Palmar filiform hyperkeratosis (FH) associated with underlying pathology?

Abstract

We describe two patients with palmar filiform hyperkeratosis, characterized by multiple thin spiny keratotic projections on the palms. The condition has been associated with an underlying malignancy in some cases. One patient has myelofibrosis, an association not previously described. In addition we describe a further patient with filiform hyperkeratoses of both palms and soles with no associated underlying disorder. In view of the relatively high risk of underlying malignancy occurring in patients with filiform hyperkeratosis, these patients should always be investigated fully.

Spiny keratoderma: case series and review

“…23 Of the three affected family members in a case from Japan, one also had esophageal malignancy and liver cirrhosis. 8 As expected the keratotic spines generally recur with cessation of treatment. 6 20,29 and systemic agents such as acitretin 25 mg daily.…”

“…[1][2][3] Numerous terms have been used to describe this clinical presentation including punctate porokeratotic keratoderma, 4,5 music box spine dermatosis, 4 multiple minute palmarplantar digitate hyperkeratoses, 5 palmar filiform parakeratotic hyperkeratosis, 6 and filiform hyperkeratosis. 7,8 The name 'spiny keratoderma' however is preferred for a number of reasons. The condition is not porokeratotic pathogenetically, the phrase 'music box spine' is no longer widely used, 'multiple minute palmar-plantar digitate hyperkeratosis' may be confused with the generalized 'multiple minute digitate hyperkeratosis' disorder, and 'filiform hyperkeratosis' may also refer to a generalized digitate keratosis.…”

Unilateral Spiny Hyperkeratosis

“…We were able to find 43 subsequent reports in the literature describing 59 cases with similar keratotic projections, without adnexal involvement [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44]. These were variously characterized as punctate, filiform, spiny, digitate, acuminate, porokeratotic or music box spine lesions.…”

Music box spine keratoderma without any systemic manifestation

“…Familial cases and the association with different malignancies such as lung, bronchial, renal, colon, or esophageal cancers were also reported. [4] Melanoma and chronic lymphatic leukemia, dyslipidemia, renal cysts, and myelofibrosis[5] were also found. However, no such association with other diseases was found in our patient.…”