Acrokeratoelastoidosis of Costa | |
---|---|
Other names | Acrokeratoelastoidosis |
Autosomal dominant is the inheritance manner for this condition | |
Specialty | Dermatology Genetics |
Usual onset | Childhood, adolescence, or early 20s. [1] |
Causes | Genetics |
Acrokeratoelastoidosis of Costa or Acrokeratoelastoidosis is a hereditary form of marginal keratoderma, and can be defined as a palmoplantar keratoderma. It is distinguished by tiny, firm pearly or warty papules on the sides of the hands and, occasionally, the feet. It is less common than the hereditary type of marginal keratoderma, keratoelastoidosis marginalis. [1]
Costa described acrokeratoelastoidosis in 1953, as a result, it is also known as Costa acrokeratoelastoidosis. Acrokeratoelastoidosis is a form of punctate palmoplantar keratoderma type 3 characterized by keratin and elastic tissue abnormalities. [1]
There have been autosomal dominant and sporadic forms observed. Acrokeratoelastoidosis isn't congenital; it develops gradually during puberty, or sometimes afterwards, and then stabilizes. In most cases, no treatment is required. [2]
Acrokeratoelastoidosis typically manifests in children and adolescents, though reports of adult onset exist. [3] Acrokeratoelastoidosis is characterized clinically by clusters of many asymptomatic little, round-to-oval, skin-colored/translucent, or yellowish-firm papules located along the lateral and medial margins of the hands and/or feet. Papules have a keratotic surface that is rough and can range in appearance from crateriform to umbilicated. [2] The posteromedial border of the feet as well as the pre-tibial region have also been reported to be involved. [4] Even though unilateral involvement has been indicated, the lesions are typically bilateral and symmetrical. [5] [6] Plaques can form when the papules merge. [2]
Except for cosmetic disfigurement, lesions are usually asymptomatic in the majority of cases. [7] Mild itchiness, hyperhidrosis, and aquagenic palmoplantar keratoderma are unusual manifestations or associations. [8]
Although there have been isolated instances of rapid development of lesions throughout pregnancy, most lesions stabilize shortly after a couple weeks to months of onset. [9]
Although there have been instances of irregular cases, acrokeratoelastoidosis is thought to be a genodermatosis with autosomal dominant inheritance, though anecdotal reports of an autosomal recessive mode exist. [2] Inherited acrokeratoelastoidosis is classified as a form of inherited punctate palmoplantar keratoderma (PPKP), specifically Type 3 PPKP, according to the classification of palmoplantar keratodermas (PPK). [10] Chromosome 2 appears to be the most likely locus responsible for inherited acrokeratoelastoidosis. [11] The AAGAB gene, which has been linked to type I PPK, has no role in acrokeratoelastoidosis. [12]
The precise pathogenesis is unknown. Although an association of persistent trauma as well as excessive sun exposure has been reported in a few cases, [13] no direct causal relationship has been established. [14]
Despite the fact that lesions usually localized to the extremities dominate the clinical presentation, some workers have reported elastorrhexis. [2] In some patients, the histopathological characteristic of this illness seen in acral papules additionally includes apparently normal-appearing skin. [15] Factors such as repeated trauma could result in a predominance of clinical manifestation associated with the disorder over the palms and soles. [2]
The anecdotal reports of Acrokeratoelastoidosis-like lesions within scleroderma patients stems from the disease's abnormal connective tissue metabolism. [16] Other anecdotal observations with unknown etiology include hyperhidrosis and aquagenic PPK. [9] [8]
The majority of reports to date have implicated a genetic defect involving chromosome 2. [11] Excessive sun exposure as well as chronic trauma have been suggested as potential factors in sporadic cases. [13]
Elastorrhexis is the disorder's histopathophysiological hallmark. Excessive generation and collection of filaggrin in the form of a dense band over the stratum granulosum before it gets incorporated into the matrix of proteins of mature epidermal keratin is believed to lead to the formation of keratotic papules. The presence of unusual dense granules in dermal fibroblasts of the lesions suggests that acrokeratoelastoidosis is the result of abnormal elastic fiber secretion rather than fiber degradation, as the name implies. [17]
Polarized videodermoscopic examination of the affected thumb and index finger areas reveals focal groups of pale-to-yellowish colored papules, some with slight umbilication, scattered with pale yellow-colored structureless areas. [2]
