A Case of Symmetrical Acrokeratoderma in an Indian Patient: A Decade-Long Misdiagnosis

Abstract

Symmetrical acrokeratoderma (SA) is a rare dermatosis characterized
by symmetric, hyperkeratotic plaques on the dorsum of the
hands, wrists, feet, and ankles, often misdiagnosed due to its resemblance
to other acral hyperkeratotic conditions. We report a
case of a 20-year-old Indian male with a decade-long history of
asymptomatic, bilaterally symmetrical plaques on the wrists and
ankles, exhibiting aquagenic maceration and seasonal variation.
Clinical findings, supported by histopathology showing hyperkeratosis,
acanthosis, and mild perivascular inflammation, confirmed
the diagnosis. Treatment with oral acitretin (25 mg) resulted in
marked improvement, which was maintained at the third month of
follow-up. This case highlights the importance of recognizing SA’s
distinct clinical features, such as the aquagenic response and seasonal
aggravation, to avoid misdiagnosis. We emphasize the need
for increased awareness and further research into its pathogenesis
and effective therapies, particularly in Indian populations where
reports are scarce.