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Dr. Alpana Mohta Ranka, MD, DNB, IFAAD, is a triple-board-certified dermatologist with over 100 research publications in peer-reviewed scientific journals.


Porokeratosis Histopathology: A Deep Dive into the Histological Findings

Porokeratosis recognized as a benign epithelial tumor, can appear in various clinical forms. It might show up as solitary lesions, multiple growths, or even specific patterns in certain clinical subtypes. A consistent histological pattern defines porokeratosis, offering deep insights into its characteristics.

Histological Characteristics of Porokeratosis

The cornoid lamella is the central histological feature in porokeratosis. Refer to Figure 1. It consists of a column of parakeratotic cells above a narrow vertical area filled with dyskeratotic and vacuolated epidermal cells.

This trait mirrors the clinically evident raised edge of the lesion. When observed under minimal magnification, porokeratosis presents as a hyperkeratotic lesion. It has a clear parakeratotic column on its periphery, possibly two if the entire lesion is considered. This structure also exhibits mild lymphocytic infiltrate, frequently with an augmented count of capillaries in the dermal layer beneath.

Cornoid lamella in a porokeratosis lesion histology slide
Figure 1: Cornoid lamella comprising of a column of parakeratotic cells overlaying a narrow vertical area of dyskeratotic and vacuolated cells within the epidermis (H and E, 100x).

Different Histological Manifestations of Porokeratosis

Classic Form: Porokeratosis of Mibelli

Features: Possible dip in the epidermis located underneath the cornoid lamella.

Actinic Variant: Disseminated Superficial Actinic Porokeratosis

Features: Slender skin layer between two cornoid lamellae. It often reveals pronounced lichenoid or superficial perivascular lymphocytic infiltration.

Unique Pattern: Porokeratosis Ptychotropica

Features: Under minimal magnification, this type displays multiple cornoid lamellae at various epidermal depths and angles. Often, dermal amyloid deposits are evident, especially in areas near folds, hinting at the possible involvement of friction.

Multiple Features: Linear and Reticulate Porokeratosis

Features: Both these variants showcase numerous cornoid lamellae.

Adnexal Variant: Porokeratotic Adnexal Ostial Nevus

Features: Distinct presence of cornoid lamellae over sweat glands or hair follicle openings.

Hyperkeratotic Variant: Verrucous Porokeratosis

Features: Pronounced hyperkeratosis might sometimes hide the cornoid lamella. It's essential to note the differences between this and porokeratosis ptychotropica.

Colorful Presentation: Pigmented Porokeratosis

Features: Appears clinically as a colored lesion. Histologically, it presents with melanocyte proliferation and melanophages in the dermis. The boundary at the cornoid lamella can be highlighted with melanocyte markers.

Key Takeaway

The most crucial aspect to recognize in porokeratosis histology is the presence of a cornoid lamella. This feature, a parakeratotic column overlying an area of dyskeratotic and vacuolated cells in the epidermis, represents the clinically visible raised margin of the lesion. Recognizing this characteristic is pivotal for an accurate diagnosis of porokeratosis.


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