ABSTRACT
The current study explores a case of symmetrical acrokeratoderma, and related literature is reviewed. A 27-year-old male presented with brownish-black plaques distributed symmetrically on the dorsum of the hands and feet for 3 years, and white maceration of the lesions was observed after immersion in water. The patient was diagnosed with symmetrical acrokeratoderma, and Hirudoid ointment was topically administered twice a day for a month. The symptoms were partially alleviated, and the patient is currently under follow-up observation.
ABSTRACT
Objective To investigate ultrahistopathological features of symmetrical acrokeratoderma.Methods Biopsy specimens were obtained from skin lesions and perilesional normalappearing skin of 6 patients with symmetrical acrokeratoderma,as well as from normal skin of 3 healthy volunteers.Then,these skin specimens were subjected to transmission electron microscopy (TEM).Results TEM showed obviously thickened stratum corneum,irregular morphology of keratinocytes and discontinuous cornified envelope.Aggregation and abnormal arrangement of keratin filaments occurred in all epidermal layers.Many vacuoles of different sizes were observed in the transitional zone between the stratum corneum and stratum granulosum.Hypogranulosis,abnormal shape and different sizes of keratohyalin granules,and reduction of membrane-coating granules were found in the stratum granulosum.Increased melanocytes with a large number of stage Ⅳ melanosomes in the cytoplasm were observed in the basal layers.Moreover,there was infiltration of a few lymphocytes in the superficial dermis.Perilesional normal-appearing skin tissues showed similar but milder ultrastructural changes.Conclusion Abnormal metabolism of keratins,epidermal differentiation complex proteins and lipids may exist in skin lesions of symmetrical acrokeratoderma,which may contribute to epidermal thickening and impairment of skin barrier function.
ABSTRACT
Symmetrical acrokeratoderma is a recently described dermatosis in young adult males of Chinese descent. In this report, we describe a series of five cases of symmetrical acrokeratoderma from India. All 5 patients had asymptomatic, brownish-black plaques distributed symmetrically over dorsum of hand and feet with variable involvement of wrist, flexural surface of forearm, elbow, ankles, shin and knee joint. Palms and soles were characteristically spared. Typically whitish maceration of the lesions was seen after immersing in water. The disease showed exacerbation in hot and humid climate with spontaneous resolution in winter. Histopathological examination showed basket weave hyperkeratosis, irregular acanthosis and mild peri-vascular lymphomononuclear infiltrate. Loosening of the stratum corneum was seen in post-immersion biopsy specimens. Acitretin appeared to provide symptomatic improvement in the short term without any long-term effect on the natural disease course. The genetic and environmental factors involved in disease causation needs to be elucidated in future. TRIAL REGISTRATION: The study was not registered in a trial registry since it was a retrospective analysis of the clinical records and not an interventional/observational study.
Subject(s)
Keratosis/ethnology , Keratosis/pathology , Adult , Child , Extremities , Humans , India , Keratosis/epidemiology , Male , White People , Young AdultABSTRACT
Objective To investigate the expressions of fatty acid-binding protein 5 (FABP5)and dihydroli-poamide dehydrogenase(DLD)in skin lesions of symmetrical acrokeratoderma(SAK), and to explore their significance. Methods Biopsy specimens were obtained from skin lesions on the wrists and perilesional skin of 9 patients with SAK, and from normal skin in the wrists of 9 healthy volunteers (control group). Reverse transcription PCR (RT-PCR)and immunohistochemical staining were performed to measure the expressions of FABP5 and DLD in these specimens. Results RT-PCR showed no significant differences in the mRNA expressions of FABP5 or DLD between lesional, perilesional and normal control skin specimens(both P > 0.05). Immunohistochemically, there was a significant increase in the extent and intensity of staining for FABP5 in SAK lesions. Concretely speaking, FABP5 was strongly expressed in the stratum corneum, granular and spinous layers in SAK lesions, but weakly expressed in the stratum corneum, granular and spinous layers in perilesional skin, and only in spinous and basal layers in normal control skin. The expression of DLD decreased in SAK lesions, and was observed only in the stratum corneum and spinous layer in a few cases of SAK. However, the full-thickness epidermis stained positive for DLD in perilesional skin, with the nuclei and cytoplasm both stained deep brown. Conclusion The overexpression of FABP5 in SAK lesions may participate in dysdifferentiation of keratinocytes, while the down-regulation of DLD expression suggests an imbalance in energy metabolism.
ABSTRACT
BACKGROUND: Symmetrical acrokeratoderma seems to be a new disorder in China, and 138 cases have been reported in the Chinese literature. OBJECTIVE: We sought to summarize the clinicopathologic features and immunophenotyping of inflammatory cells in 34 new cases. METHODS: Clinical data of 34 patients were prospectively collected over 4 years. Histopathology and immunostaining of infiltrated cells were performed in 27 and 9 patients, respectively. RESULTS: Brown to black hyperkeratotic patches were symmetrically distributed over the acral regions in 33 cases and on the scalp in 1 case, with a whitish change after water contact or sweating. The condition was aggravated in summer and alleviated in winter in 33 patients. History of ichthyosis vulgaris was seen in 23 cases. The typical histopathology included epidermal hyperkeratosis, acanthosis, and papillary dermal perivascular infiltrate of lymphohistiocytes. Number of CD3(+), CD4(+), and CD8(+) cells increased in lesional and perilesional skin compared with normal-appearing skin. The skin lesions developed slowly but were confined to the acral predilection sites after the mean follow-up of 25.4 ± 13.8 months. LIMITATIONS: The follow-up time was short. CONCLUSION: This disorder may represent a peculiar dermatosis that is frequently associated with ichthyosis vulgaris. No specific therapy is available for the disorder.