The most common histopathological findings are hyperkeratosis, hypergranulosis, milder acanthosis, collagen homogenization, and changes in the dermal elastic fibers, which are lesser and fragmented (elastorrhexis). Hyperkeratosis can sometimes cause depression in the underlying epithelial planes, resulting in a concavity. In the superficial dermis, there are areas of collagen homogenization with thin elastic and decreased and fragmented fibers. [7]
Conditions considered to be members of the family of marginal and acral keratodermas, as well as other distinct disorders that involve the acral parts with comparable appearing lesions, are included in the differential diagnosis. [2] Involvement of the edge or palmoplantar transition areas characterize marginal keratodermas, and when the dorsum of the hands and feet are involved the keratoderma are called inverse. [18]
Some of the essential differentials include Focal acral hyperkeratosis, which is distinguishable on histopathology due to changes constrained to the epidermis and the lack of elastorrhexis, Keratoelastoidosis marginalis, which is linked to with extreme sun exposure and displays prominent actinic damage. Additional variations of acral keratoderma include hereditary papulotranslucent acrokeratoderma, acrokeratoderma hereditarium punctatum, punctate palmoplantar keratoderma, and other conditions like acrokeratosis verruciformis of Hopf, degenerative collagenous plaques, digital papular calcinosis, verruca plana, primary cutaneous amyloidosis, and mosaic acral keratoderma. [2]
Treatment can be difficult. It is not recommended for the majority of patients. [19] Mild keratolytics, such as salicylic acid, can help on occasion, but recurrences are common. [7] Oral retinoids, particularly acitretin, have been indicated as the most effective treatment; however, relapse after cessation is unavoidable. [9] One patient has benefitted from the erbium:YAG laser. During the 6-month follow-up period, there was no recurrence. [20] Topical retinoids tend to be ineffective. [21]
A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of this system is as a barrier against the external environment.
Palmoplantar keratodermas are a heterogeneous group of disorders characterized by abnormal thickening of the stratum corneum of the palms and soles.
Hyperkeratosis is thickening of the stratum corneum, often associated with the presence of an abnormal quantity of keratin, and also usually accompanied by an increase in the granular layer. As the corneum layer normally varies greatly in thickness in different sites, some experience is needed to assess minor degrees of hyperkeratosis.
Sclerodactyly is a localized thickening and tightness of the skin of the fingers or toes that yields a characteristic claw-like appearance and spindle shape of the affected digits, and renders them immobile or of limited mobility. The thickened, discolored patches of skin are called morphea, and may involve connective tissue below the skin, as well as muscle and other tissues. Sclerodactyly is often preceded by months or even years by Raynaud's phenomenon when it is part of systemic scleroderma.
Meleda disease (MDM) or "mal de Meleda", also called Mljet disease, keratosis palmoplantaris and transgradiens of Siemens, is an extremely rare autosomal recessive congenital skin disorder in which dry, thick patches of skin develop on the soles of the hands and feet, a condition known as palmoplantar hyperkeratosis. Meleda Disease is a skin condition which usually can be identified not long after birth. This is a genetic condition but it is very rare. The hands and feet usually are the first to show signs of the disease but the disease can advance to other parts of the body. Signs of the disease include thickening of the skin, on hands and soles of feet, which can turn red in color. There currently is no cure and treatment is limited, but Acitretin can be used in severe cases.
Pruritic urticarial papules and plaques of pregnancy (PUPPP), known in United Kingdom as polymorphic eruption of pregnancy (PEP), is a chronic hives-like rash that strikes some women during pregnancy. Some skin changes are known to occur in people who are pregnant while other skin conditions, or dermatoses, that people have prior to getting pregnant will become altered or symptoms will increase. Pruritic urticarial papules and plaques of pregnancy (PUPPP) is one of many skin conditions that is specific to pregnancy and occurs in about 1 in every 160 (0.625%) of pregnancies.
Dermatopathia pigmentosa reticularis(DPR) is a rare, autosomal dominant congenital disorder that is a form of ectodermal dysplasia. Dermatopathia pigmentosa reticularis is composed of the triad of generalized reticulate hyperpigmentation, noncicatricial alopecia, and onychodystrophy. DPR is a non life-threatening disease that largely affects the skin, hair, and nails. It has also been identified as a keratin disorder. Historically, as of 1992, only 10 cases had been described in world literature; however, due to recent advances in genetic analysis, five additional families studied in 2006 have been added to the short list of confirmed cases.
