Acanthoma fissuratum
Acanthoma fissuratum, also called granuloma fissuratum or spectacle frame acanthoma, is a benign skin lesion caused by reactive epidermal hyperplasia. It develops from persistent, repeated friction and pressure where the skin is in direct contact with the nose pads or earpieces of a pair of glasses.
Mechanical Pressure and Local Micro-ischemia
- Constant pressure and friction: Ongoing pressure from frames that fit poorly, are too heavy, or have off-center nose pads creates mechanical shear stress on the epidermis. This compresses the superficial capillary network in the papillary dermis, starving the area of blood supply at a microscopic level.
- A central fissure forms: At the point of maximum pressure, keratinocytes lose their attachments and a small fissure or ulcer opens up along the line where the frame touches the skin.
- Compensatory thickening on both sides: In response to the split and the chronic friction, keratinocytes on either side of the fissure divide rapidly, building raised bands of thickened epidermis that hug the central groove.
The Two-Part "Coffee Bean" Structure
The combination of a split down the middle and thickened ridges on both edges gives the lesion a very distinctive clinical and microscopic appearance: a round or oval bump divided by a narrow vertical groove, much like a coffee bean or two bread rolls pressed together.
At Haute-Derma, our approach to acanthoma fissuratum combines complete removal of the mechanical pressure with repair of the damaged skin microstructure. Using digital dermoscopy and high-frequency skin ultrasound, our doctors measure the depth of the fissure and assess the surrounding vascular inflammation to rule out malignancy. Treatment starts by eliminating the source of pressure, followed by Vbeam Perfecta laser to close the inflamed, proliferating vessels, gentle fractional Er:YAG laser to resurface the thickened edges, and PDRN injections to regenerate tissue. Together, these heal the lesion, close the fissure and restore a smooth, natural skin surface without invasive surgery.
Histopathology and Dermoscopic Diagnostic Criteria
Characteristic Microscopic Findings
Under the microscope, acanthoma fissuratum clearly shows its nature as a symmetrical, reactive overgrowth:
- Central fissure (cleft): A V- or U-shaped defect in the epidermis that dips down into the papillary dermis. The groove is lined by parakeratosis or by necrotic fibrin crust.
- Symmetrical acanthosis: On both sides of the fissure, the epidermis is markedly thickened and raised, with elongated rete ridges but no atypia or loss of maturation.
- Chronic dermal inflammation: Just beneath the fissure, the superficial dermis contains an inflammatory infiltrate of lymphocytes, plasma cells and histiocytes, along with new blood vessel formation.
- Intact basement membrane: The basement membrane is fully intact, with no sign of destruction or of keratinocytes invading deeper tissue.
Dermoscopic Diagnostic Criteria
Digital dermoscopy at Haute-Derma reveals the characteristic features:
- "Coffee bean" or "sandwich" pattern: Two pale pink or creamy yellow raised edges flank a bright red or gray-brown linear groove in the center.
- Central linear cleft: White-yellow crust or streaks of dried blood are clearly visible along the groove.
- Dotted and short linear vessels: Mildly dilated capillaries are evenly spread over the pink background of the two thickened ridges, reflecting friction-induced microvascular inflammation.
Clinical Features
- Appearance: A firm, well-defined papule or raised plaque that is skin-colored, pale pink or mildly red, split down the middle by a narrow fissure.
- Typical locations:
- Retroauricular fold / superior auricular crease: From pressure of the earpieces.
- Side of the nasal bridge: Where the two nose pads rest.
- Symptoms: Usually mildly painful or stinging whenever glasses are worn or the area is pressed. It may bleed slightly if rubbed hard.
Clinical and Histologic Differential Diagnosis
| Acanthoma Fissuratum | Basal Cell Carcinoma (BCC) | Winkler Disease (CNH) |
|---|---|---|
| Mechanical friction and pressure from glasses | UV-induced gene mutations | Local ischemia of the ear perichondrium |
| Coffee-bean pattern (2 raised edges, 1 groove) | Arborizing vessels, leaf-like areas | Volcano pattern, centripetal vessels |
| Contact points of frames / nose pads | Any sun-exposed skin | Helical rim (cartilage) |
| Intact basement membrane, no cartilage damage | Invades and destroys the basement membrane | Focal perichondrial necrosis |
| Benign | Locally malignant | Benign |
Pressure Relief and Regenerative Treatment at Haute-Derma
Our treatment strategy for acanthoma fissuratum removes the underlying mechanical pressure and rebuilds the skin's microstructure so the lesion heals naturally without a scar:
Vascular Assessment and Pressure Relief
- Assessing the lesion: Dermoscopy and 20–50 MHz skin ultrasound measure the depth of the fissure and pinpoint the exact pressure point.
- Removing the pressure: Patients are asked to have their frames adjusted, switch to soft medical-grade silicone nose pads, or temporarily wear contact lenses or lighter frames so the pressure is fully removed.
Fractional Laser Treatment of the Thickened Edges
- Vbeam Perfecta 595 nm laser: Applied directly to the fissure and both thickened edges to close dilated capillaries and settle the chronic inflammation.
Er:YAG 2940 nm laser (leveling the raised edges): Precisely vaporizes the thickened acanthotic borders layer by layer, bringing the lesion level with the surrounding skin without harming the healthy tissue beneath.
Biological Repair and Filling the Fissure
- Regenerative micro-injections: Stem cell exosomes plus salmon DNA PDRN are micro-injected directly into the fissure to stimulate fibroblasts to make collagen and fill the epidermal defect.
- Protective dressing: A thin, transparent hydrocolloid patch is placed where the glasses sit to protect the lesion from accidental friction during daily activities.
