Introduction
Acanthoma fissuratum is a rare skin condition with a history of chronic trauma. Acanthoma fissuratum has no gender or age preferences. The affected area of the acanthoma fissuratum has an established persistent trauma history. No granulomatous skin changes are obtained in acanthoma fissuratum. The exact etiology of the incidence of acanthoma fissuratum is unknown, but it is observed that acanthoma fissuratum has some predisposing factors. Some of the predisposing factors of acanthoma fissuratum are mentioned below.
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Ill-fitting spectacle frames.
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The weight of glasses.
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Concomitant skin disease.
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Abnormal anatomy contributes to the development of the lesions.
What Is Acanthoma Fissuratum?
In 1932, Sutton first described the cases of acanthoma fissuratum. The case's etiology presents a history of ill-fitting dentures at the superior labial alveolar sulcus. Another issue was characterized by Epstein, granuloma fissuratum of the ear. It was observed that the acanthoma fissuratum is commonly involved in the ear, including the retro auricular sulcus, superior auricular sulcus, and lateral aspect of the bridge of the nose near the inner canthus. Ill-fitting frames are the predisposing factor for acanthoma fissuratum in the ear. Other rarely involved areas of acanthoma fissuratum are the posterior fourchette of the vulva, penis, and outer auditory canal. The principal treatment of acanthoma fissuratum comprises the removal of the stimulus, which usually leads to the reversal of the lesion. However, other modalities can be performed, including surgical excision, intralesional corticosteroids, and electrosurgery. The other synonyms of acanthoma fissuratum are mentioned below.
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Spectacle frame granuloma.
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Granuloma fissuratum.
What Are the Causes of Acanthoma Fissuratum?
The accepted theory is that acanthoma fissuratum occurs due to chronic irritation. Friction and pressure at the contact site with the glasses frame cause acanthoma fissuratum in most cases. Factors that contribute to the development of acanthoma fissuratum include:
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Poorly fitted spectacle frames.
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Heavy frames.
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Pre-existing skin disease.
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Local anatomical abnormalities.
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The use of hearing aids.
What Are the Features of Acanthoma Fissuratum?
Classically, the symptoms of acanthoma fissuratum typically present as unilateral firm, folded coin-shaped lesions, flesh-colored papules, and nodules. Plaque with a central groove divides the lesion into two halves gaining a coffee bean appearance. The symptoms are often misdiagnosed with basal cell carcinoma and adnexal carcinoma. Histopathology shows acanthosis and hyperkeratosis with variable parakeratosis.
Color: Firm flesh-colored papule,
Appearance: Nodule, or plaque with a central furrow, a coffee bean appearance.
Other Symptoms: Painful, particularly if ulcerated.
Areas Involved: The lesions are located where the glasses rest on the individual's skin, most commonly, the lateral bridge of the nose or the retro auricular or superior auricular sulcus (behind the ear).
How to Diagnose Acanthoma Fissuratum?
The following tests and methods may be used to diagnose acanthoma fissuratum:
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Individual physical examination and medical history evaluation (a history of wearing spectacles is helpful in establishing the diagnosis)
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Dermoscopy: Dermoscopy is a diagnostic technique in which a dermatologist examines the skin with a magnifying lens.
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Wood's lamp analysis: The healthcare expert analyzes the skin using UV light during this treatment. It is used to examine changes in skin pigmentation.
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Biopsy of the skin: A biopsy of skin tissue is taken and sent to a laboratory for pathological analysis. Under a microscope, the pathologist analyzes the biopsy. The pathologist arrives at a definitive diagnosis after combining clinical data, specific research on tissues (if necessary), and microscopy findings.
A differential diagnosis may be used to exclude illnesses that have similar signs and symptoms, such as basal cell carcinoma. Although a skin tissue sample is not required, the dermatologist may recommend one depending on his or her clinical assessment. Many clinical disorders can have symptoms that are similar to one another. To arrive at a definitive diagnosis, a physician may order additional tests to rule out other clinical problems.
When a biopsy is performed or a lesion is removed, the following histological findings are observed:
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The epidermis has prominent acanthosis, minor ortho-hyperkeratosis, and hypergranulosis.
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Small, slightly dilated vascular proliferation in the papillary dermis, with varying patchy chronic inflammation in a fibrotic stroma backdrop.
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Rete ridges that are broad, blunt-ended, and centrally attenuated
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Spots of spongiosis and parakeratosis.
What Is the Differential Diagnosis of Acanthoma Fissuratum?
Some of the features of acanthoma fissuratum are similar to other skin conditions. The symptoms should not be misdiagnosed. Some of the differential diagnoses of acanthoma fissuratum are
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Adnexal carcinoma.
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Genital herpes.
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Neoplastic disorders.
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Bowen's disease.
Basal Cell Carcinoma
Basal cell carcinoma is a cancerous condition that causes lesions in the skin. These types of cancers are specific to the basal cells. The most commonly affected site on the skin receives a higher degree of exposure to the sun. In some patients, it can be a life-threatening condition. The advancements in the medical field have resulted in a complete cure for basal cell carcinoma. The lesions that are detected early have a higher chance of recovery.
Squamous Cell Carcinoma
Squamous cell carcinoma, SCC is a type of skin cancer that develops in the squamous cells, which are thin and flat cells that make up the outermost layer of the skin (epidermis). All places in the body containing squamous cells can be affected by this cancer. It is the second most common type of skin cancer, is relatively slow-growing and does not usually result in fatal complications if treated early. Prolonged sun or UV (ultra-violet) radiation exposure (tanning beds or lamps) is the most common cause of this type of skin cancer.
What Is the Treatment for Acanthoma Fissuratum?
Acanthoma fissuratum is an asymptomatic benign condition and does not require any treatment. The treatment is mainly done to maintain the cosmesis of the patient, and usually, the symptoms of acanthoma fissuratum will be resolved independently. The treatment methods for acanthoma fissuratum are mentioned below.
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Intralesional corticosteroid injection is administered.
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Recurrence is expected if the chronic stimulus continues.
How May Acanthoma Fissuratum Be Prevented?
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Acanthoma fissuratum can be avoided by wearing glasses that are comfortable, well-fitting, and light.
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Where possible, consider switching to contact lenses for a period of time to allow the skin lesions to heal.
Conclusion
Acanthoma fissuratum is a rare skin condition caused due to chronic stimulus on the skin. The exact etiology of the acanthoma fissuratum is unknown, and the symptoms are commonly due to the ill-fitting frames. Commonly seen in areas under skin friction and rarely affects the genitals. The symptoms of acanthoma fissuratum are benign and resolved independently. Treatment such as intralesional corticosteroid injection is administered mainly to improve the symptoms.
