Case of the Month

40 year old woman with multiple tiny, thin, bumps on her upper arms. She reports they started developing about four years ago. She has never had anything like this before. No one in her family has any similar lesions.  Her primary care doctor told her it was a condition called keratosis pile Eris. Her only Internet research seem to indicate that it was not and she presents for a second opinion. On examination the lesions were reminiscent of lichen and spiny lotuses, however the bilateral wide spread occurrence led me to think of biopsy would give more information. She was otherwise healthy.

Multiple Minute Digitate Keratoses (a.k.a. spiked hyperkeratoses)

This is an extremely rare condition. It's been reported to be transmitted by an autosomal dominant manner and also sporadically. The condition can also be associated with systemic inflammation and/or malignancy. In this particular patient I recommend of ammonium lotion lotion twice daily. Because the leions were more mysterious than symptomatic, she was or than happy to receive the correct diagnoses. The plan in the future is to use a topical anesthetic cream and to remove any symptomatic lesions. I also recommended that she contact her primary care physician and initiate a  general medical examination appropriate for her age and sex.

The pathology report contained the following information:

“…The stratum corneum contains spicules of densely compacted orthokeratin with intervening normal basket weave stratum corneum. These keratotic spicules are not associated with hair follicles. Many arise from finely pointed epidermal elevations. The epidermis is otherwise normal. There is no significant inflammation within the dermis.  These findings are most consistent with multiple minute digitate keratoses (spiked hyperkeratosis). A diagnosis of lichen spinulosis was considered, but no keratotic follicular plugs characteristic of this disorder were noted.”

For additional information see the references below:

http://emedicine.medscape.com/article/1604461-overview

http://dermatology.cdlib.org/1705/1_case_reports/1_11-00117/article.html