Acral fibrokeratoma

Acral Fibrokeratoma

Acral fibrokeratoma, also known as digital fibrokeratoma, is a benign skin lesion that typically occurs on the fingers, toes, or other acral locations. It is characterized by a small, firm, dome-shaped, and often skin-colored nodule that may have a hyperkeratotic surface. The condition is relatively rare and usually presents as a solitary growth, although multiple lesions have been reported in some cases.

Etiology and Pathogenesis

The exact cause of acral fibrokeratoma is unknown. It is considered to be a reactive process rather than a true neoplasm. Some theories suggest that it may arise in response to trauma or irritation, but this has not been conclusively proven. Histologically, acral fibrokeratoma is composed of dense fibrous tissue with overlying epidermal hyperplasia and hyperkeratosis.

Clinical Features

Acral fibrokeratoma typically presents as a small (usually less than 1 cm in diameter), skin-colored, or slightly pink nodule. It is often located on the fingers, particularly around the nail bed, but can also occur on the toes and, less commonly, on other acral parts of the body. The lesion is usually asymptomatic, but its location may lead to discomfort or functional impairment, especially if it interferes with normal activities or wearing shoes.

Diagnosis

The diagnosis of acral fibrokeratoma is primarily clinical, based on the characteristic appearance and location of the lesion. Dermoscopy can aid in the diagnosis by revealing specific features such as a collarette of scale and central fibrous core. In uncertain cases, a biopsy may be performed to confirm the diagnosis histologically and to rule out other conditions such as squamous cell carcinoma, warts, or other fibrous tumors.

Treatment

Treatment of acral fibrokeratoma is usually not necessary unless the lesion causes discomfort or cosmetic concerns. If removal is desired, options include surgical excision, cryotherapy, or laser therapy. Surgical excision is the most definitive treatment and typically results in complete removal of the lesion. However, there is a risk of recurrence, especially if the lesion is not completely excised.

Prognosis

The prognosis for acral fibrokeratoma is excellent, as it is a benign condition. Once removed, the lesion usually does not recur, although new lesions may develop in other locations.

Prevention

There are no specific measures to prevent the development of acral fibrokeratoma. Avoiding trauma or irritation to the fingers and toes may theoretically reduce the risk, but this has not been proven.