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Innumerable Filiform Papules—Diagnosis

Innumerable Filiform Papules—Diagnosis Diagnosis: Multiple minute digitate hyperkeratosis (MMDH). Microscopic findings and clinical course Histologic analysis revealed a filiform projection of compact orthohyperkeratosis forming a thin, hornlike structure. The underlying epidermis was mildly acanthotic and devoid of dysplasia. Mild hypergranulosis was noted as was subtle perivascular lymphocytic infiltrate (Figure 2). The features were consistent with multiple minute digitate hyperkeratosis. The patient applied 12% ammonium lactate lotion twice a day to the affected areas resulting in significant flattening of the lesions. Figure 2. View LargeDownload Discussion In 1967, Goldstein1 described a disorder of keratinization in a patient with digitate papules on the chest and anterolateral aspects of the arms and legs. The lesions were 1 to 2 mm in length and one-third to 1 mm in diameter. Multiple biopsy specimens from that patient demonstrated acanthosis and hypergranulosis underlying a narrow hyperkeratotic horn. Goldstein called this entity multiple minute digitate hyperkeratosis.1 Similar cases have been reported under many names, including music spine dermatosis, conical keratosis, hyperkeratotic spicules, digitate keratosis, disseminated spiked hyperkeratosis, minute aggregate hyperkeratosis, and familial disseminated filiform hyperkeratosis. All reported cases describe filiform or digitate papules, sometimes coexisting with dome-shaped keratotic papules, involving the back, chest, shoulders, and sometimes the abdomen, arms, legs, face, palms, and soles.2 The differential diagnosis includes keratosis pilaris, pityriasis rubra pilaris, Kyrle disease, lichen spinulosus, phrynoderma, Flegel disease, lichen planopilaris, and punctate porokeratosis; however, the lesions are quite distinct both clinically and histologically. Although some cases have been reported to be familial, others have been sporadic or associated with malignant lesions, nonneoplastic disease, radiation exposure, and medications.2 Among numerous reports of MMDH coincident with malignant neoplasms, multiple myeloma appears to have the strongest association. Interestingly, radiotherapy has been associated with the development of MMDH restricted to exposed skin.3 While classification systems have been proposed, none has been generally accepted, and the pathogenesis of the disease remains unknown. Histologic descriptions vary. Typical descriptions include a hyperkeratotic column overlying a focally acanthotic epidermis. Epidermal “tenting” is frequently described, and both hypergranulosis and hypogranulosis have been reported.2-4 It has been suggested that orthokeratosis is seen in familial and sporadic forms, while parakeratosis is more typical of postinflammatory lesions.4 Multiple minute digitate hyperkeratosis is a chronic disorder, and spontaneous remissions are unusual. Advocated treatments include etretinate and topically applied urea, salicylic acid, fluorouracil, tretinoin, and retinoids (vitamin A).2,3 Return to . References 1. Goldstein N Multiple minute digitate hyperkeratosis. Arch Dermatol 1967;96 (6) 692- 693PubMedGoogle ScholarCrossref 2. Guarneri CGuarneri FVaccaro MBorgia FCannavò SP Multiple minute digitate hyperkeratoses. Int J Dermatol 2005;44 (8) 664- 667PubMedGoogle ScholarCrossref 3. Ramselaar CToonstra J Multiple minute digitate hyperkeratosis report of two cases. Eur J Dermatol 1999;9 (6) 460- 465PubMedGoogle Scholar 4. Takagawa SSatoh TYokozeki HNishioka K Multiple minute digitate hyperkeratoses. Br J Dermatol 2000;142 (5) 1044- 1046PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Innumerable Filiform Papules—Diagnosis

