An Atypical Case of Acrokeratosis Verruciformis of Hopf Responding to Combined Acitretin and Cryotherapy

Abstract

Acrokeratosis verruciformis of Hopf (AKVH) is a rare genetic skin condition associated with an ATP2A2 gene mutation, thus affecting keratinization. Classically, AKVH appears in childhood over acral sites as symmetrical, flat, verruca plana-like lesions with an autosomal dominant inheritance, while sporadic cases affect atypical sites in adulthood. As this entity can closely mimic other verrucous skin conditions, identifying characteristic histopathological changes is essential to make a diagnosis in the absence of genetic studies, especially in resource-poor countries. This is the first reported case of AKVH from North-East India clinically mimicking extensive verruca vulgaris in an adult with a possible sporadic occurrence. AKVH is usually difficult to treat and superficial ablation is the treatment of choice. However, this case highlights the role of cryotherapy with acitretin in the management of AKVH with a rapid response.