Acrokeratosis Verruciformis of Hopf Workup

Updated: May 11, 2018
  • Author: Sarah Sweeney Pinney, MD, FAAD; Chief Editor: William D James, MD  more...
  • Print

Approach Considerations

Skin biopsy is needed to establish the diagnosis.

Dermoscopy of these lesions may demonstrate irregular white homogenous areas and cobblestoning, which could be helpful in making or confirming the diagnosis. [28]


Histologic Findings

The sections reveal hyperkeratosis, regular acanthosis, and papillomatosis with a prominent granular layer, typically having a “church spire” appearance. Parakeratosis is not a feature. No epidermal vacuolization is present, and a mild dermal inflammatory infiltrate can be seen. [15]

Darier disease is the most important differential diagnosis, and patients may show identical findings upon clinical examination. Dyskeratotic cells are characteristic of Darier disease, especially in well-established lesions, but these are not present upon histologic examination of acrokeratosis verruciformis.

Epidermodysplasia verruciformis, plane warts, and seborrheic keratoses, which may also clinically simulate lesions of acrokeratosis verruciformis, can be distinguished on the basis of histologic features.