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Linear Keratotic Lesions in a Young Woman

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A woman in her 20s presented with linear hyperkeratotic papules on her right arm. The patient reported that these asymptomatic lesions were present since birth and did not appear to change on sun exposure or with seasons. She had no family history of similar cutaneous feature.

Physical examination revealed that these lesions were distributed in a Blaschkoid pattern. On close inspection, numerous reddish punctate keratotic papules were observed on the patient’s right forearm that coalesced into plaques on the dorsum of her right hand (Figure 1). No extracutaneous abnormalities were found. A skin biopsy specimen from the patient’s right arm was obtained.

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C. Porokeratotic eccrine ostial and dermal duct nevus

Histologic examination revealed acanthosis, focal hyperkeratosis, and epidermal invagination. The eccrine ducts and ostia were hyperplastic and dilated (Figure 2A). The parakeratotic cornoid lamellae were found on the acrosyringium (Figure 2B). A diagnosis of porokeratotic eccrine ostial and dermal duct nevus (PEODDN) was made based on cutaneous and characteristic histopathologic findings. The diagnosis was further confirmed through genetic testing for GJB2 (OMIM 121011), which was performed using DNA extracted from the affected epidermis and hyperplastic eccrine ducts by laser-captured microdissection. We found a mosaic missense mutation c.134G>A (p.Gly45Glu) in GJB2. Cryotherapy was recommended, but the patient refused.

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Article Information

Corresponding Author: Zhimiao Lin, MD, Department of Dermatology, Peking University First Hospital, 8 Xishiku St, Beijing 100034, China (zhimiaolin@bjmu.edu.cn).

Published Online: May 23, 2018. doi:10.1001/jamadermatol.2018.0024

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
Abell  E, Read  SI.  Porokeratotic eccrine ostial and dermal duct naevus.  Br J Dermatol. 1980;103(4):435-441.PubMedGoogle ScholarCrossref
2.
Aloi  FG, Pippione  M.  Porokeratotic eccrine ostial and dermal duct nevus.  Arch Dermatol. 1986;122(8):892-895.PubMedGoogle ScholarCrossref
3.
Easton  JA, Donnelly  S, Kamps  MA,  et al.  Porokeratotic eccrine nevus may be caused by somatic connexin26 mutations.  J Invest Dermatol. 2012;132(9):2184-2191.PubMedGoogle ScholarCrossref
4.
Jonard  L, Feldmann  D, Parsy  C,  et al.  A familial case of keratitis-ichthyosis-deafness (KID) syndrome with the GJB2 mutation G45E.  Eur J Med Genet. 2008;51(1):35-43.PubMedGoogle ScholarCrossref
5.
Masferrer  E, Vicente  MA, Bassas-Vila  J, Rovira  C, González-Enseñat  MA.  Porokeratotic eccrine ostial and dermal duct naevus: report of 10 cases.  J Eur Acad Dermatol Venereol. 2010;24(7):847-851.PubMedGoogle ScholarCrossref
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