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DERMATOLOGICA SINICA 30 (2012) 37–38
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RESIDENT’S FORUM
Multiple whitish papules on the groins in a man
Case report
A man 41 years of age presented with asymptomatic skin lesions,
which he had for 2 years. Multiple small, whitish, papules that
resembled deep-seated vesicles covered his scrotum, bilateral
groins, and perianal area (Figure 1). No similar skin lesions
appeared elsewhere, and he had no family history of inherited
skin diseases. Skin biopsy showed a picture of prominent acantholysis in the suprabasal and middle layer of the epidermis. Some dyskeratotic cells within the acantholytic epidermis, hyperkeratosis,
and acanthosis were also noted (Figure 2). Direct immunofluorescence studies were negative. After the diagnosis was made, he
was treated with a topical steroid and the lesions persisted without
discomfort.
Figure 1 (A) Multiple whitish papules on the scrotum, perianal area, and groins, (B) whitish papules, some with coalescent lesions on the left groin.
Figure 2 (A) Prominent acantholysis in the suprabasal and middle layer of the epidermis. Hyperkeratosis and acanthosis were also noted, (B) acantholysis and some dyskeratotic
cells.
1027-8117/$ – see front matter Copyright Ó 2011, Taiwanese Dermatological Association. Published by Elsevier Taiwan LLC. All rights reserved.
doi:10.1016/j.dsi.2011.09.022
38
Resident’s Forum / Dermatologica Sinica 30 (2012) 37–38
Diagnosis
Acantholytic dermatosis of the genitocrural area.
The etiology and pathogenesis of acantholytic dermatosis of the
genitocrural area is still unknown. The warm, moist environment
and easily physical friction of the genital region might be one of
the factors that triggers the disorder. There were no reports of
genetic study to date.
Discussion
Acantholytic dermatosis of the genitocrural area was first reported
by Chorzelski and colleagues in 1984 with the term “papular acantholytic dyskeratosis of the vulva” as a unique entity of focal acantholytic dyskeratoses.1 It is an acquired dermatosis that appears on
the genital area. Most reported cases occur in young to middle-aged
women with lesions developed on the vulva.2 Only a few reports of
this disease have occurred in men.3
Clinically, it is characterized as numerous tiny skin-colored or
whitish papules that develop on the genitocrural area and may
become confluent and resemble deep-seated vesicles. Female
patients mostly report lesions on the labia major, but they may
extend to the perianal area, the inguinal region, or the upper medial
aspects of the thighs. In men, it may occur on the scrotum or the
penile area. Although it might be pruritic, most cases were asymptomatic. Evidence does not suggest that the disease is inherited.
Histopathologically, the condition shows prominent acantholysis,
which can involve the full layer of the epidermis. Dyskeratosis
with corps ronds and grains may be seen. There may be hyperkeratosis and focal parakeratosis. The immunofluorescence studies are
negative, which is an important finding to help differentiate it from
pemphigus.
Several diseases should be considered as the differential diagnoses. Hailey-Hailey disease develops not only on the groins, but
it also appears on the axillae and other friction areas and often presents as painful erosions, fissures, or scaly erythematous plaques.
Hailey-Hailey disease has an autosomal dominant family history,
which is not seen in this disease. Darier disease mostly erupts in
the seborrheic area and also has autosomal dominant inheritance.
In addition, the histologic picture with marked dyskeratotic cells
makes a difference. Grover disease presents with lesions that are
located on sun-exposure areas, and spontaneous healing often
occurs within a few weeks or months. Alternatively, acantholytic
acanthoma is mainly solitary and usually occurs on the trunk of
older individuals.
Conclusion
Treatments with topical steroids and topical retinoids had been
reported to improve the condition, but some reports suggest that
they are unhelpful.4 The most effective treatment appears to be
local ablation of the lesion by cryotherapy, electrocautery, or laser
therapy.5 However, because the lesions are not harmful, an accurate
diagnosis with reassurance may be enough for the patients.
Chao-Chieh Yang, Yang-Chih Lin
Mackay Memorial Hospital, Taiwan
Yu-Hung Wu*
Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan
Mackay Medicine, Nursing and Management College, Taipei, Taiwan
* Corresponding author. Yu-Hung Wu,
No. 92, Section 2, Zhongshan North Road, Zhongshan District,
Taipei City 10449, Taiwan.
Tel.: þ886 2 25433535 2556; fax: þ886 2 25433535 2210.
E-mail address: [email protected]
References
1. Chorzelski TP, Kudejko J, Jablonska S. Is papular acantholytic dyskeratosis of the
vulva a new entity? Am J Dermatopathol 1984;6:557–60.
2. Cooper PH. Acantholytic dermatosis localized to the vulvocrural area. J Cutan
Pathol 1989;16:81–4.
3. Wong TY, Mihm Jr MC. Acantholytic dermatosis localized to genitalia and crural
areas of male patients: a report of three cases. J Cutan Pathol. 1994;21:27–32.
4. Krishnan RS, Ledbetter LS, Reed JA, Hsu S. Acantholytic dermatosis of the vulvocrural area. Cutis 2001;67:217–9, 20.
5. Dittmer CJ, Hornemann A, Rose C, et al. Successful laser therapy of a papular
acantholytic dyskeratosis of the vulva: case report and review of literature.
Arch Gynecol Obstet 2010;281:723–5.
Received: Dec 21, 2010
Revised: Jan 20, 2011
Accepted: Jul 4, 2011