You are in: eMedicine Specialties > Dermatology > BENIGN NEOPLASMS Acquired Digital FibrokeratomaArticle Last Updated: Mar 26, 2008AUTHOR AND EDITOR INFORMATIONSection 1 of 9
  Author: Elizabeth Kline Satter, MD, MPH, Staff Dermatologist and Head of Dermatopathology for Residency Program, Department of Dermatology, Naval Medical Center, San Diego Elizabeth Kline Satter is a member of the following medical societies: Alpha Omega Alpha and American Medical Women's Association Editors: Abby S Van Voorhees, MD, Assistant Professor, Director of Psoriasis Services and Phototherapy Units, Department of Dermatology, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania; David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic; Christen M Mowad, MD, Associate Professor, Department of Dermatology, Geisinger Medical Center; Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania; William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System Author and Editor Disclosure Synonyms and related keywords: ADFK, acral fibrokeratoma, acquired periungual fibrokeratoma, Koenen tumor, Koenen's tumor, garlic clove fibroma, subungual fibrokeratoma, periungual fibrokeratoma INTRODUCTIONSection 2 of 9
  BackgroundIn 1968, Bart et al1 described 10 cases of an uncommon acquired growth that was located on the fingers. Although it clinically resembled a cutaneous horn or rudimentary supernumerary digit, it had distinct histopathological findings. The authors named this growth acquired digital fibrokeratoma (ADFK). Subsequently, Pinkus2 reported 28 more cases; however, because the lesions Pinkus described also occurred on the proximal hand, toes, soles, and one in the prepatellar region, he suggested the entity might be more appropriately called acquired acral fibrokeratoma. PathophysiologyDespite the fact that most patients deny a history of precedent trauma, the major hypothesis is that subclinical injury contributes to the development of these lesions. FrequencyUnited StatesCurrently, no means of tracking nonmelanoma skin cancer, much less various benign dermatological conditions, are available in the United States; therefore, the actual incidence of acquired acral fibrokeratoma is unknown. Most cases reported in the literature involve individual case reports presented because of the lesions' unusual size, location, histological features, or association with other conditions. Only a few reports describe a series of patients, with 50 patients being the most reported from any one institution.4 Therefore, whether this condition is rare or rarely reported remains unclear. Mortality/MorbidityADFKs are benign stationary lesions that are more cosmetically bothersome than they are problematic. However, patients who have been reported to have giant acral digital fibromas on the dorsum or plantar surface5, 6 of the foot may report some discomfort. RaceADFKs have been reported in persons of all races. SexADFKs seem to have a slight male predominance; however, at this time too few cases have been described to adequately assess the significance of any sexual predilection.7 AgeThe patients reported with ADFKs range in age from 12-70 years, with most cases occurring in middle-aged adults. Clinically similar lesions that occur in young children are more likely to represent rudimentary supernumerary digits. CLINICALSection 3 of 9
HistoryMost patients present with an asymptomatic protuberance. PhysicalClinically, ADFKs manifest as solitary, skin-colored, dome-shaped papules or tall fingerlike protrusions with a hyperkeratotic surface. Most lesions are small and do not exceed 1.5 cm in height or diameter, but giant lesions measuring in excess of 3 cm have been documented.8 An important clinical finding reported to help differentiate ADFKs from other similar lesions is a collarette of slightly raised skin that encircles the base of the lesion, thereby creating a moatlike configuration.9 CausesThe etiology is unknown. Although trauma has been implicated, no studies can substantiate this hypothesis. DIFFERENTIALSSection 4 of 9
Corns Cutaneous Horn Infantile Digital Fibromatosis Pyogenic Granuloma (Lobular Capillary Hemangioma) Supernumerary Digit Warts, Nongenital
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| Media file 1: Clinical picture of a pedunculated acquire digital fibrokeratoma. | |
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| Media file 2: Flat-topped, skin-colored acquired digital fibrokeratoma in an acral location. | |
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| Media file 3: Slightly raised skin encircling the base of an acquired digital fibrokeratoma, creating a moat. | |
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| Media file 4: Domed-shaped papule with overlying hyperkeratosis. The dermal core is composed of increased collagen bundles and blood vessels oriented along the vertical axis of the lesion. | |
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| Media file 5: Close up showing the increased collagen bundles and blood vessels oriented along the vertical axis of the lesion. | |
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| Media file 6: A different acquired digital fibrokeratoma showing similar findings of a domed-shaped lesion with a vertically aligned fibrovascular core. | |
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Acquired Digital Fibrokeratoma excerpt
Article Last Updated: Mar 26, 2008
