Download 15. Degenerative collagenous plaques of the hands

Case No. 15
1
Author: Kanawat Kanjanapiboon, M.D.
Chakkrapong Chunhasewee, M.D.
Patient: A 66-year-old Thai woman from Samut Prakarn
Chief complaint: Bilateral symmetrical linear firm plaques on the radial side
of the index fingers for 10 years
Present illness: The patient developed bilateral asymptomatic symmetrical
plaques on the distal part of radial side of both index fingers for 10 years.
The lesions gradually extended to proximal part of radial side of both index
fingers.
Past history: The patient denies any underlying diseases
Family history: No family members experienced with this condition similar
to the patient.
Physical examination: Unremarkable
Dermatologic examination:
Bilateral symmetrical ill-defined border glistening skin color
hyperkeratotic plaques distributed in linear pattern along the radial side of
the index fingers and extended to the ulnar side of both hands.
Histopathology: Slide No. 58-3275, 58-3275*
Sections display slightly acanthotic acral epidermis with
hyperkeratosis. Neither spongiosis nor interface change is seen. The dermis
shows increased bluish material with entrapped collagen bundles. No
cellular component is observed. Verhoeff van Gieson demonstrates
decreased numbers of elastic fibers.
Diagnosis: Degenerative collagenous plaques of the hands
Treatment: Topical treatments with retinoids, urea and salicylic acid creams
have been applied and avoiding sunlight and wearing gloves were also
advised. Avoidance of repetitive pressure or friction is suggested to prevent
disease progression.
Discussion:
Degenerative collagenous plaques of the hands (DCPH) develop in the sixth
to seventh decade of life.1 Men are more predominantly affected than women. A
high proportion of cases are reported in Caucasians. There is no familial
predisposition. The clinical manifestations are bilateral with symmetrical linear
plaques at the junction of the dorsal and palmar skin from the medial aspect of the
thumb distally onto the lateral aspect of the index finger. The lesions extend to the
distal interphalangeal joint of the index finger. The ulnar side of the hand and other
sites on the fingers are rarely involved. The course of this disease is slowly
progressive and asymptomatic.
The pathological findings of DCPH show an acellular zone of haphazardly
arranged collagen with some bundles running perpendicular to the epidermis.2 The
bundles of collagen are admixed with fragmented elastic fibers and distinctive
angulated amorphous basophilic elastotic masses in the upper dermis. These masses
are composed of degenerative elastic fibers and calcium.1 Chornic actinic damage
and repetitive long-term trauma and pressure inducing degenerative collagenous
and elastotic processes are implicated in the pathogenesis.3,4
Acrokeratoelastoidosis (AKE) and focal acral hyperkeratosis are two
important entities in the differential diagnosis of DCPH.
Table1. The differential diagnosis of DCPH5
Disorder
Clinical features
Histologic features
Degenerative collagenous
More common in older
Marked degeneration of
plaques
patients (40-60 years),
collagen and elastin
usually associated with
fibers
chronic sun exposure
Acrokeratoelastoidosis
Small round-oval to
Hyperkeratosis,
(AKE)
rhomboid-shaped,
epidermal hypertrophy,
yellowish papules on
and decreased elastic
palmar/plantar surfaces fibers in the dermis
of the hands and feet
Focal acral hyperkeratosis
Identical to AKE, except
Lack of elastorhexis in
(FAH)
it is more common in
the dermis, elastic tissue
blacks
is intact
According to the table shown above, this case is clinically and histologically
compatible with DCPH.
Interhospital Conference 2016
Institute of Dermatology
35
References:
1. Jordaan HF, Rossouw DJ. Digital papular calcific elastosis: A
histopathological, histochemical and ultrastructural study of 20 patients. J
Cutan Pathol 1990; 17: 358-370.
2. Richie EB, Williams HM. Degenerative collagenous plaques of the hands.
Arch Dermatol 1996; 93: 202-203.
3. Mehregan AH. Degenerative collagenous plaques of the hands. Arch
Dermatol 1966; 93: 633.
4. Koscard E. Keratoelastoidosis marginalis of the hands. Dermatologica
1964; 131: 169-175.
5. Weimin Hu, Thomas F. Cook, Gary J. Vicki, and Dee Anna Glasser.
Acrokeratoelastoidosis. Pediatric Dermatol 2002; 19: 320-2.
Interhospital Conference 2016
Institute of Dermatology
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