Dermatology Made Easy is based on the most popular topics from DermNet NZ's vast array of material. The book combines the essential focus of the ‘Made Easy’ book series with the authority and knowledge base of DermNet NZ's unparalleled resources.
Author: Vanessa Ngan, Staff Writer, 2007.
Acrokeratoelastoidosis is a rare condition in which there are small firm warty or pearly papules on the sides of the hands and feet. They were first described by Costa in 1953, hence are sometimes referred to as Costa’s acrokeratoelastoidosis. Acrokeratoelastoidosis is considered a form of punctate palmoplantar keratoderma type III.
Acrokeratoelastoidosis usually starts in childhood or adolescence and appears to affect females more frequently than males. It is a rare genetic skin disorder with autosomal dominant inheritance patterns (if one parent is affected there is a 50% chance that each child will be affected). However, sporadic cases have also occurred.
Although acrokeratoelastoidosis is genetic in origin the precise cause has not yet been determined. A possible linkage to chromosome 2 has been proposed. In addition it appears to occur in patients with either systemic sclerosis or localised scleroderma, however further studies are required to determine any relationship between the two conditions.
A similar appearance may arise on the sides of the hands in fair skinned patients that have had a lot of exposure to the sun. This is part of the skin ageing process and results from degeneration of the deeper layers of the skin by ultraviolet radiation. It is not inherited. It is known as keratoelastoidosis marginalis, marginal keratoderma of palms and degenerative collagenous plaques of the hands.
Signs and symptoms of acrokeratoelastoidosis start to arise at around puberty or sometimes later. Most patients slowly develop small bumps over the sides of their hands and feet. The papules are about 2-5mm in diameter and form small clusters. Although the papules look like plane warts they are more keratotic (made of horny skin tissue) and firm, and they do not coalesce. They may sometimes be a yellowish colour.
Once developed the papules of acrokeratoelastoidosis remain unchanged indefinitely.
Because acrokeratoelastoidosis is a genetic disorder, no cure is available. Treatment is also not indicated as in most patients, once developed, the eruption is stable and causes no problems. Mild keratolytics such as urea cream have been used, but recurrences are common.
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