Unilateral Spiny Hyperkeratosis

Abstract

We describe the first case of unilateral spiny hyperkeratosis (SH) of the left hand, review the literature and discuss possible patho- mechanisms. SH can be sporadic or familial, often appearing in healthy individuals. However, there is an association with various malignancies in a significant number of the sporadic cases. Although there is no satisfactory explanation of this association, we agree with previous authors that a patient with SH appearing in adult life should be evaluated and followed for the presence of malignancy. Other patients with SH may suffer from a variety of nonmalignant diseases, which may be coincidental or causally related. SH is not a premalignant lesion of the skin and should not be confused with porokeratosis which has a malignant potential. Except for excision of individual lesions, there is no permanent cure.

Two Case Reports of Columnar Dyskeratosis, an Unusual Keratinisation Disorder

“…5). This condition is characterised by a depressed area with a spike-like orthoparakeratotic column above it [15]. In some of the keratinocytes, a perinuclear halo is present.…”

Spiny acral hyperkeratosis in coincidence with malignant melanoma

“…Remarkably, almost one‐third of affected patients also have malignant disease or develop it later. Malignancies associated with SH include leukaemia and carcinomas of the breast, bronchus, rectosigmoid, kidney, oesophagus, ovary or larynx 2,3,6,7 . MM plus SH has only been reported once before, to our knowledge 6 …”

“…SH localized to the chest, arms and legs were first described in 1967, and a variant restricted to the palms and soles was named ‘punctate keratoderma’ in 1971 1 . Since then, approximately 60 cases have been reported with similar keratotic projections: 38 with restriction to the palms and soles, 21 with sparing of the acral skin, and 1 with involvement of both acral and proximal skin 2,3 . Although the clinical presentation is quite consistent, the nomenclature is not, comprising terms such as ‘multiple minute digitate hyperkeratosis’, ‘palmar filiform parakeratotic hyperkeratosis’, ‘keratosis punctata palmoplantaris’ and ‘punctate porokeratotic keratoderma’ 4 .…”

“…The authors speculated that the underlying genetic defect of the keratodermas might contribute to malignant transformation. Furthermore, SH has been reported as a comorbidity of several systemic diseases such as diabetes mellitus, hyperlipoproteinaemia, cardiovascular disease, kidney or liver cysts, asthma, peptic ulcer, gout, myelofibrosis and Crohn’s disease, although at least some of these coincidences are likely to be purely chance, considering the high prevalence of many of these conditions 2,3 …”

Spiny keratoderma of the palms and soles – once seen, never forgotten

“…Our patient had a history of asbestosis, diabetes, and progressive renal dysfunction. The reported correlation between the acquired entity and underlying chronic diseases or malignancies is still unclear [ 7 ] , and might also be due to the fact that the likelihood of developing chronic diseases or malignancies is generally higher in patients above the age of 50. Nevertheless, patients with the acquired form should undergo thorough malignancy screening at the time of diagnosis, as well as during follow-up visits to be scheduled at regular, age-appropriate intervals.…”