Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2022;12(3):e2022084 1 Dermatology Practical & Conceptual Dermoscopic View of Papular Acantholytic Dyskeratosis of the Genitocrural Region Dua Cebeci1, İlkay Can2, İbrahim Kobat3 1 Famagusta State Hospital Dermatology And Venerology Department, Famagusta, Cyprus 2 Balıkesir State Hospital Dermatology And Venerology Department, Balıkesir, Turkey 3 Famagusta State Hospital Pathology Department, Famagusta, Cyprus Key words: acantholytic dyskeratosis, genital region, domed papules Citation: Cebeci D, Can İ, Kobat İ. Dermoscopic view of papular Acantholytic Dyskeratosis (PAD) of the genitocrural region. Dermatol Pract Concept. 2022;12(3):e2022084. DOI: https://doi.org/10.5826/dpc.1203a84 Accepted: October 21, 2021; Published: July 2022 Copyright: ©2022 Cebeci et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding author: Dua Cebeci, Famagusta Stat Hospital, Famagusta, Cyprus, Telephone number : 05488586367 E-mail : perolidua@gmail.com Introduction Papular acantholytic dyskeratosis (PAD), also known as ac- antholytic dermatosis of the vulvocrural (or anogenital) re- gion is a rare skin disorder reported more common in women than men. Recent studies have revealed that mutations in the ATP2C1 gene, typically seen in Hailey-Hailey disease, are also detected in papular acantholytic dermatosis of the ano- genital region [1]. We report a case of a 49-year-old female with pruritic papular eruptions over the vulvocrural area. Histology of lesions revealed focal acantholysis with pres- ence of dyskeratotic cells resembling corps ronds and grains.  Case Presentation A 49-year-old female patient presented with persistent pru- ritic papular rash in both inguinal regions for 6 months. The patient applied to the obstetrics clinic with similar complaints and was referred to the dermatology clinic considering as condyloma. She had no history or family history of any skin disorder. Physical examination revealed multiple whitish pruritic papules with underlying erythematous patches in both inguinal regions (Figure 1A). No lesions were found at other locations and her nails were normal. KOH test was negative. Skin biopsy showed numerous typical acantholy- tic dyskeratotic cells in the stratum corneum and spinosum. There was also hyperkeratosis and irregular acanthosis in the epidermis and lymphocytic infiltration in the underlying dermis and no evidence of viral infection, dysplasia or ma- lignancy (Figure 2). Dermoscopic examination (×10 magni- fication in polarized mode) showed an irregular star-shaped (circled) brown pigmentation and globular domed brown papules (Figure 1B). Direct immunofluorescence or genetic studies were not performed. Clinical and histopathological PAD was present. 0.1% topical mometasone furoate and topical tacrolin 0.1 cream were started on the patient. The patient showed a minimal improvement and is still being fol- lowing up. Constent form was obtained from the patient. 2 Research Letter | Dermatol Pract Concept. 2022;12(3):e2022084 Figure 2. (a) Low-power view of a papule showing suprabasal cleft, dyskeratosis, and acantholytic cells (H&E, ×10). (b) High-power view of dyskeratotic acantholytic cells (corps ronds, H&E, ×40). Figure 1. (a) Multiple shiny whitish papules 2 mm to 3 mm in diameter in a cobblestone pattern on the medial aspect of the thigh, on the perineum, and in the perianal region. (b) Dermoscopic image showing brown pigmentation and globular domed brown papules. Conclusions Localized PAD to the genitocrural area is a rare and distinct clinical entity that was first described by Bernard Ackerman in 1972 as focal acantholytic dyskeratosis. The dermoscopic features of Hailey-Hailey and Darier disease been described before in several studies but the der- moscopic features of the reported cases of PAD have not been experienced. In Hailey-Hailey disease, the combination of pink and white areas was more prominent. Minor erosions and ulcerations may also accompany it. In contrast, polyg- onal, star-like, roundish-oval, whitish, yellowish areas with peripheral halos have been described in Dariers disease [2]. In this report, brown to gray hyperpigmented domed papules with a central hypopigmented core were the main dermoscopic findings. By reporting the dermoscopy of this case PAD, we would like to point out the usefulness of such dermoscopy in assisting the recognition of this entity. References 1. Al-Muriesh M, Abdul-Fattah B, Wang X, Zhao M, Chen S, Huang C. Papular acantholytic dyskeratosis of the anogenital and genitocrural area: case series and review of the literature. J Cutan Pathol. 2016;43(9):749-758. DOI: 10.1111/cup.12736. PMID: 27161553. 2. Kadiri S, Bay Bay H, Chaoui R, Douhi Z, Elloudi S, Mernissi FZ. Dermoscopy of Hailey - Hailey disease: Is it useful? Our Dermatol Online. 2020;11(e):e50.1-e50.2. DOI: 10.7241/ ourd.2020e.50.