Track: Case Reports

Abstract:

Keratoelastoidosis marginalis of the hands (KEMH) is a rare benign punctate papular keratoderma that is thought to be the result of solar damage and chronic trauma; however, the exact pathogenesis of this process is not completely understood. KEMH is a rare entity that is even more rarely biopsied. We present a case of a 66-year-old female with linear scaly plaques on the lateral and medial surface of the index finger and thumb, respectively. A punch biopsy revealed mild acanthosis with primarily orthohyperkeratosis, areas of parakeratosis and serum crust. No atypia was identified in the epidermis. The dermis demonstrated prominent solar elastosis with areas of thickened and fragmented elastic fibers, and thickened collagen bundles. No inflammatory infiltrates or calcifications were identified. A PAS stain was negative for fungal organisms. The microscopic findings along with the clinical distribution of the lesions led to the diagnosis of KEMH. Though the histologic findings are not specific to KEMH, the distribution of lesions is pathognomonic for KEMH. This case highlights the classical microscopic findings as well as the importance of clinicopathologic correlation to differentiate this rare entity from other papular keratodermas and related disorders.

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John Maize