Acrokeratosis Verruciformis (AKV) is a rare genetic skin disorder that causes wart-like (verrucous) lesions, typically on the hands, feet, elbows, knees, and forearms. It is usually inherited in an autosomal dominant pattern and caused by mutations in the ATP2A2 gene, which is also involved in Darier disease. Lesions are generally benign, but they can be cosmetically distressing or prone to secondary infection or irritation.
Overview of Treatment
There is no definitive cure for AKV, but several treatment options are available to manage and reduce the appearance of lesions.
1. Topical Treatments
These are often first-line therapies for mild or localized cases:
Topical retinoids (e.g., tretinoin, adapalene)
Help normalize keratinization and reduce hyperkeratotic lesions
Salicylic acid (keratolytic agent)
Helps exfoliate thickened skin
Urea creams (keratolytic and moisturizing)
Help reduce scaling and soften skin
5-fluorouracil cream
Occasionally used for persistent lesions due to its antiproliferative effects
2. Systemic Treatments
For widespread or resistant lesions:
Oral retinoids (e.g., acitretin, isotretinoin)
Effective in reducing keratinization
Require careful monitoring for side effects (e.g., liver function, lipid profile)
3. Procedural Treatments
Used for isolated or bothersome lesions:
Cryotherapy (liquid nitrogen)
Freezes and destroys the lesion
Laser therapy (e.g., CO₂ laser, Er:YAG)
Ablative lasers can remove thickened lesions with good cosmetic outcomes
Electrosurgery or curettage
Physical removal, usually reserved for stubborn or solitary lesions
4. Photodynamic Therapy (PDT)
A newer option with limited but promising results
Involves applying a photosensitizer followed by light exposure to target abnormal cells
5. Genetic Counseling
Since AKV is often inherited, family screening and genetic counseling are recommended, especially in familial cases.
6. Monitoring & Follow-up
Long-term dermatologic follow-up is important
Rare reports of squamous cell carcinoma arising in AKV lesions suggest a need for vigilance, especially if lesions change or ulcerate
Note:
Treatment results can be variable, and relapse is common.
A dermatologist should tailor treatment based on the severity, location, and symptoms.