Circumscribed acral hypokeratosis
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Synopsis
CAH classically presents as a solitary circumscribed, depressed, erythematous plaque on the palm or sole, although cases with multiple lesions have been described. The dominant hand is most frequently affected, specifically the thenar or hypothenar region. Less common locations include the fingertips and medial soles. CAH is typically asymptomatic, but tenderness and burning have occasionally been reported.
CAH usually remains consistent in size, shape, and color over time. Spontaneous resolution has been reported in several cases. There has been one report of an actinic keratosis developing within a lesion of CAH.
The pathophysiology is unclear, but recent immunohistochemical findings have shown abnormal cytokeratin expression in CAH lesions. This discovery, along with the reports of congenital lesions, may indicate that CAH occurs as a result of abnormal epidermal keratinization.
Codes
ICD10CM:L98.9 – Disorder of the skin and subcutaneous tissue, unspecified
SNOMEDCT:
201070005 – Atrophic spots of skin
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Squamous cell carcinoma in situ (Bowen disease)
- Squamous cell carcinoma
- Basal cell carcinoma
- Porokeratosis of Mibelli
- Pseudocircumscribed palmar or plantar hypokeratosis
- Porokeratotic eccrine ostial and dermal duct nevus (PEODDN)
- Psoriasis
- Seborrheic keratosis
- Dyshidrotic dermatitis
- Ulcerated fibroma
- Friction blister
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References
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Last Reviewed:12/05/2019
Last Updated:01/10/2020
Last Updated:01/10/2020
Circumscribed acral hypokeratosis