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acquired digital fibrokeratoma

Published: September 18, 2026Updated: September 18, 2026

Important: Informational content intended for healthcare professionals. It does not replace clinical evaluation or establish a doctor-patient relationship.

Overview

  • Definition and synonyms
    • A benign, fibrous, keratotic skin tumor that originates in the acral dermis and presents as a small, solitary, firm papule or nodule, almost always on the fingers or toes, with a characteristic hyperkeratotic collarette at the base. Kint 1985 , Shih 2019 , Wang 2024 , Navea 2023
    • Alternative names:
      • Acquired digital fibrokeratoma (ADF)
      • Acquired digital fibrokeratoma (ADF)
      • Acquired acral fibrokeratoma
      • Acquired periungual/epiungual fibrokeratoma (when it involves the nail apparatus) Lencastre 2019 , Göktay 2015
  • History
    • The entity was defined as a specific tumor of the fingers by Bart et al. in 1968, in a classic case series. Bart 1968
    • Subsequent studies (Kint 1985) characterized its histology in detail and established it as a benign neoplasm with collagen neoformation by fibroblasts. Kint 1985
  • Epidemiology
    • Rare tumor; the true incidence is unknown and most data come from small series and isolated cases. Shih 2019 , Wang 2024
    • It is most prevalent in middle-aged adults (mean age ~40–50 years), with a slight male predominance. Kint 1985 , Wang 2024
    • Location: the vast majority on fingers or toes (periungual or not), rarely on soles or heels. Bart 1968 , Shih 2019 , Navea 2023
    • Pediatric cases are exceptional; one case has been reported in a 6-year-old child, probably the youngest described. Vance 2025
  • ICD-10 and ICD-11 codes (guideline)
    • ICD-10-CM : usually coded within D23.x – Other benign skin tumors , selecting subcategory by location (upper limb, lower limb, etc.), as there is no specific code for FQDA.
    • ICD-11 : It is located within group 2F8 – Benign skin neoplasms , adjusted by anatomical region (hand, foot).
  • Diagnostic checklist (quick)
    • Essential clinic
      • Solitary acral (finger/toe) papule/nodule, firm, <1–1.5 cm.
      • Skin-colored or pink, with a hyperkeratotic collarette at the base.
      • Slow evolution (months-years), generally asymptomatic.
      • Typical location: back/side of finger or periungual region.
    • Data that reinforces the diagnosis
      • Absence of intense pain typical of glomus.
      • Absence of easy bleeding like pyogenic granuloma.
      • There are no multiple periungual lesions (if present, assess for Koenen/tuberous sclerosis).
    • Minimum paraclinical tests
      • Dermoscopy (optional): homogeneous whitish-pink central area ± fine vessels, hyperkeratotic border. Shih 2019
      • No specific laboratory tests are required.
    • Biopsy
      • Excisional biopsy or deep shave including the implantation base and deep dermis.
      • Histology: hyperkeratosis, acanthosis, thick vertical collagen, soft fibroblasts, fine capillaries, no significant atypia . Kint 1985 , Wang 2024
      • IHC (if in doubt): Factor XIIIa+, CD34– or minimal; HPV– if wart is suspected. McNiff 2005 , Göktay 2015

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