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 Table of Contents  
LETTER TO THE EDITOR
Year : 2018  |  Volume : 38  |  Issue : 1  |  Page : 49-51

Acral acrochordon: an unusual site of presentation


Department of Dermatology and Venereology, Pramukhswami Medical College, Karamsad, Gujarat, India

Date of Submission03-Dec-2017
Date of Acceptance11-Dec-2017
Date of Web Publication12-Mar-2018

Correspondence Address:
Pragya A Nair
(Dermatology, Venereology & Leprosy), Department of Dermatology and Venereology, Pramukhswami Medical College, Karamsad, Gujarat 388325
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejdv.ejdv_11_17

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How to cite this article:
Nair PA, Kota RK. Acral acrochordon: an unusual site of presentation. Egypt J Dermatol Venerol 2018;38:49-51

How to cite this URL:
Nair PA, Kota RK. Acral acrochordon: an unusual site of presentation. Egypt J Dermatol Venerol [serial online] 2018 [cited 2018 Apr 20];38:49-51. Available from: http://www.ejdv.eg.net/text.asp?2018/38/1/49/227100



A 72-year-old female presented to skin OPD with an asymptomatic lesion over her right palm since 10 years. There was no history of bleeding or discharge from the lesion and no history of friction over the site except for the routine daily activities. The patient had no other associated comorbidities. On examination, a single sessile, soft skin, colored lesion 0.5×0.5 cm in size was present on proximal part of proximal phalanx of palmar aspect of right middle finger ([Figure 1]). Routine hematological investigations including lipid profile, complete blood counts, and blood sugars were within normal limits. Her height was 150 cm and weight was 51 kg. Clinically, diagnosis of acrochordon was made. Excision biopsy was performed, which on histopathology showed hyperplastic epidermis with orthokeratosis, parakeratosis, hypergranulosis, and papillomatosis ([Figure 2]a). The underlying dermis showed ecstatic and dilated vascular channels in an edematous stroma ([Figure 2]b), suggesting diagnosis of acrochordon.
Figure 1 Single, sessile, soft skin, colored lesion on proximal phalanx of palmar aspect of right middle finger.

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Figure 2 (a) Hyperplastic epidermis with orthokeratosis, parakeratosis, hypergranulosis, and papillomatosis (hematoxylin and eosin stain, 4×). (b) Dilated vascular channels in edematous stroma of dermis (hematoxylin and eosin stain, 10×).

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Acrochordon or fibroepithelial polyp, commonly known as a skin tag, is a benign, pedunculated, or sessile papillomatous growth of skin mainly composed of epidermal and stromal component. Its size varies between 1 and 5 mm and usually involves intertriginous areas like the neck, axilla, or groin [1], which is in contrast to our case, where it was present over proximal phalynx of palmar aspect of right middle finger. We could not find any case of acrochordon on palms or soles even after extensive search. Acrochordon has been reported to have an incidence of 46% in the general population [2]. Nearly 60% of individuals acquire them by the age of 69 years [3]. Acrochorda are harmless and typically painless and do not grow or change over time [4]. The surface of an acrochordon may be smooth or irregular in appearance and is often raised from the surface of the skin on a fleshy stalk called a peduncle. It can affect any age, including infants.

Three types of acrochorda have been described [4]:
  1. Papules that are small, furrowed, measuring 1–2 mm in width and height, and present mostly on the neck and the axillae.
  2. Filiform lesions, single or multiple, measuring 2 mm in width and 5 mm in length occurring elsewhere on the body.
  3. Large, pedunculated tumor or nevoid, baglike, soft fibromas which occur on the lower part of the trunk.


The etiology of skin tags is not well understood. They are thought to occur because of frictional rubbing between skin surfaces as they are commonly found in skin creases and folds [2]. There are reports of skin tags over penis following chronic use of condom catheter. It has been proposed that these are secondary to the negative pressure of the condom catheter and the irritation and inflammation associated with its long-term use [5].

Possible role of trauma in skin tags was studied by El Safoury et al. and they suggested that mast cells through the release of mediators like tumor necrosis factor-α and tumor necrosis factor-related apoptosis-inducing ligand might play a role in the pathogenesis of skin tags in response to trauma [6]. Dianzini et al. [7] suggested role of low-risk human papillomavirus 6 and 11 in pathogenesis of acrochorda.

They are usually seen alone but are sometimes associated with colonic polyps (Gardner syndrome), diabetes, obesity, hyperlipidemia, insulin resistance, acromegaly, Birt–Hogg–Dubé syndrome, and polycystic ovary syndrome [4]. They appear or increase in number when a patient is gaining weight, having insulin resistance, or during pregnancy [1]. Shenoy et al. [8] have reported significantly high prevalence of metabolic syndrome in patients with skin tags. In our case, no such association was observed.

Skin tags are diagnosed generally by clinical features. Over common sites like neck, groin, and axillae, it needs to be differentiated from conditions like fibrokeratoma, accessory tragus, pedunculated seborrheic keratosis, pleomorphic fibroma, and polypiodal intradermal melanocytic nevus. Palm is an unusual site for skin tag to occur where one need to think of cutaneous horn, common warts, or seborrheic keratosis in differential diagnosis. Histopathology helps to rule out other conditions. Microscopically, an acrochordon consists of a fibrovascular core, sometimes also with fat cells, covered by an unremarkable epidermis or by acanthotic, flattened, or frond-like epithelium [4].

Treatment of skin tags includes cryotherapy or surgical excision.

Our presented case shows acrochordon occurring over the ventral aspect of right middle finger, which is an unusual site for presentation.

Acknowledgements

The authors acknowlege the Department of Pathology, Pramukhswami Medical College, for the diagnosis and photographs of slides.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gorai S, Saha A, Misra P, Nag S. Broad based giant fibroepithelial polyp over an unusual location: a report. Indian Dermatol Online J 2016; 7:548–549.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Banik R, Lubach D. Skin tags: localization and frequencies according to sex and age. Dermatologica 1987; 174:180–183.  Back to cited text no. 2
    
3.
Rasi A, Faghihi A, Rahmanzadeh Y, Hassannejad H. A comparison study of lipid profile levels between skin tags affected people and normal population in Tehran, Iran. Adv Biomed Res 2014; 3:109.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Kishan Kumar YH, Sujatha C, Ambika H, Seema S. Penile acrochordon: an unusual site of presentation. A case report and review of the literature. Int J Health Allied Sci 2012; 1:122–125.  Back to cited text no. 4
    
5.
Fetsch JF, Davis CJ Jr, Hallman JR, Chung LS, Lupton GP, Sesterhenn IA. Lymphedematous fibroepithelial polyps of the glans penis and prepuce: a clinicopathologic study of 7 cases demonstrating a strong association with chronic condom catheter use. Hum Pathol 2004; 35:190–195.  Back to cited text no. 5
    
6.
El Safoury OS, Fawzy MM, Hay RM, Hassan AS, El Maadawi ZM, Rashed LA. The possible role of trauma in skin tags through the release of mast cell mediators. Indian J Dermatol 2011; 56:641–646.  Back to cited text no. 6
    
7.
Dianzani C, Calvieri S, Pierangeli A, Imperi M, Bucci M, Degener AM. The detection of human papillomavirus DNA in skin tags. Br J Dermatol 1998; 138:649–651.  Back to cited text no. 7
    
8.
Shenoy C, Shenoy MM, Krishna S, Pinto M. Skin tags are not merely cosmetic: a study on its association with metabolic syndrome. Int J Health Allied Sci 2016; 5:50–52.  Back to cited text no. 8
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