Multiple minute digitate hyperkeratoses associated with paraproteinaemia

Abstract

An 87 year old woman with dementia presented with multiple digitate hyperkeratoses on her face, limbs and chest. She had a previous diagnosis of a paraproteinaemia, with a serum monoclonal band of immunoglobulin G-kappa and anaemia being detected. The skin biopsy of these hyperkeratotic lesions was characterized by multiple areas of orthokeratosis with immunoglobulin deposition. There was no association with hair follicles. These multiple digitate hyperkeratoses have been associated with underlying systemic disorders including malignancies.

Multiple minute digitate hyperkeratosis: A proposed algorithm for the digitate keratoses

“…Treatments have not been reported in the literature. We favor the term ''postirradiation digitate keratosis'' over the synonymous terms presented in Table I, as this was the term first used when described by Burns 35 in 1986. Hyperkeratotic spicules [39][40][41][42][43][44][45][46][47] are follicular or nonfollicular digitate keratoses of the face (nose in particular), and may also involve the scalp, trunk, and limbs. They are often associated with paraproteinemia, multiple myeloma, and cryoglobulinemia, but may be idiopathic.…”

Diagnosis of Common Dermopathies in Dialysis Patients: A Review and Update

“…Follicular hyperkeratosis is overproliferation of keratin in the hair follicles. There are many different types of follicular hyperkeratosis, such as familial, sporadic, malignancy associated, postinflammatory, postirradiation; however, it may be challenging to distinguish between these types both clinically and histologically (27). It is also difficult to attribute one histological form of hyperkeratosis to ESRD.…”

“…It is also difficult to attribute one histological form of hyperkeratosis to ESRD. Non‐neoplastic follicular hyperkeratosis is often associated with renal failure (27).…”

Eruptive ulcerative follicular spicules heralding progression of smoldering multiple myeloma

“…To the best of our knowledge, a total of 23 patients—including ours—(18 males, 5 females) have been described to date (Table ) . The eruption preceded the diagnosis of MM in 12/23 patients, while in seven patients—including ours—it heralded the progression or relapse of the plasma cell disorder . The temporal relationship between the dermatosis and the hematological disorder was not specified in four reports .…”