Acanthomas, disseminated epidermolytic D23.L

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Definition
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Benign, acquired, wart-like skin lesions that show the clinical picture of epidermolytic acanthomas and occur preferentially in light-exposed areas Fine-tissue granular degeneration of the epidermis.

Etiopathogenesis
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Obviously no viral genesis, UV light can induce lesions (e.g. after PUVA bath therapy or dermatitis solaris)

Localization
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Preferably on light-exposed skin of the upper back.

Clinical features
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Multiple, isolated standing, 3-5 mm large, skin-coloured, slightly brownish hyperkeratotic, verrucous papules. Partly agonizing itching.

Histology
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  • Premature and defective keratinization of the keratinocytes. Intact stratum basale. The cells of the stratum spinosum and stratum granulosum are perinuclearly vacuolated, show pale eosinophilic cytoplasm and blurred cell boundaries. Overall widening of the stratum granulosum with many irregularly shaped keratohyalin-like granules. Orthohyperkeratosis overlying the lesions.
  • Electron microscopy: Clumped and thickened keratin/tonofilament aggregates perinuclear in the suprabasal keratinocytes. Enlarged keratohyalin granules. Intact desmosomes.

Diagnosis
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Histology.

Differential diagnosis
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Congenital cornification disorders (e.g. dyskeratosis follicularis), seborrheic warts (s. verruca seborrhoica), flat warts ( verrucae planae juveniles).

Therapy
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Local therapy with 0.1% tretinoin (e.g. Cordes VAS) and 0.025% fluocinolone acetonide ointment/cream (e.g. jellin ointment/cream) once/day for 4 weeks.

Literature
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  1. Metzler G et al (1997) Disseminated epidermolytic acanthomas. Dermatologist 48: 740-742
  2. Sanchez-Carpintero I et al (1999) Disseminated epidermolytic acanthoma probably related to trauma. Br J Dermatol 141: 728-730

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020