Acanthosis Palmaris

What are tripe palms?

Tripe palms are characterised by thickened velvety palms that have the appearance of tripe, the stomach lining of beef, pork, or sheep. Approximately 90% of cases of tripe palms are associated with internal malignancy. This skin disease is very rare. It usually occurs before the diagnosis of the cancer, but may arise during any point in the course of the malignancy.

Tripe palms are also known as acanthosis palmaris and acquired pachydermatoglyphia. 

What is the cause of tripe palms?

The cause of tripe palms is not clearly understood but is thought that it is due to substances from the associated cancer that stimulate the palmar skin cells to proliferate.

Tripe palms are frequently seen in conjunction with acanthosis nigricans. In these cases, the underlying malignancy is most commonly stomach (35%) or lung (11%) cancer. In cases where tripe palms occur without acanthosis nigricans, lung cancers are usually responsible. Less commonly associated cancers include head and neck tumours, and tumours of the genitourinary tract.

Tripe palms are less frequently associated with bullous pemphigoid, psoriasis, and exfoliative dermatitis.

How is the diagnosis made?

The diagnosis is made from the characteristic appearance of tripe palms. Scaling and skin thickening may be noted on skin biopsy but these are are non-specific histological findings.

In over 40% of patients, tripe palms are the first sign of an undiagnosed cancer, hence all patients should undergo a full diagnostic workup for an associated malignancy, particularly lung or gastrointestinal carcinoma.

What is the treatment for tripe palms?

Patients with tripe palms need to undergo medical examination, appropriate blood tests and X-rays to check for internal malignancies.

There is no specific treatment for tripe palms. It has been reported that approximately 30% of cases resolve once the underlying cancer is treated. However, tripe palms inconsistently respond to successful therapy and may persist for many years despite remission of the underlying cancer.