History

Patients with minute digitate hyperkeratosis (spiny hyperkeratosis) report multiple tiny spiky hyperkeratotic projections on the trunk or limbs. Sometimes, small domed papules can be seen. Patients rarely report any other symptomatology.

Physical Examination

Lesions of minute digitate hyperkeratosis (spiny hyperkeratosis) are white, yellow, brown, or flesh colored nonfollicular spicules, as shown in the image below. They are occasionally flat-topped, dome shaped, or crateriform papules. They generally measure 0.5-5 mm long and 0.3-3 mm in diameter. Most reported cases note presence on the trunk and limbs, with sparing of the face and palmoplantar surfaces. However, no evidence-based review has been performed on the location of multiple minute digitate hyperkeratosis.

Multiple minute digitate hyperkeratosis. Published with permission granted from and with copyright retained by the American Medical Association. Clark JL, Davis G, Bennett DD. Arch Dermatol. 2008 Aug;144(8):1051-6.

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Differential Diagnoses

Caccetta TP, Dessauvagie B, McCallum D, Kumarasinghe SP. Multiple minute digitate hyperkeratosis: a proposed algorithm for the digitate keratoses. J Am Acad Dermatol. 2012 Jul. 67 (1):e49-55. [QxMD MEDLINE Link].
Eskin-Schwartz M, Metzger Y, Peled A, Weissglas-Volkov D, Malchin N, Gat A, et al. Somatic Mosaicism for a "Lethal" GJB2 Mutation Results in a Patterned Form of Spiny Hyperkeratosis without Eccrine Involvement. Pediatr Dermatol. 2016 May. 33 (3):322-6. [QxMD MEDLINE Link].
Lee NY, Ibrahim O, Khetarpal S, Gaber M, Jamas S, Gryllos I, et al. Dermal Microflora Restoration With Ammonia-Oxidizing Bacteria Nitrosomonas Eutropha in the Treatment of Keratosis Pilaris: A Randomized Clinical Trial. J Drugs Dermatol. 2018 Mar 1. 17 (3):285-288. [QxMD MEDLINE Link].
Weibel L, Berger M, Regenass S, Kamarashev J, Hafner J, French LE. Follicular spicules of the nose and ears--quiz case. Arch Dermatol. 2009 Apr. 145(4):479-84. [QxMD MEDLINE Link].
Chee SN, Ge L, Agar N, Lowe P. Spiny keratoderma: case series and review. Int J Dermatol. 2017 Sep. 56 (9):915-919. [QxMD MEDLINE Link].
Miller A, Aires D, Fraga G. Multiple minute digitate hyperkeratoses: a case report. Dermatol Online J. 2011. 17(5):1. [QxMD MEDLINE Link].
Ramselaar C, Toonstra J. Multiple minute digitate hyperkeratoses report of two cases with an updated review and proposal for a new classification. Eur J Dermatol. 1999 Sep. 9(6):460-5. [QxMD MEDLINE Link].
Benoldi D, Zucchi A, Allegra F. Multiple minute digitate hyperkeratoses. Clin Exp Dermatol. 1993 May. 18(3):261-2. [QxMD MEDLINE Link].
Mueller KK, Yeager JK. Clinical considerations in digitate dermatosis. Int J Dermatol. 1997 Oct. 36(10):767-8. [QxMD MEDLINE Link].
Rubegni P, De Aloe G, Pianigiani E, Cherubini-Di Simplicio F, Fimiani M. Two sporadic cases of idiopathic multiple minute digitate hyperkeratosis. Clin Exp Dermatol. 2001 Jan. 26(1):53-5. [QxMD MEDLINE Link].
Holzer AM, Hughey LC. Trichodysplasia of immunosuppression treated with oral valganciclovir. J Am Acad Dermatol. 2009 Jan. 60(1):169-72. [QxMD MEDLINE Link].
Caccetta TP, Dessauvagie B, McCallum D, Kumarasinghe SP. Multiple minute digitate hyperkeratosis: A proposed algorithm for the digitate keratoses. J Am Acad Dermatol. 2010 Nov 1. [QxMD MEDLINE Link].
Bordel-Gomez M. Palmoplantar spiny keratoderma associated with chronic lymphoid leukaemia. J Eur Acad Dermatol Venereol. 2008 Dec. 22(12):1507-8. [QxMD MEDLINE Link].
Takagawa S, Satoh T, Yokozeki H, Nishioka K. Multiple minute digitate hyperkeratoses. Br J Dermatol. 2000 May. 142(5):1044-6. [QxMD MEDLINE Link].
Zarour H, Grob JJ, Andrac L, Bonerandi JJ. Palmoplantar orthokeratotic filiform hyperkeratosis in a patient with associated Darier's disease. Classification of filiform hyperkeratosis. Dermatology. 1992. 185(3):205-9. [QxMD MEDLINE Link].
Torres G, Behshad R, Han A, Castrovinci AJ, Gilliam AC. "I forgot to shave my hands": A case of spiny keratoderma. J Am Acad Dermatol. 2008 Feb. 58(2):344-8. [QxMD MEDLINE Link]. [Full Text].
Sriprakash K, Yong-Gee S. Multiple minute digitate hyperkeratoses associated with paraproteinaemia. Australas J Dermatol. 2008 Nov. 49(4):233-6. [QxMD MEDLINE Link].
Balus L, Donati P, Amantea A, Breathnach AS. Multiple minute digitate hyperkeratosis. J Am Acad Dermatol. 1988 Feb. 18(2 Pt 2):431-6. [QxMD MEDLINE Link].
Cox NH, Ince P. Transient post-inflammatory digitate keratoses. Clin Exp Dermatol. 1989 Mar. 14 (2):170-2. [QxMD MEDLINE Link].
Goldstein N. Multiple minute digitate hyperkeratoses. Arch Dermatol. 1967 Dec. 96(6):692-3. [QxMD MEDLINE Link].

