Track: Case Reports

Abstract:

Introduction:

Collagenous and elastotic marginal plaques of the hands (CEMPH) is a rare and underrecognized clinicopathologic entity first described in 1960 as “degenerative collagenous plaques of the hands.” It typically presents as slowly progressive, bilateral linear plaques along the radial or ulnar margins of the hands, most often in older adult Caucasian males with a history of chronic sun exposure or manual labor. Histologically, it is characterized by thickened, haphazardly arranged collagen bundles, basophilic elastotic material, and occasional dystrophic calcification in the superficial reticular dermis. While actinic damage and repeated trauma are considered contributory, pathogenesis remains unclear.

Case presentation:

A 32-year-old woman presented with long-standing, slowly progressive scaly plaques on the medial and lateral aspects of both hands, associated with burning and stinging sensations. The patient denied excessive sun exposure, occupational or recreational contact with caustic agents, and any family history of similar conditions. Histopathologic evaluation showed a relatively acellular and avascular upper reticular dermis, replaced by thickened, hyalinized collagen bundles arranged in a disorganized pattern, with some fibers oriented perpendicular to the epidermis. Elastorrhexis was demonstrated with Verhoeff–Van Gieson staining, and calcified collagen bundles were confirmed with Von Kossa stain. These histopathologic findings supported the diagnosis of CEMPH.

Conclusion:

This case illustrates a presentation of CEMPH in a young woman without known environmental or occupational risk factors. It highlights the importance of recognizing this rare and underdiagnosed condition outside its typical demographic context and underscores the diagnostic value of clinicopathologic correlation in evaluating persistent hand plaques.

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Trent Irwin