Hematoxylin-eosin staining of both biopsy specimens showed massive hyperkeratosis with mild papillomatosis and acanthosis and a shallow depression underlying the hyperkeratosis (Figure 3). Elastic stains (Verhoeff–van Gieson) revealed a decreased number and thinning and fragmentation of elastic fibers in the dermis. These findings are consistent with acrokeratoelastoidosis. Therapy was initiated with 12% lactic acid cream at the time of diagnosis. The patient has not required any further treatment, and the papules have remained asymptomatic.
Congenital Hyperkeratotic Papules in a 15-Year-Old Girl—Diagnosis. Arch Dermatol. 2004;140(4):479-484. doi:10.1001/archderm.140.4.479-f