Circumscribed acral hypokeratosis.
BACKGROUND
Circumscribed acral hypokeratosis (CAH) is an idiopathic condition that typically presents as an acquired, solitary, asymptomatic, well-defined, depressed, flat-based deformity, with a slightly raised border on the palm or, rarely, the sole. Histologically, the lesional epidermis is depressed with a characteristic, abrupt, hyperkeratotic, slightly-raised ridge at the transition from normal skin.


OBJECTIVE
We sought to present 3 additional cases of CAH.


METHODS
A review of 3 cases of CAH was performed. Liquid phase polymerase chain reaction (PCR) was conducted to evaluate for human papillomavirus (HPV).


RESULTS
Three cases of CAH were reviewed. One patient had a history of a burn at the site prior to developing the disorder while another patient, as a child, had a history of verruca plantaris in the same location. Lesions were solitary, involving the palm or sole, in 2 cases and in one case they were multiple involving both the palms and the soles. HPV testing detected HPV type 6 in the lesion of one patient who previously was treated for warts in the same location. Topical fluorouracil, calcipotriol ointment under occlusion, and clobetasol ointment under occlusion were unsuccessful in one patient.


CONCLUSIONS
In case 2, we were pathology consultants and unable to evaluate the clinical appearance of the lesion.


CONCLUSIONS
CAH may involve palms and/or soles. Lesions may be solitary or multiple, and vary widely in size. We believe that CAH most likely represents a reaction pattern developing in response to various stimuli, including trauma, HPV, or both.
Berk
David R
DR
Division of Dermatology, Washington University School of Medicine, St Louis, MO 63110, USA. DBerk@im.wustl.edu
Böer
Almut
A
Bauschard
Fred D
FD
Hurt
Mark A
MA
Santa-Cruz
Daniel J
DJ
Eisen
Arthur Z
AZ
D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000150:complications; D005260:Female; D005533:Foot Dermatoses / Q000150:complications / Q000473:pathology* / Q000821:virology; D005534:Foot Diseases / Q000150:complications; D006229:Hand Dermatoses / Q000150:complications / Q000473:pathology*; D052163:Human papillomavirus 6 / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007642:Keratosis / Q000150:complications / Q000473:pathology* / Q000821:virology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D014860:Warts / Q000150:complications