Pachyonychia congenita is a rare group of autosomal dominant skin disorders that are caused by a mutation in one of five different keratin genes. Pachyonychia congenita is often associated with thickened toenails, plantar keratoderma, and plantar pain.
Lichen nitidus is a chronic inflammatory disease of unknown cause characterized by 1–2 mm, discrete and uniform, shiny, flat-topped, pale flesh-colored or reddish-brown papules that may appear as hypopigmented against dark skin. Occasionally, minimal scaling is present or can be induced by rubbing the surface of the papules. The disease usually affects children and young adults and is painless and usually nonpruritic, although protracted itching may occur in some cases. It is sometimes referred to by dermatologists as "mini lichen planus".
Parakeratosis is a mode of keratinization characterized by the retention of nuclei in the stratum corneum. In mucous membranes, parakeratosis is normal. In the skin, this process leads to the abnormal replacement of annular squames with nucleated cells. Parakeratosis is associated with the thinning or loss of the granular layer and is usually seen in diseases of increased cell turnover, whether inflammatory or neoplastic. Parakeratosis is seen in the plaques of psoriasis and in dandruff.
Anetoderma is a benign but uncommon disorder that causes localized areas of flaccid or herniated sac-like skin due to a focal reduction of dermal elastic tissue. Anetoderma is subclassified as primary anetoderma, secondary anetoderma, iatrogenic anetoderma of prematurity, congenital anetoderma, familial anetoderma, and drug-induced anetoderma.
Kyrle disease is identified as a form of an acquired perforating disease. Other major perforating diseases are elastosis perforans serpiginosa and reactive perforating collagenosis. Recently, however, there is a controversy on categorizing Kyrle disease with perforating dermatosis or a subtype of acquired perforating collagenosis.
Eccrine angiomatous hamartoma (EAH), first described by Lotzbeck in 1859, is a rare benign vascular hamartoma characterized histologically by a proliferation of eccrine and vascular components. EAH exists on a spectrum of cutaneous tumors that include eccrine nevus, mucinous eccrine nevus and EAH. Each diagnostic subtype is characterized by an increase in the number as well as size of mature eccrine glands or ducts, with EAH being distinguished by the added vascular component.
Acrokeratosis verruciformis is a rare autosomal dominant disorder appearing at birth or in early childhood, characterized by skin lesions that are small, verrucous, flat papules resembling warts along with palmoplantar punctate keratoses and pits. However sporadic forms, whose less than 10 cases have been reported, presents at a later age, usually after the first decade and generally lack palmoplantar keratoses. Whether acrokeratosis verruciformis and Darier disease are related or distinct entities has been controversial, like Darier's disease, it is associated with defects in the ATP2A2 gene. however the specific mutations found in the ATP2A2 gene in acrokeratosis verruciformis have never been found in Darier's disease.
Adrenergic urticaria is a skin condition characterized by an eruption consisting of small (1-5mm) red macules and papules with a pale halo, appearing within 10 to 15 min after emotional upset. There have been 10 cases described in medical literature, and involve a trigger followed by a rise in catecholamine and IgE. Treatment involves propranolol and trigger avoidance.
Acral persistent papular mucinosis (APPM) is a rare form of lichen myxedematosus. It is characterized by small papules on the backs of the hands, wrists, and extensor aspects of the distal forearms, with no further clinical or laboratory indications. Lesions tend to persist and may grow in number gradually. Because there are no symptoms, treatment is rarely required.
Granuloma multiforme is a cutaneous condition most commonly seen in central Africa, and rarely elsewhere, characterized by skin lesions that are on the upper trunk and arms in sun-exposed areas. It may be confused with tuberculoid leprosy, with which it has clinical similarities. The condition was first noted by Gosset in the 1940s, but it was not until 1964 that Leiker coined the term to describe "a disease resembling leprosy" in his study in Nigeria.
Howel–Evans syndrome is an extremely rare condition involving thickening of the skin in the palms of the hands and the soles of the feet (hyperkeratosis). This familial disease is associated with a high lifetime risk of esophageal cancer. For this reason, it is sometimes known as tylosis with oesophageal cancer (TOC).
Palmoplantar keratoderma with deafness, also known as Palmoplantar keratoderma-deafness syndrome is a rare genetic disorder which is characterized by either focal or diffuse early-onset palmoplantar keratoderma and sensorineural deafness. Transmission is autosomal dominant with incomplete penetrance.