Retention hyperkeratosis over surgical scar: case report and review of literature

Background: Retention hyperkeratosis (RHK) is benign and commonly seen skin condition in dermatology clinics. Hyperkeratosis refers to the increased thickness of the outermost layer of skin stratum corneum. RHK occurs when there is abnormality of routine desquamation that can be associated with poor hygiene. There are various types of hyperkeratosis, and could be divided according to their etiology. Although RHK is commonly recognized by dermatologists it is rarely reported. To the best of our knowledge, this is the first reported case of RHK over surgical scar. Case Description: A 63-year-old male presented to our dermatology clinic with severe RHK over a midline sternotomy scar post-coronary artery bypass grafting (post-CABG) in which he developed over the past 8 years. Our patient's history was significant in avoiding touching the surgical area as he feared disturbing the healing process of his surgical wound We discussed in details as further examination and investigations took a place on clinic-base during his management. Conclusions: Since RHK is associated with poor hygiene as we have seen in our patient's case, it could be prevented by providing the patient instructions regarding his wound care and general hygiene postoperatively and management of hyperkeratosis differs depending on type, severity, and chronicity. Our case represents a rare extreme manifestation related to the fear of our patient cleaning surgical wounds.