Author: DermNet NZ Editor in Chief: Adjunct A/Prof Professor Amanda Oakley, Dermatologist, Hamilton, New Zealand. July 2018. Copy edited by Maria McGivern/Gus Mitchell.
Keratoelastoidosis marginalis is an acquired form of marginal keratoderma. It is characterised by small firm warty or pearly papules on the sides of the index fingers and thumbs in patients who have had a lot of exposure to the sun. It is more common than acrokeratoelastoidosis, the inherited form of marginal keratoderma.
Other names for keratoelastoidosis marginalis are degenerative collagenous plaques of the hands, marginal papular acrokeratoderma, marginal keratoelastoidosis of the hands, collagenous and elastotic marginal plaques of the hands, and digital papular calcific elastosis.
Keratoelastoidosis marginalis arises in older people of any skin colour who have mainly worked outdoors. It is part of the skin ageing process and results from degeneration of the deeper layers of the skin by trauma and ultraviolet radiation.
Keratoelastoidosis marginalis is diagnosed in patients over 50 years of age. Irregular, sometimes crateriform, keratotic papules arise on the lateral sides of the index fingers and the medial sides of the thumbs and may coalesce into plaques. The surrounding skin tends to have a yellowish hue. Patients may have other signs of sun damage, such as solar elastosis, solar comedones, and Favre–Racouchot syndrome.
Once developed, keratoelastoidosis marginalis remains unchanged indefinitely. The papules do not usually cause any symptoms.
In most cases, keratoelastoidosis marginalis is a clinical diagnosis determined by age of onset, lack of family history, and the presence of other signs of sun damage.
A skin biopsy may be performed. Histopathological examination of the collagenous and elastotic marginal plaques of the hands reveals focal hyperkeratosis, acanthosis, hypergranulosis, and elastorrhexis, as well as other solar degenerative changes.
Keratoelastoidosis marginalis has been treated with laser therapy, topical keratolytics (eg, salicylic acid) topical retinoids (eg, tazarotene and tretinoin), oral isotretinoin, and cryotherapy. These may provide temporary relief. Lifelong daily year-round sun protection is recommended.
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