Medical Care
Treatment of acrokeratosis paraneoplastica depends on the type and stage of the underlying neoplasm. Successful treatment of the underlying malignancy typically improves the acrokeratosis paraneoplastica skin lesions.
Recurrence of acrokeratosis paraneoplastica skin lesions in a successfully treated patient implies a recurrence of the malignancy. [24, 25]
If the malignancy is untreatable or does not respond to treatment, acrokeratosis paraneoplastica skin-directed therapy may improve the eruption; however, the response to treatment is variable and often unsatisfactory. [12]
Improvement has been reported with the use of topical and systemic retinoids, topical and oral corticosteroids, salicylic acid, topical vitamin D analogues, and psoralen plus UVA (PUVA). [13]
One report suggests a role for zinc supplementation in patients with acrokeratosis paraneoplastica. [2]
Consultations
Consultation with an internal medicine specialist for a malignancy workup is appropriate with an acrokeratosis paraneoplastica diagnosis.
Consultation with a hematologist, oncologist, otolaryngologist, pulmonologist, and/or gastroenterologist also can assist with focused evaluations related to acrokeratosis paraneoplastica.
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Acrokeratosis paraneoplastica. A 67-year-old woman presented with scaly plaques of the hands, feet, ears, and nose associated with esophageal squamous cell carcinoma. The eruption resolved with resection of the cancer. Image courtesy of Ronald Grimwood, MD.
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Acrokeratosis paraneoplastica. A 67-year-old woman presented with scaly plaques of the hands, feet, ears, and nose associated with esophageal squamous cell carcinoma. The eruption resolved with resection of the cancer. Image courtesy of Ronald Grimwood, MD.
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Bazex syndrome. Acquired palmar keratoderma in a woman with a history of breast cancer and recent primary lung cancer. Courtesy of Jeffrey J. Meffert, MD.
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Bazex syndrome. Violaceous psoriasiform dermatitis on the ankles. Lung cancer appeared to be in remission; both keratoderma and psoriasiform plaques resolved quickly with clobetasol ointment. Courtesy of Jeffrey J. Meffert, MD.
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At this power, a patchy lichenoid infiltrate of predominantly lymphocytes can be seen underneath an epidermis with psoriasiform hyperplasia and serum crust in the parakeratotic cornified layer (hematoxylin and eosin, 100X).
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Focal vacuolar interface change is seen with associated pigment incontinence and exocytosis of lymphocytes (hematoxylin and eosin, 200X).
