Interactive Case Study - January 2026

A 32-year-old female with scaly plaques on the hands

Blake Vest MD

Rebecca Philips MD

A 32-year-old female presented with long-standing scaly plaques on the medial and lateral aspects of the bilateral hands. The patient reported the lesions had a burning sensation and were slowly progressing over the course of many months. She denied excessive sun exposure or occupational/recreational contact with caustic or sensitizing agents. She reported no family history of similar lesions.

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Figure 1: Clinical Photo

Figure 2: H&E 20x

Figure 3: H&E 100x

Figure 4: Verhoeff-Van Geisen Stain

Figure 5: Von Kossa Stain

Which of the following is the best diagnosis?

Acrokeratoelastoidosis of Costa

Acrokeratosis verruciformis of Hopf

Collagenous and elastotic marginal plaques

Focal acral hyperkeratosis

Pseudoxanthoma elasticum-like papillary dermal elastolysis

Which systemic disease has been associated with this condition?

Alkaptonuria

Argyria

Buschke-Ollendorf syndrome

Fabry disease

Goltz syndrome

Which of the following is a method utilized for staining elastic tissue?

Alizarin red

Auramine-rhodamine

Leder

Orcein

Von Kossa

Sonthalia S, Aboobacker S. Acrokeratoelastoidosis. Updated May 8, 2023. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2025.
Genedy R, Taha A. Acrokeratosis verruciformis of Hopf: dermoscopic and histopathological study of two siblings. Clin Exp Dermatol. 2021;46(7):1313-1314.
Burks JW, Wise LJ Jr, Clark WH Jr. Degenerative collagenous plaques of the hands. Arch Dermatol. 1960;82:362-366.
Patel M, et al. Collagenous and elastotic marginal plaques of the hands. Cutis. 2017 March;99(3):E25-E28.
Jordaan HF, Rossouw DJ. Digital papular calcific elastosis: a histopathological, histochemical and ultrastructural study of 20 patients. J Cutan Pathol. 1990;17(6):358-370.
Lee EA, Kim HS, Kim HO, Park YM. A case of focal acral hyperkeratosis. Ann Dermatol. 2009;21(4):426-428.
Rongioletti F, Izakovic J, Romanelli P, Lanuti E, Miteva M. Pseudoxanthoma elasticum-like papillary dermal elastolysis: a large case series with clinicopathological correlation. J Am Acad Dermatol. 2012;67(1):128-135.
Good AJ, Snodgrass AL, De Benedetto A, Motaparthi K. Collagenous and elastotic marginal plaques of the hand: A potential clue to the diagnosis of alkaptonuria. J Cutan Pathol. 2019;46(1):74-79.
Jerger SE, Parekh U. Argyria. In: StatPearls. Treasure Island, FL: StatPearls Publishing; August 8, 2023.
Pope V, Dupuis L, Kannu P, et al. Buschke-Ollendorff syndrome: a novel case series and systematic review. Br J Dermatol. 2016;174(4):723-729.
Chan B, Adam DN. A Review of Fabry Disease. Skin Therapy Lett. 2018;23(2):4-6.
Lee T, Lin MY, Lin Z. Focal Dermal Hypoplasia. JAMA Dermatol. 2023;159(9):998-999.
Calonje JE, Brenn T, Lazar AJ, Billings SD, eds. McKee's Pathology of the Skin: With Clinical Correlations. 5th ed. Elsevier; 2019.
Kazlouskaya V, Malhotra S, Lambe J, Idriss MH, Elston D, Andres C. The utility of elastic Verhoeff-Van Gieson staining in dermatopathology. J Cutan Pathol. 2013;40(2):211-225.

Acknowledgements

We would like to thank Dr. Andres Garcia for referring this case to us and the patient for allowing us to share the case.

Author Profiles

Blake Vest

University of Texas Medical Branch

Blake Vest is currently a fellow in dermatopathology at the University of Texas Medical Branch. He attended medical school at Southern Illinois University School of Medicine and completed his dermatology residency at the University of Iowa. After finishing his training, he plans to join a private practice in Southern California and practice both dermatology and dermatopathology.

Rebecca Philips

Galveston Dermatology

Dr. Rebecca Philips attended medical school at the University of Texas Medical Branch (UTMB) in Galveston. After an internship at Houston Methodist Hospital, she returned to UTMB for her dermatology residency and served as a chief resident during her final year. She completed her training with a fellowship in dermatopathology at UTMB. Dr. Philips is a board-certified dermatologist and dermatopathologist and practices both general dermatology and dermatopathology.

Question:

Interactive Case Study - January 2026

Acknowledgements

Author Profiles

A 32-year-old female with scaly plaques on the hands

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