“I forgot to shave my hands”: A case of spiny keratoderma

Abstract

A 57 year old Caucasian man presented with multiple asymptomatic spiny papules on the palms and soles that he had been shaving off with a razor for many years. He was otherwise healthy with no personal or family history of skin disease or malignancy. A diagnosis of spiny keratoderma of the palms and soles or "music box spine dermatosis" was made. The clinical, histologic, and electron microscopic features of spiny keratoderma are distinct. This entity previously had multiple classifications and it is important to distinguish it from other keratodermas as some keratodermas can be linked to cutaneous and internal malignancies and conditions: poly cystic kidney disease, liver cysts, Darier's disease, and hyperlipoproteinemia among others. Spiny keratodermas can have systemic associations and do not resolve spontaneously. Treatment is generally ineffective.

Multiple Keratotic Papules on the Palm and Fingers

“…2,3 Some cases of the acquired form of the disease have an association with internal malignancies (bronchial, renal, rectal, breast carcinoma, and melanoma). The hereditary form develops between 12 and 50 years of age, whereas the acquired/idiopathic cases normally affect patients older than 50 years.…”

“…The hereditary form develops between 12 and 50 years of age, whereas the acquired/idiopathic cases normally affect patients older than 50 years. 2 The etiopathogenesis of spiny keratoderma is not entirely clear. 2,3 Some cases of the acquired form of the disease have an association with internal malignancies (bronchial, renal, rectal, breast carcinoma, and melanoma).…”

“…2 The filiform and spiny nature of the keratosis is typical of spiny keratoderma and readily distinguishes it from most of the clinical entities listed above. 2 The filiform and spiny nature of the keratosis is typical of spiny keratoderma and readily distinguishes it from most of the clinical entities listed above.…”

“…2 The filiform and spiny nature of the keratosis is typical of spiny keratoderma and readily distinguishes it from most of the clinical entities listed above. 2,7 Recurrence is common after cessation of therapy but mechanical debridement can provide long-term benefits. Distinction from porokeratosis is particularly important, considering its potential association with squamous cell carcinoma.…”

Unilateral punctate porokeratosis - Case report

“…9 Moreover, although some reports point to a link with cancer this has not been conclusively established. 10 While some lesions of the palms and soles may be spiny in PP, underlying keratinocyte changes (vacuolation and dyskeratosis) target a correct diagnosis.…”