Acquired Digital Fibrokeratoma (ADFK): Acral Fibrokeratoma…

In 1968 Bart, et al described 10 cases of an acquired growth that was located on the fingers.  Alothough clinically these lesions resembled a cutaneous horn or a rudimentary digit, they had distinct histologic features.  He suggested the name Acquired Digital Fibrokeratoma (ADFK).  Subsequently Pinkus described 28 more cases but some of these patients had lesions not only involving the fingers but also the proximal hand (see below), toes, sole and prepetellar region.  For this reason Verallo recommended calling this condition Acral Fibrokeratoma.


The lesions are characterized by a pinkish, hyperkeratotic, hornlike projection occurring on a finger, toe, palm, or sole.  The projection usually emerges from a collarette of elevated skin.  The average age of onset around is around 40 years.  They often resemble a rudimentary or supernummerary digit, cutaneous horn or neuroma.  They are easy to distinguish from warts in that they lack the verrucous surface changes observed in warts.  Onset during immuosuppressive therapy has been reported and grouped lesions may occur.  Multiple periungual lesions are often associated with Tuberous Sclerosis.  I have removed these by simple shave biopsy, matching the contours of the skin as closely as possible.  They heal fine leaving little scarring.  To read more about ADFK click HERE and HERE.