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Keratoses come in many different flavors. It is a non-specific term united by a raised scaly lesion, usually solitary. Under the microscope, the distinctions can be made. Diseases ranging from benign seborrheic keratosis to premalignant actinic keratoses and porokeratoses can be identified.


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Circumscribed palmar hypokeratosis: new observations.

Resnik KS, Dileonardo M.

Institute for Dermatopathology in Conshohocken, Pennsylvania.
Am J Dermatopathol. 2006 Apr;28(2):112-6. Abstract quote  

Circumscribed hypokeratosis is a characteristic depression both clinically and histopathologically that was originally described as representing a distinctive acquired epidermal malformation of volar skin. To date, 16 patients with this entity have been reported.

On the basis of clinical features and histopathologic findings in 4 new patients, coupled with information about some of the previously reported patients, there is evidence to suggest that this dermatosis could be secondary to trauma.
Circumscribed Palmar or Plantar Hypokeratosis: Two Cases of a Recently Described Entity of Unknown Origin.

Mensing CH, Schleusner VH, Sander CA, Mensing H.

From the *Department of Dermatology, Allgemeines Krankenhaus St. Georg, Hamburg, Germany; and daggerDermatologist in private practice, Hamburg, Germany.

Am J Dermatopathol. 2005 Jun;27(3):247-249. Abstract quote  

Circumscribed palmar or plantar hypokeratosis is a new entity recently described by Perez et al in 2002. It seems to be underdiagnosed or clinically it is often misdiagnosed as Bowen's disease or porokeratosis. Obviously the number of case reports of circumscribed palmar or plantar hypokeratosis has increased since the first publication by Perez et al.

The histopathological hallmarks of this condition are a stair-like configuration with an abrupt thinning of the stratum corneum from uninvolved to involved skin with a central hypokeratotic area. There are no atypical keratinocytes or cornoid lamellation.

We describe two new patients with circumscribed palmar hypokeratosis. In one case there were additional histopathological features including the loss of granular cell layer in the center of the lesion and an overlying compact thin parakeratotic layer.
Circumscribed palmar or plantar hypokeratosis: a distinctive epidermal malformation of the palms or soles.

Perez A, Rutten A, Gold R, Urbina F, Misad C, Izquierdo MJ, Requena C, Aliaga A, Kutzner H, Requena L.

Department of Dermatology, Hospital General Universitario, Valencia, Spain.

J Am Acad Dermatol. 2002 Jul;47(1):21-7. Abstract quote  

BACKGROUND: Epidermal malformations of the skin include a group of heterogeneous developmental defects that result from errors in morphogenesis of the epidermis during intrauterine life.

OBJECTIVE: The purpose of this study was to report the clinical and histopathologic features of a distinctive epidermal malformation involving the skin of the palms or soles.

METHODS: Ten patients were included in this study. All of them showed the same clinical features that consisted of a solitary circumscribed and circular area of erythematous depressed skin on the palm or on the sole. Diagnosis was confirmed by histopathologic study.

RESULTS: All patients were middle aged or elderly. Nine patients were women and one was a man. The lesions showed predilection for the skin of the thenar and hypothenar regions of the palm or the medial side of the sole. Histopathologic study demonstrated a depression of the epidermis, with a sharp stair between normal and involved skin. The epidermis covering the depression showed markedly thinner horny layer and a slightly diminished granular cell layer when compared with adjacent noninvolved skin. Keratinocytes of the squamous cell layer, granular cells, and corneocytes showed, otherwise, a normal appearance. Serial sections failed to demonstrate cornoid lamellation.

CONCLUSION: On the basis of the clinical and histopathologic findings in these 10 patients, we have named this malformation circumscribed palmar or plantar hypokeratosis. This lesion seems to be a distinctive entity that has not been previously described.

Henry JB. Clinical Diagnosis and Management by Laboratory Methods. Twentieth Edition. WB Saunders. 2001.
Rosai J. Ackerman's Surgical Pathology. Ninth Edition. Mosby 2004.
Sternberg S. Diagnostic Surgical Pathology. Fourth Edition. Lipincott Williams and Wilkins 2004.
Robbins Pathologic Basis of Disease. Seventh Edition. WB Saunders 2005.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 6th Edition. McGraw-Hill. 2003.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fourth Edition. Mosby 2001.

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Last Updated April 26, 2006

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