Spiny keratoderma: a common under-reported dermatosis

Spiny keratoderma: Report of three cases

BACKGROUND

Spiny keratoderma shows "music box spine" keratotic papules limited to the palms and soles and these lesions do not cause any trouble besides the cosmetic impairment and the sensation of roughness of hands and soles.

AIM

To present cases and review the literature on spiny keratoderma.

PATIENTS/METHODS, RESULTS

Three cases of spiny keratoderma are presented. The first case is a 52-year-old man with protein S deficiency presented with multiple spiny keratotic papules on palms and soles for more than 30 years, referring to remove them with a razor blade. The second case is an 84-year-old man who was hospitalized due to a rectal adenocarcinoma diagnosed 2 months before and presented multiples papules on palms and soles that were present for more than 50 years, with worsening after being bedridden. The third case is a 59-year-old woman who had since birth together with relatives the same type of spiny keratotic papules on palms and soles.

CONCLUSION

The authors discuss the epidemiologic data and differential diagnosis of spiny keratoderma, as well as the related literature. Associations with systemic disease or malignancy occur in some acquired cases. It is important to distinguish from other palmoplantar keratodermas as some of that can be linked to cutaneous and internal malignancies. To date, no cases of spiny keratoderma in patients with protein S deficiency and only one case of association with rectal carcinoma have been reported.

Spiny keratoderma: case series and review

BACKGROUND

Spiny keratoderma is a rare, possibly under-reported, condition characterized by discrete keratotic plugs arising from the palms, soles, or both. It has been associated with malignancies though there is debate as to whether spiny keratoderma is a true paraneoplastic phenomenon. It has also been linked to a variety of non-neoplastic conditions, and several cases appear to be familial.

METHODS

We describe two additional cases of this rare entity and review the literature.

RESULTS

Thirty-seven cases of spiny keratoderma, including ours, have been reported in the literature. Average age at presentation was 63 years. Earliest age of onset was 11 months. A variety of ethnicities were represented. Ten cases were associated with malignancies. Six cases appeared to be inherited in an autosomal dominant fashion. Several cases were reported in healthy individuals as an incidental finding though it is possible that an associated malignancy or systemic disease will declare itself with time. Treatment is generally unsatisfying with keratotic spines often recurring on cessation. Interestingly, in some patients, the spines resolve after treatment of an underlying malignancy.

CONCLUSIONS

This small case series provides an opportunity to revisit the fascinating phenomena of spiny keratoderma, its possible associations, and implications for follow-up. Due to the association with cancer, all patients presenting with spiny keratoderma should undergo baseline age-appropriate malignancy screening, thence 1-2 times yearly, or as symptoms arise.

[Spiny hyperkeratosis of the palms and soles]

Spiny hyperkeratosis of the palms and soles is a rare dermatosis presenting as multiple tiny keratotic plugs on the palms and soles. There are two different forms of spiny keratoderma of the palms and soles - the hereditary form and the acquired form. The latter is usually associated with internal malignancies or systemic disease. Since spiny hyperkeratosis of the palms and soles has been under-reported and under-diagnosed, it is important for dermatologists not to forget this disease in daily practice. We report this rare disease for the first time in the German literature.

Statins in dermatology

Statins are competitive inhibitors of 3-hydroxy-3-methylyglutaryl-coenzyme A reductase and reduce low-density lipoprotein-C levels. Statins are well-tolerated drugs used for prevention of atherosclerosis and cardiovascular events. Statins possess anti-inflammatory, immunomodulatory, antioxidant, metabolic, and possible anticancer effects. Statins are reported to be effective against psoriasis, dermatitis, graft-versus-host disease, uremic pruritus, vitiligo, and hirsutism. Topical forms of statins are employed in the treatment of acne, seborrhea, rosacea, and rhinophyma. Animal studies show the beneficial effect of statins against contact dermatitis and wound healing. They have promising anti-HIV effects as well. This article succinctly reviews the various cellular and molecular effects of statins, their applications in cutaneous medicine and their side effects.

[Spiny keratoderma of the palms: a case study]

Spiny keratoderma of the palms is an infrequent entity of unknown etiology. Most of the cases described are acquired, but there are also family cases. This dermatosis is characterized by the appearance of hyperkeratotic, generally asymptomatic, projections on the palms and/or soles, measuring only a few millimeters. In the histological study, parakeratotic columns of cornoid lamellae were observed on an epidermis with a thin or absent granular layer. Its association with malignant tumor pathologies of different types has been described. We present a new case of this entity, which had the peculiarity of a relationship of the parakeratotic column with the acrosyringium in some histological sections, a finding typical of a porokeratotic eccrine ostial or dermal duct nevus.