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Year : 2000  |  Volume : 66  |  Issue : 2  |  Page : 91-92

Multiple keratoacanthomas of hands simulating discoid lupus erythematosus

Adarsh Chopra, Manjit Kaur, Dimple Chopra 
 

Correspondence Address:
Adarsh Chopra


Abstract

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


How to cite this URL:
Chopra A, Kaur M, Chopra D. Multiple keratoacanthomas of hands simulating discoid lupus erythematosus. Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2019 Oct 22 ];66:91-92
Available from: http://www.ijdvl.com/text.asp?2000/66/2/91/4880


Full Text

 Introduction



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. [1] 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. [3]

 Case Report



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.

 Discussion



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. [3] 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. [4] 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.

References

1Lever WF, Schaumburg-Lever G. Tumors and cysts of the epider­mis. In: Histopathology of the Skin. JB Lippincott Company, Phila­delphia. 7th edition 1990: 523-577.
2Tarnowski WH. Multiple keratoacanthomas. Arch Dermatol 1966; 94: 74-80.
3Rossman 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.
4Ghadially 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.

 

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