Derm Dx: Asymptomatic hyperkeratotic papules - Clinical Advisor

Derm Dx: Asymptomatic hyperkeratotic papules

Slideshow

  • Slide

A 51-year-old man with limited mentation is referred for evaluation of 2 papules on his back. The papules are asymptomatic and of uncertain duration. He has been diagnosed with oculocerebrorenal (Lowe) syndrome and has been receiving dialysis for the past 2 years. Medical history is positive for basal cell carcinoma. Examination of the patient’s back reveals 2 firm hyperkeratotic papules and scattered seborrheic keratoses.

Warty dyskeratoma, also known as isolated dyskeratosis follicularis, is a keratinization disorder that characteristically manifests as a solitary papule or nodule with a central keratotic plug. The term was first coined in 1957 by Szymanski, who noted a well-defined lesion...

Submit your diagnosis to see full explanation.

Warty dyskeratoma, also known as isolated dyskeratosis follicularis, is a keratinization disorder that characteristically manifests as a solitary papule or nodule with a central keratotic plug. The term was first coined in 1957 by Szymanski, who noted a well-defined lesion with a cup-shaped invagination containing a keratotic plug using microscopy.1

The plug is comprised of acantholytic dyskeratotic cells that manifest central basophilia and pyknotic nuclei surrounded by a clear halo. These so-called corps ronds are an additional hallmark of the condition.2

Multiple warty dyskeratomas have been reported occasionally,3 and oral4 and genital5 involvement has also been reported. Surgical removal of the papules by either punch biopsy or simple excision is curative. Involution of lesions may be accomplished with isotretinoin when surgery is impractical.6

Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.

References

  1. Szymanski FJ. Warty dyskeratoma: a benign cutaneous tumor resembling Darier’s disease microscopically. AMA Arch Dermatol. 1957;75(4):567-572.
  2. Fitzpatrick TB (ed). Dermatology in General Medicine. 4th ed. New York: McGraw-Hill; 1993:865-866.
  3. Koç M, Kavala M, Kocatürk E, et al. Multiple warty dyskeratomas on the scalp. Dermatol Online J. 2009;15(2):8.
  4. Allon I, Buchner A. Warty dyskeratoma/focal acantholytic dyskeratosis—an update on a rare oral lesion. J Oral Pathol Med. 2012;41(3):261-267.
  5. Hsu S, Ledbetter LS, Krishnan RS, Reed JA. Acantholytic dermatosis of the vulvocrural area. J Am Acad Dermatol. 2003;48(4):638-639.
  6. Hunag CC, Chang YJ, Wu YH. Oral isotretinoin in the treatment of a patient with multiple warty dyskeratoma. J Am Acad Dermatol. 2009;60(3 Supplement 1):AB42.
Next hm-slideshow in Derm DX