Acrokeratosis verruciformis of Hopf exhibiting Darier disease-like cytological features

The relationship between acrokeratosis verruciformis (AVH; also known as Hopf disease) and Darier disease (DD) has been debated for several decades. There is still substantial controversy over the characterization and association of AVH with DD. Certain histopathological features overlapping with those of DD have been demonstrated in patients with AVH. Although cytological findings have been described in DD, no study has identified the cytological changes in AVH. We report a case of AVH exhibiting a DD-like cytological manifestation. The samples from the most prominent lesions were examined by split-skin smear test. Cytological examination showed acantholytic keratinocytes, dyskeratotic acantholytic cells, corps ronds and grains. Histopathological examination showed compact hyperkeratosis, hypergranulosis, slight acanthosis, circumscribed epidermal elevations resembling church spires, and a cleft in the granular layer with several acantholytic cells. Our case indicates that the cytological findings of AVH are similar to those of DD.