Media Gallery

Multiple minute digitate hyperkeratosis. Published with permission granted from and with copyright retained by the American Medical Association. Clark JL, Davis G, Bennett DD. Arch Dermatol. 2008 Aug;144(8):1051-6.
Multiple minute digitate hyperkeratosis. Published with permission granted from and with copyright retained by the American Medical Association. Clark JL, Davis G, Bennett DD. Arch Dermatol. 2008 Aug;144(8):1051-6.

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Author

Annie Wester, MD, MS Resident Physician, Department of Dermatology, Vanderbilt University Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

James W Swan, MD Associate Professor of Medicine, Division of Dermatology, Loyola University Stritch School of Medicine; Attending Physician, Loyola University Medical Center; Attending Physician, Section of Dermatology, Hines Veterans Affairs Medical Center

James W Swan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Chicago Dermatological Society

Disclosure: Nothing to disclose.

Rashid M Rashid, MD, PhD Director, Mosaic Clinic Hair Transplant Center of Houston

Rashid M Rashid, MD, PhD is a member of the following medical societies: American Academy of Dermatology, Council for Nail Disorders, Houston Dermatological Society, International Society of Hair Restoration Surgery, Texas Dermatological Society, Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Timothy McCalmont, MD Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco; Editor-in-Chief, Journal of Cutaneous Pathology

Timothy McCalmont, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Dermatopathology, California Medical Association, College of American Pathologists, United States and Canadian Academy of Pathology

Disclosure: Received consulting fee from Apsara for independent contractor.

Sections Multiple Minute Digitate Hyperkeratoses
Overview
Presentation
DDx
Workup
Treatment
Media Gallery
References

Multiple Minute Digitate Hyperkeratoses Clinical Presentation

History

Physical Examination

References

Tables

Contributor Information and Disclosures

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