report of three cases

BACKGROUND

Spiny keratoderma shows "music box spine" keratotic papules limited to the palms and soles and these lesions do not cause any trouble besides the cosmetic impairment and the sensation of roughness of hands and soles.

AIM

To present cases and review the literature on spiny keratoderma.

PATIENTS/METHODS, RESULTS

Three cases of spiny keratoderma are presented. The first case is a 52-year-old man with protein S deficiency presented with multiple spiny keratotic papules on palms and soles for more than 30 years, referring to remove them with a razor blade. The second case is an 84-year-old man who was hospitalized due to a rectal adenocarcinoma diagnosed 2 months before and presented multiples papules on palms and soles that were present for more than 50 years, with worsening after being bedridden. The third case is a 59-year-old woman who had since birth together with relatives the same type of spiny keratotic papules on palms and soles.

CONCLUSION

The authors discuss the epidemiologic data and differential diagnosis of spiny keratoderma, as well as the related literature. Associations with systemic disease or malignancy occur in some acquired cases. It is important to distinguish from other palmoplantar keratodermas as some of that can be linked to cutaneous and internal malignancies. To date, no cases of spiny keratoderma in patients with protein S deficiency and only one case of association with rectal carcinoma have been reported.

Somatic Mosaicism for a "Lethal" GJB2 Mutation Results in a Patterned Form of Spiny Hyperkeratosis without Eccrine Involvement

BACKGROUND

Spiny hyperkeratosis refers to a rare clinical phenotype characterized by nonfollicular keratotic projections and sometimes associated with other acquired and inherited conditions. We describe a case of congenital patterned spiny hyperkeratosis.

METHODS

To identify the cause of this disorder, we used a combination of whole exome sequencing, direct sequencing and TaqMan assay.

RESULTS

We found that the peculiar clinical features displayed by the patient are due to somatic mosaicism for a heterozygous mutation in the GJB2 gene.

CONCLUSION

Because histopathologic examination of two independent biopsies did not reveal porokeratotic eccrine ostial and dermal duct nevus (PEODDN), previously reported to result from somatic mutations in GJB2, it appears that mutations in this gene can cause nevoid spiny hyperkeratosis in the context of PEODDN or as an isolated finding.

Unilateral keratoderma in a mother and her son

BACKGROUND

Keratoderma is a group of conditions characterized by hyperkeratosis affecting the skin on the soles of the feet and palms of the hands bilaterally. The classification of keratodermas depends on whether it is inherited or acquired and on its clinical features, including diffuse or focal involvement of the skin and the morphology of lesions present.

CASE REPORT

We describe the rare case of a 54-year-old female who presented with a nearly 40-year history of punctate keratoderma on her right palm and sole. History taking revealed that her biologic son also has unilateral left-sided keratoderma. The clinical presentation of unilateral keratoderma has been reported only four times in the literature.