Dermoscopy of Acrokeratosis Verruciformis of Hopf

Acrokeratosis verruciformis of Hopf: Dermoscopic approach in lighter phototypes

“…Dear Editor, I read with great interest the paper by Llamas-Molina et al, 1 who described dermoscopic findings of acrokeratosis verruciformis of Hopf (AKVH) in a dark-skinned patient having a Fitzpatrick phototype VI. The authors emphasized that their report is the first dermoscopic description of such a condition in black skin, yet all the instances available in the literature so far deal with dark-skinned patients, with reported phototypes being IV and V. [2][3][4] On the other hand, no description about dermoscopy of AKVH in lighter phototypes (I-III) is reported. This might be relevant as it is well-known that dermoscopic patterns of non-neoplastic dermatoses may significantly differ when comparing fair and dark skin rather than in the context of these two groups of skin tones.…”

“…Although this case shares the presence of a white background with previous instances, no other findings described in the previous four cases were observed, including white lines/network, whitish-yellowish septae, desquamation, dotted vessels within reticulation, cobblestone appearance and brown dots arranged radially at the periphery. [1][2][3][4] Such differences are due to the different reaction patterns typical of darkskinned patients, including a higher tendency to pigmentary reactions and thickening of epidermal layers (e.g. hyperkeratosis, hypergranulosis and acanthosis) which might give rise F I G U R E 1 Clinical examination shows non-confluent, whitish, flat papules with well-demarcated margins on the dorsal aspect of the right hand (a); dermoscopy (polarized hand-held dermoscope-×10 magnification) reveals a homogeneous white background with loss of physiological skin creases (b).…”