Papular Acantholytic Dyskeratosis Localized to the Perineal and Perianal Area in a Young Male
A 26-year-old man presented with discomfort in his perianal area for the past 6 months. He reported that he had first noticed an asymptomatic eruption that he could feel as rough skin and ignored it. He later showed it to his wife who described it as several small grayish bumps. Over the past 2 months, he started getting a burning and itching sensation in that area. On examination, he had grayish-white areas perianally with multiple firm, coalescent papules extending a little posterior toward the natal fold and anteriorly on the perineum []. There were some excoriations and maceration in some areas. There were no vesicles, oozing, or bleeding. Gram staining and 10% KOH mount did not show any organism. Proctoscopy performed by a surgeon showed normal anal mucosa. All other mucosae were normal. Penis, scotum, and groin were normal. No other area on his body was affected. He was a healthy man with a negative personal or family history of atopy or any other pre-existing dermatosis. He had no relevant sexual history. He had taken treatment from two dermatologists in the past 2 months who had given potent topical steroids and oral antihistamines, which did not benefit him. A 3-mm punch biopsy showed circumscribed foci of hyperkeratosis with acantholytic dyskeratosis and subrabasal cleft formation []. Within the foci, the epidermis showed scattered acantholytic dyskeratotic cells (corps ronds) []. The stratum corneum showed a column of parakeratotic dyskeratotic cells (grains). Underlying dermis showed sparse superficial perivascular lymphohistiocytic infiltrate. Mild papillomatosis was seen as well. Clinicopathological correlation ruled in favor of papular acantholytic dyskeratosis of the perianal area.