Case Letter

Collagenous and Elastotic Marginal Plaques of the Hands

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Practice Points

  • The etiology of collagenous and elastotic marginal plaques of the hands (CEMPHs) is attributed to collagen and elastin degeneration by chronic actinic damage, pressure, or trauma.
  • It is important to keep CEMPH in mind when dealing with occupational cases of repeated long-term trauma or pressure to the hands as well as excessive sun exposure. It should be separated from other diseases and avoid being misdiagnosed as a malignant lesion.


 

References

To the Editor:
Collagenous and elastotic marginal plaques of the hands (CEMPHs) has several names including degenerative collagenous plaques of the hands, keratoelastoidosis marginalis, and digital papular calcific elastosis. This rare disorder is an acquired, slowly progressive, asymptomatic, dermal connective tissue abnormality that is underrecognized and underdiagnosed. Clinical presentation includes hyperkeratotic translucent papules arranged linearly on the radial aspect of the hands.

A 74-year-old woman described having "rough hands" of more than 20 years' duration. She presented with 4-cm wide longitudinal, erythematous, firm, depressed plaques along the lateral edge of the second finger and extending to the medial thumb in both hands (Figure 1). She had attempted multiple treatments by her primary care physician, including topical and oral medications unknown to the patient and light therapy, all without benefit over a period of several years. We have attempted salicylic acid 40%, clobetasol cream 0.05%, and emollient creams containing α-hydroxy acid. At best the condition fluctuated between a subtle raised scale at the edge to smooth and occasionally more red-pink, seemingly unrelated to any treatments.

Figure 1. Longitudinal, erythematous, firm, depressed plaques (4-cm wide) along the lateral edge of the second finger and extending to the medial thumb on the right hand.

The patient did not have plaques elsewhere on the body, and notably, the feet were clear. She did not have a history of repeated trauma to the hands and did not engage in manual labor. She denied excessive sun exposure, though she had Fitzpatrick skin type III and a history of multiple precancers and nonmelanoma skin cancers 7 years prior to presentation.

Histology of CEMPH reveals a hyperkeratotic epidermis with an avascular and acellular replacement of the superficial reticular dermis by haphazardly arranged, thickened collagen fibers (Figure 2A-2C). Collagen fibers were oriented perpendicularly to the epidermal surface. Intervening amorphous basophilic elastotic masses were present in the upper dermis with occasional calcification and degenerative elastic fibers (Figure 2D).

Figure 2. Histopathology shows vertically oriented, thickened collagen bundles with mixed elastin (A)(H&E, original magnification ×10). The collagen bundles are arranged haphazardly (B and C)(H&E, original magnification ×20[B]; Verhoeff-van Gieson, original magnification ×10[C]). Altered elastic fibers are present in the upper dermis (D)(H&E, original magnification ×4).

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