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Dermoscopy of acrokeratosis verruciformis of Hopf

1 Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
2 Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Date of Submission30-Nov-2019
Date of Decision20-Jan-2020
Date of Acceptance06-Mar-2020
Date of Web Publication19-Sep-2020

Correspondence Address:
Anupama Bains,
Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur - 342 001, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/idoj.IDOJ_598_19

How to cite this URL:
Rajan M B, Bains A, Vedant D. Dermoscopy of acrokeratosis verruciformis of Hopf. Indian Dermatol Online J [Epub ahead of print] [cited 2021 Jan 26]. Available from: https://www.idoj.in/preprintarticle.asp?id=295473

Dear Editor,

A 21-year-old female presented with multiple asymptomatic brown colored papules symmetrically distributed over dorsum of hands and feet [Figure 1]a and [Figure 1]b. She also had multiple brownish greasy papules over face and trunk along with longitudinal erythronychia in finger nails. Dermoscopy of the acral papules showed central white homogenous areas, central white network, peripheral cobble stone appearance, multiple brown-colored pigment dots arranged radially in the periphery (Sun-ray appearance) and regularly arranged brown dots with background erythema in the nonlesional skin [Figure 2]a and [Figure 2]b. Histopathology was suggestive of Darier's disease [Figure 3].
Figure 1: (a) Multiple brown colored flat papules over dorsum of both hands. (b) Multiple brown colored flat papules over dorsum of both feet

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Figure 2: (a) Dermoscopic image of dorsum of hand showing papule with central homogenous areas (black arrow), central white network (red arrow) and peripheral cobble stone appearance (blue arrow) (Dermlite™ DL4, 3Gen Inc., San Juan Capistrano, CA; 10× magnification; polarized mode). (b) Dermoscopic image of dorsum of feet showing brown colored pigment dots forming sun-ray appearance in the periphery of lesions (Black arrow) with regularly arranged brownish dots with background erythema in nonlesional skin (Red arrow) (Dermlite™ DL4, 3Gen Inc., San Juan Capistrano, CA; 10× magnification; polarized mode)

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Figure 3: Photomicrograph showing oblique section with basket weave hyperkeratosis, irregular acanthosis, multiple suprabasal clefts (Black arrow), along with acantholytic and dyskeratotic cells (Red arrow) (H and E stain, ×400)

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Acrokeratosis verruciformis of Hopf (AKV) is characterized by symmetrically distributed flat papules over acral sites.[1] It is commonly associated with Darier's disease. Sporadic cases are also reported in literature and it often creates diagnostic dilemma with other conditions having similar clinical presentation viz. lichen planus, verruca plana, seborrheic keratosis.[2] Although histopathological examination is the gold standard to differentiate these conditions, dermoscopy has its own value in differentiating these clinical entities [Table 1].[2],[3],[4],[5] Behera et al. described dermoscopic findings of AKV and did histopathological correlation; central white homogenous area and peripheral cobblestone appearance – broad band of hyperkeratosis and acanthosis.[2] Since we did not perform biopsy in nonlesional skin, it is difficult to ascertain the histopathological correlate for brown dots. The possible reasons may be accentuation of pre-existing pigment network or subclinical dyskeratotic acantholysis, warrants further research. Sunray appearance was noticed only in large mature lesions due to their stretching effect, causing superimposition of peripheral brown dots. Our observations of sunray appearance and nonlesional brown dots did not get attention in previous literature. Since these are not reported in other conditions with acral papules, these findings may have additional diagnostic value in differentiation of AKV.
Table 1: Dermoscopic features of clinical entities presenting as flat topped acral papules

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Agrawal SN, Jane SD, Rawal AA. Acrokeratosis verruciformis of Hopf in family. Indian Dermatol Online J 2014;5:17-9.  Back to cited text no. 1
  [Full text]  
Behera B, Prabhakaran N, Naveed S, Kumari R, Thappa DM, Gochhait D. Dermoscopy of acrokeratosis verruciformis of Hopf. J Am Acad Dermatol 2017;77:e33-5.  Back to cited text no. 2
Gungor S, Topal IO, Goncu EK. Dermoscopic patterns in active and regressive lichen planus and lichen planus variants: A morphological study. Dermatol Pract Concept 2015;5:45-53.  Back to cited text no. 3
Kim WJ, Lee WK, Song M, Kim HS, Ko HC, Kim BS, et al. Clinical clues for differential diagnosis between verruca plana and verruca plana-like seborrheic keratosis. J Dermatol 2015;42:373-7.  Back to cited text no. 4
Senel E. Dermatoscopy of non-melanocytic skin tumors. Indian J Dermatol Venereol Leprol 2011;77:16-22.  Back to cited text no. 5
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