Circumscribed acral hypokeratosis: A benign localized lesion in the palm

Circumscribed acral hypokeratosis is a benign entity, usually presenting in middle-aged women, over the thenar or hypothenar eminences (less frequently in the soles) as an asymptomatic depressed pink plaque with well-defined borders [Figure 1].¹ Dermoscopy shows regularly distributed white dots (which we have described as rosettes) which appear to correspond to the acrosyringium [Figure 2].² Histologic examination shows an abrupt stair-like thinning of the horny layer. Although no clear etiology has been determined for circumscribed acral hypokeratosis, it has been proposed to be a localized acquired genodermatosis of keratinocytes secondary to repeated trauma or other noxious exposition.^3,4 Even though it is usually benign in its course, there are a few reports of premalignant transformation in the elderly.⁵ Treatment options in such cases include cryotherapy, topical fluorouracil or calcipotriol, ablative laser or surgery, with variable results.^3,4 Circumscribed acral hypokeratosis is an underdiagnosed dermatosis and it should be included in the differential diagnosis of well-defined erosive lesions of the palms and the soles.

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Figure 1:

Circumscribed acral hypokeratosis: depressed pink plaque with well-defined borders

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Figure 2:

Circumscribed acral hypokeratosis: regularly distributed white rosettes in a pink background (Dermlite DL200 HR polarized light mode, ×10)

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