Multiple scrotal epidermolytic acanthomas; secondary to trauma?

Abstract

Epidermolytic hyperkeratosis (EH) is an abnormality of epidermal maturation, most commonly due to mutations in keratins 1 and 10, which may be a congenital or an acquired defect. The term epidermolytic acanthoma was applied to a solitary discrete epidermal proliferation characterized by EH. Subsequently there have been several reports of disseminated epidermolytic acanthomas. We report a rare case of multiple epidermolytic acanthomas localized to the scrotum. With the aetiology of epidermolytic acanthoma unknown, trauma has been postulated as a possible cause. Our patient repetitively scratched his scrotum for 5 years and we believe that this action triggered his multiple scrotal epidermolytic acanthomas.

Solitary epidermolytic acanthoma: a clinical and histopathological study

“…Underlying implicated factors include ultraviolet radiation, immunosuppression, trauma, altered keratin expression and viral infection 14,16–20 . Association of EA with the former three factors has been described in anecdotal case reports 14,16,17,20 . Similar to bullous ichthyosiform erythroderma, which is characterized by decreased expression of keratins 1 and 10 secondary to genetic mutations, an immunohistochemical study on five solitary EAs demonstrated an abnormality in the expression of keratins 1 and 10 in lesional skin compared to adjacent normal skin 3,18 .…”

“…The etiopathogenesis of EA is not clear. Underlying implicated factors include ultraviolet radiation, immunosuppression, trauma, altered keratin expression and viral infection 14,16–20 . Association of EA with the former three factors has been described in anecdotal case reports 14,16,17,20 .…”

Linear epidermolytic acanthoma of vulva: An unusual presentation

“…These mutations could be induced by numerous factors as UV radiation through intense sun exposure, [3] immunosuppression [4] or repeated trauma. [5,8] Electron microscopy demonstrates that the mechanism of blister formation is cytolysis rather than acantholysis. [7] Attempts to isolate human papilloma virus DNA, in biopsies of EA cases, have been negative.…”

“…[2] The term EA is applied to discrete epidermal proliferations characterized by EH. EA has been described in different locations, namely eyelid, leg, anus, [2] abdomen, [3] back, [4] forearm, [4] scrotum [5] and the vulval region. [6,7] In a majority of the reports, the lesions are solitary, but multiple lesions have also been described, especially in the scrotum [5] and vulva.…”

“…EA has been described in different locations, namely eyelid, leg, anus, [2] abdomen, [3] back, [4] forearm, [4] scrotum [5] and the vulval region. [6,7] In a majority of the reports, the lesions are solitary, but multiple lesions have also been described, especially in the scrotum [5] and vulva. [6] Disseminated lesions have also been well documented, [3,4] especially in one patient associated with underlying immunosuppression due to kidney transplantation [4] where up to 100 lesions were present.…”