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Collagenous and elastotic marginal plaques of the hands pathology

Author: Assoc Prof Patrick Emanuel, Dermatopathologist, Auckland, New Zealand, 2013.

Collagenous and elastotic marginal plaques of the hands (CEMPH) presents as symmetric, hyperkeratotic, linear plaques along the lateral aspects of the hands. It has otherwise been reported as digital papular calcific elastosis of the hands, and keratoelastoidosis marginalis.

Histology of CEMPH

Histologic findings in CEMPH include epidermal acanthosis with some loss of the rete pattern associated with overlying hyperkeratosis (figure 1). There are thick acellular collagen bundles in the dermis (figure 2). In addition, there are fragmented degenerative elastic which may form elastotic masses. These masses sometimes calcify (figure 3).

Special studies for CEMPH

Elastic stains will show a reduction of elastic fibres. The residual elastic fibres are disorganized or can form masses

Differential diagnosis of CEMPH pathology

Dermal elastosis – the dense fibroplasia and clinical features help to distinguish this disorder from regular dermal elastosis.

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