|Year : 2000 | Volume
| Issue : 2 | Page : 91-92
Multiple keratoacanthomas of hands simulating discoid lupus erythematosus
Adarsh Chopra, Manjit Kaur, Dimple Chopra
A 38-year-old woman presented with multiple, well-defined, erythematous, scaly, slightly painful nodules progressing to plaques on the palms, dorsa of fingers of both hands since 6 years. Healed lesions had well-defined hyperpigmented margins with slight central atrophy. Clinical diagnosis of discoid lupus erythematosus was made, but histopatholgoy confirmed the diagnosis of keratoacanthomas
|How to cite this article:|
Chopra A, Kaur M, Chopra D. Multiple keratoacanthomas of hands simulating discoid lupus erythematosus.Indian J Dermatol Venereol Leprol 2000;66:91-92
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Chopra A, Kaur M, Chopra D. Multiple keratoacanthomas of hands simulating discoid lupus erythematosus. Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2019 Jul 20 ];66:91-92
Available from: http://www.ijdvl.com/text.asp?2000/66/2/91/4880
Multiple keratoacanthomas are rare as compared to solitary keratoacanthomas. There are two variants of multiple keratoacanthomas - the multiple self healing epitheliomas of the skin or Ferguson - Smith type, and the eruptive keratoacanthomas or Grzybowski type. Multiple self-healing keratoacanthomas usually occur on face and extremities but it can occur on any part of the body including mucous membranes, palms and soles.  Generally there are no more than a dozen lesions at any one time. Keratoacanthomas reach their full size within 6 to 8 weeks and then involute spontaneously but slowly in less than 6 months. Healing take place with slightly depressed scars. 
A 38-year-old woman presented with 6 years' history of spontaneous eruption of multiple, well defined, slightly erythematous, scaly nodules to plaques of variable sizes over both the palms and dorsa of fingers. Each lesion started as a small nodule which slowly increased in size and developed into scaly plaques in one to two months time and.persisted for 2-3 months and then involuted slowly but spontaneously leaving an area with hyperpigmented border and central atrophy [Figure 1]. New lesions continued to appear on her finger creases and palms.
The lesions were painful and interfered with her work. At the time of presentation healed as well as active lesions were present. There was history of photosensitivity, otherwise there was no history of fever, joint pains, Raynaud's phenomenon or any seasonal variations. On physical and systemic examination no abnormality was detected except mild anaemia. Patient was a manual worker (Floor sweeping and utensil cleaning). There was no similar family history. Clinically, possibility of discoid lupus erythematosus of palms was considered and biopsy was taken from the border of active lesion.
Investigations revealed that her haemoglobin was low as 8.5 gm%. Other investigations including total and differential leukocyte counts, complete urinalysis, fasting blood sugar, blood urea, serum creatinine, total and differential serum proteins were all within normal limits. ESR was 40 mm in 1st hour. X-ray chest and hands were normal.
Report of biopsy stained with haematoxylin and esosin under light microscopy revealed a keratin filled invagination of the epidermis. The epidermis was acanthotic and strands of epidermis were protruding into the dermis. At places the epidermal strands were poorly differentiated from the surrounding stroma. The epidermis in some areas was giving a glassy, eosinophlic appearance. Dyskeratotic cells showing individual cell keratinization were present. Extensive lichenoid infiltrate was present at dermoepidermal junction and around sweat glands. Histopathological diagnosis of multiple self healing keratoacanthomas was made.
Robert et al (1964) reported a woman patient with the rare eruptive variant of multiple keratoacanthomas over face, scalp, shoulders, anterior chest with lesions on the palms, soles and in the larynx.  In multiple, as in solitary keratoacanthomas, lesions arising in hair bearing parts of the skin have their onset in the upper portion of hair follicle. The evolution and regression of these tumours parallel the known cyclic behaviour of hair follicle, and accounts for the "self healing" propensity of keratoacanthomas. The sites of origin of lesions arising on the palms, the soles, and the mucous membranes is not apparent' but sunlight and mechanical trauma is considered as one of the aetiological factor.  In our patient there was strong positive history of photosensitivity and she was a manual worker. For her livelihood she used to sweep and clean the floors and utensils in many houses. This mechanical trauma may be the precipitating cause in our patient. We report this case because of its rare isolated presentation over palms and fingers only.
|1||Lever WF, Schaumburg-Lever G. Tumors and cysts of the epidermis. In: Histopathology of the Skin. JB Lippincott Company, Philadelphia. 7th edition 1990: 523-577.|
|2||Tarnowski WH. Multiple keratoacanthomas. Arch Dermatol 1966; 94: 74-80.|
|3||Rossman RE, Freeman RG, Knox JM, et al. Multiple keratoacanthomas: a case study of the eruptive type with observations on pathogenesis. Arch Dermatol 1964; 89 : 374-381.|
|4||Ghadially FN. Keratoacanthoma. In: Fitzpatrick TB, Eisen AZ, Walff K, Freedberg IM, Austen KF eds. Dermatology in General Medicine. McGraw-Hill Company, New York, 1987: 766-772.|