Acral fibrokeratoma, also known as an acquired digital fibrokeratoma, and acquired periungual fibrokeratomaFreedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. . is a skin lesion characterized by a pinkish,

hyperkeratotic Hyperkeratosis is thickening of the stratum corneum (the outermost layer of the Epidermis (skin), epidermis, or skin), often associated with the presence of an abnormal quantity of keratin,Kumar, Vinay; Fausto, Nelso; Abbas, Abul (2004) ''Robbins ...

, hornlike projection occurring on a

finger A finger is a prominent digit (anatomy), digit on the forelimbs of most tetrapod vertebrate animals, especially those with prehensile extremities (i.e. hands) such as humans and other primates. Most tetrapods have five digits (dactyly, pentadact ...

toe Toes are the digits of the foot of a tetrapod. Animal species such as cats that walk on their toes are described as being ''digitigrade''. Humans, and other animals that walk on the soles of their feet, are described as being ''plantigrade''; ...

, or

palm Palm most commonly refers to: * Palm of the hand, the central region of the front of the hand * Palm plants, of family Arecaceae ** List of Arecaceae genera **Palm oil * Several other plants known as "palm" Palm or Palms may also refer to: Music ...

.James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. .

Signs and symptoms

Acral fibrokeratoma typically manifest as a non-symptomatic protuberance that does not go away on its own. In a clinical setting, it manifests as a single, well-defined, skin-colored

papule A papule is a small, well-defined bump in the skin lesion, skin. It may have a rounded, pointed or flat top, and may have a umbilication, dip. It can appear with a Peduncle (anatomy), stalk, be thread-like or look warty. It can be soft or firm a ...

with a distinctive

collarette at the base. Though it can also be found in other places like the lower lip, nose, elbow, pre-patellar region, and periungual tissue, it mostly affects the fingers and toes. Usually, the lesion is smaller than 1 cm, however reports of acral fibrokeratomas larger than 1 cm, known as giant acral fibrokeratomas, have been made.

Causes

Although the exact cause of acral fibrokeratoma is unknown, prolonged irritation or trauma, particularly in the acral regions, have been suggested as potential contributing factors. In particular, it is thought that acral fibrokeratoma is exacerbated by recurrent trauma to the same location. This explains why the more frequently damaged areas are the acral regions, which are prone to severe trauma daily.

Diagnosis

The histopathologic examination of acral fibrokeratoma usually shows

hyperkeratosis Hyperkeratosis is thickening of the stratum corneum (the outermost layer of the epidermis, or skin), often associated with the presence of an abnormal quantity of keratin,Kumar, Vinay; Fausto, Nelso; Abbas, Abul (2004) ''Robbins & Cotran Pathol ...

and uneven acanthosis in the epidermis; dense, interwoven

collagen Collagen () is the main structural protein in the extracellular matrix of the connective tissues of many animals. It is the most abundant protein in mammals, making up 25% to 35% of protein content. Amino acids are bound together to form a trip ...

bundles with dilated

capillaries A capillary is a small blood vessel, from 5 to 10 micrometres in diameter, and is part of the microcirculation system. Capillaries are microvessels and the smallest blood vessels in the body. They are composed of only the tunica intima (the in ...

primarily oriented along the lesion's long axis comprise the lesion's core.

Treatment

There are reports of several treatment options for acral fibrokeratoma, including

curettage Curettage ( or ), in medical procedures, is the use of a curette (French, meaning "scoop" Mosby's Medical, Nursing & Allied Health Dictionary, Fourth Edition, Mosby-Year Book 1994, p. 422) to remove tissue by scraping or scooping. Curettages ...

cauterization Cauterization (or cauterisation, or cautery) is a medical practice or technique of burning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate bleeding and damage, remove an undesired growth, o ...

, shave excision, and

cryotherapy Cryotherapy, sometimes known as cold therapy, is the local or general use of low temperatures in medical therapy. Cryotherapy can be used in many ways, including whole body exposure for therapeutic health benefits or may be used locally to treat ...

. Nonetheless, surgical excision is regarded as the principal and most successful form of treatment.

References

External links

VisualDx

{{Soft tissue tumors and sarcomas Dermal and subcutaneous growths Conditions of the skin appendages