A case of multiple warty dyskeratomas overexpressing SERCA2 in acantholytic cells

A 60-year-old Japanese woman had a history of acneiform rashes and pruritus from age 20. She had sought medical attention at the age of 49 due to the progressive enlargement of the lesions. Despite various therapeutic interventions, including topical steroids and oral cyclosporine, the condition continued to worsen. Upon examination at age 60, erythematous areas with hyperkeratotic nodules were noted, and a dermoscopic evaluation revealed keratin plugs within the hair follicles. A histopathological analysis showed suprabasal acantholysis, with grains and corps ronds dispersed throughout the lesions. Genetic testing identified a non-pathogenic variant in ATP2A2, which effectively excluded Darier's disease. We made the final diagnosis of warty dyskeratomas (WD). Human papillomavirus was not implicated. Notably, immunohistochemical analyses revealed the overexpression of SERCA2, which further supported the diagnosis of WD rather than Darier's disease. WD is a rare, benign, dermatological condition that typically affects middle-aged women and is often localized to the scalp. While histologically similar to Darier's disease, WD lacks the pathogenic mutations in ATP2A2. Ultimately, the diagnosis of WD was confirmed in our patient through a comprehensive assessment of clinical, histopathological, and genetic findings.