Indian Dermatology Online Journal

: 2021  |  Volume : 12  |  Issue : 2  |  Page : 374--375

Dermoscopy of acrokeratosis verruciformis of hopf

M Bandhala Rajan1, Anupama Bains1, Deepak Vedant2,  
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

Correspondence Address:
Anupama Bains
Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur - 342 001, Rajasthan

How to cite this article:
Rajan M B, Bains A, Vedant D. Dermoscopy of acrokeratosis verruciformis of hopf.Indian Dermatol Online J 2021;12:374-375

How to cite this URL:
Rajan M B, Bains A, Vedant D. Dermoscopy of acrokeratosis verruciformis of hopf. Indian Dermatol Online J [serial online] 2021 [cited 2022 Jan 18 ];12:374-375
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Full Text

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}{Figure 2}{Figure 3}

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}

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