Acrokeratosis verruciformis of Hopf is a localized disorder of keratinization affecting the distal extremities. It develops during infancy or early childhood with no sexual predilection. The disease seems to be inherited in an autosomal dominant fashion. We describe a 55-year-old male with multiple, flat-topped papules on the left dorsum of the hand. The histologic findings showed marked hyperkeratosis, acanthosis, papillomatosis of the epidermis and circumscribed elevation of the epidermis which characteristically resembled "church spires". This case is unusual in that the patient had late onset of the lesions and no family history of the condition.
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