Archives of Dermatology , Volume 144 (8) – Aug 18, 2008

Innumerable Filiform Papules—Diagnosis

Abstract

Diagnosis: Multiple minute digitate hyperkeratosis (MMDH). Microscopic findings and clinical course Histologic analysis revealed a filiform projection of compact orthohyperkeratosis forming a thin, hornlike structure. The underlying epidermis was mildly acanthotic and devoid of dysplasia. Mild hypergranulosis was noted as was subtle perivascular lymphocytic infiltrate (Figure 2). The features were consistent with multiple minute digitate hyperkeratosis. The patient applied 12% ammonium...
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Publisher
American Medical Association
Copyright
Copyright © 2008 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.144.8.1051-f
Publisher site
See Article on Publisher Site

Abstract

Diagnosis: Multiple minute digitate hyperkeratosis (MMDH). Microscopic findings and clinical course Histologic analysis revealed a filiform projection of compact orthohyperkeratosis forming a thin, hornlike structure. The underlying epidermis was mildly acanthotic and devoid of dysplasia. Mild hypergranulosis was noted as was subtle perivascular lymphocytic infiltrate (Figure 2). The features were consistent with multiple minute digitate hyperkeratosis. The patient applied 12% ammonium lactate lotion twice a day to the affected areas resulting in significant flattening of the lesions. Figure 2. View LargeDownload Discussion In 1967, Goldstein1 described a disorder of keratinization in a patient with digitate papules on the chest and anterolateral aspects of the arms and legs. The lesions were 1 to 2 mm in length and one-third to 1 mm in diameter. Multiple biopsy specimens from that patient demonstrated acanthosis and hypergranulosis underlying a narrow hyperkeratotic horn. Goldstein called this entity multiple minute digitate hyperkeratosis.1 Similar cases have been reported under many names, including music spine dermatosis, conical keratosis, hyperkeratotic spicules, digitate keratosis, disseminated spiked hyperkeratosis, minute aggregate hyperkeratosis, and familial disseminated filiform hyperkeratosis. All reported cases describe filiform or digitate papules, sometimes coexisting with dome-shaped keratotic papules, involving the back, chest, shoulders, and sometimes the abdomen, arms, legs, face, palms, and soles.2 The differential diagnosis includes keratosis pilaris, pityriasis rubra pilaris, Kyrle disease, lichen spinulosus, phrynoderma, Flegel disease, lichen planopilaris, and punctate porokeratosis; however, the lesions are quite distinct both clinically and histologically. Although some cases have been reported to be familial, others have been sporadic or associated with malignant lesions, nonneoplastic disease, radiation exposure, and medications.2 Among numerous reports of MMDH coincident with malignant neoplasms, multiple myeloma appears to have the strongest association. Interestingly, radiotherapy has been associated with the development of MMDH restricted to exposed skin.3 While classification systems have been proposed, none has been generally accepted, and the pathogenesis of the disease remains unknown. Histologic descriptions vary. Typical descriptions include a hyperkeratotic column overlying a focally acanthotic epidermis. Epidermal “tenting” is frequently described, and both hypergranulosis and hypogranulosis have been reported.2-4 It has been suggested that orthokeratosis is seen in familial and sporadic forms, while parakeratosis is more typical of postinflammatory lesions.4 Multiple minute digitate hyperkeratosis is a chronic disorder, and spontaneous remissions are unusual. Advocated treatments include etretinate and topically applied urea, salicylic acid, fluorouracil, tretinoin, and retinoids (vitamin A).2,3 Return to . References 1. Goldstein N Multiple minute digitate hyperkeratosis. Arch Dermatol 1967;96 (6) 692- 693PubMedGoogle ScholarCrossref 2. Guarneri CGuarneri FVaccaro MBorgia FCannavò SP Multiple minute digitate hyperkeratoses. Int J Dermatol 2005;44 (8) 664- 667PubMedGoogle ScholarCrossref 3. Ramselaar CToonstra J Multiple minute digitate hyperkeratosis report of two cases. Eur J Dermatol 1999;9 (6) 460- 465PubMedGoogle Scholar 4. Takagawa SSatoh TYokozeki HNishioka K Multiple minute digitate hyperkeratoses. Br J Dermatol 2000;142 (5) 1044- 1046PubMedGoogle ScholarCrossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Aug 18, 2008

Keywords: keratosis,papule

References