Case Number : Case 2499 - 04 February 2020 Posted By: Uma Sundram

Acrokeratosis verruciformis of Hopf

On a quick glance, some of the histology features suggests nodular prurigo but there is a ? sub-epidermal split near the middle of the photomicrographs. Dermal inflammatory changes are minimal and no convincing interface changes.

More history will be useful such any blisters at any stage mixed with the described skin changes. DIF/ELISA for BP180/230 would be important ancillary tests to rule out unusual to rare variants of BP especially pemphigoid nodularis.

Finally, in this age group one has to be aware of common dermatoses with unusual presentations such as scabies though the sparse inflammatory changes in dermis would be a bit unusual.

I see only lichen simplex chronicus alterations.

LSC

Lichen simplex chronicus/prurigo nodularis. DIF was negative. I like the idea of unusual blistering disorders; one could also consider late presentations of genodermatoses such as acrodermatitis verruciformis, Darier disease and acquired ichthyosis. The clinical lesions did not fit with these latter considerations.