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Inflammatory Skin Diseases
Published in Aimilios Lallas, Zoe Apalla, Elizabeth Lazaridou, Dimitrios Ioannides, Theodosia Gkentsidi, Christina Fotiadou, Theocharis-Nektarios Kirtsios, Eirini Kyrmanidou, Konstantinos Lallas, Chryssoula Papageorgiou, Dermatoscopy A–Z, 2019
Aimilios Lallas, Zoe Apalla, Elizabeth Lazaridou, Dimitrios Ioannides, Theodosia Gkentsidi, Christina Fotiadou, Theocharis-Nektarios Kirtsios, Eirini Kyrmanidou, Konstantinos Lallas, Chryssoula Papageorgiou
Porokeratosis displays a pathognomonic dermatoscopic pattern consisting of two parts: the peripheral rim (corresponding to the cornoid lamella) and the atrophic center. The rim is a thin, well-defined, white-yellowish scale, continuous or broken in some parts (“white track”) (Figure 6.34). Occasionally, the peripheral rim is pigmented and slightly elevated, simulating the volcanic crater. The previously mentioned pattern allows a straightforward diagnosis of porokeratosis, even in clinically equivocal cases. In the central part of the lesion, the dermatoscopic criteria vary accordingly to the phase of evolution. In early active lesions, dotted and globular vessels prevail, while in the late stage, a central white color is present corresponding to dermal fibrosis/atrophy. Blue/gray dots or granules indicate resolving lesions.
Nail in dermatological diseases
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
Piyush Kumar, Niharika Ranjan Lal
There is no clear consensus on treatment for nail dystrophy associated with porokeratosis. Topical therapies such as keratolytics, retinoids, vitamin D derivatives, 5-flurouracil ointment, imiquimod cream, and diclofenac gel; systemic retinoids; locally destructive modalities like dermabrasion, cryotherapy, photodynamic therapy, and carbon dioxide laser; and surgical excision and skin grafting have been tried with variable success.15
Skin and soft tissue
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Porokeratosis is an uncommon AD inherited condition characterised by abnormal skin keratinisation that leads to malignant degeneration – risks ~7.5%–11%. Typical lesions are annular plaques with horny borders and flattened centres. There are various forms with disseminated superficial actinic porokeratosis (DSAP) being the most common. Experience with 5-FU, imiquimod, oral retinoids and PDT has been described, but none are entirely satisfactory.
Efficacy and safety of topical treatments for seborrheic keratoses: a systematic review
Published in Journal of Dermatological Treatment, 2023
Nicole Natarelli, Amanda Krenitsky, Kerry Hennessy, Sarah Moore, James Grichnik
Wijayanti et al. described a case in which remission was not obtained following four-week use of Tretinoin 0.05% cream (19). However, this case was atypical in that the multiple lesions mimicked porokeratosis, which may have impacted treatment efficacy. In addition, the lesions were only treated for four weeks, in comparison to four months as described by Herron et al. It is also necessary to note that the evidence reported by Wijayanti et al. is of the lowest quality as a single case report. Given the only moderate success and resulting irritation, it remains unlikely that vitamin A-based topical treatments would become accepted as a preferred alternative to current invasive approaches.
Punctate porokeratosis—pruritic and hyperkeratotic papules on the palms and feet
Published in Baylor University Medical Center Proceedings, 2020
Patrick Michael Jedlowski, Gina Rainwater, So Yeon Paek
On histopathology, porokeratosis is distinguished by characteristic coronoid lamellae, a parakeratotic column with loss of the granular layer and dyskeratotic keratinocytes.2 Diagnosis of PP is confirmed with biopsy; however, preliminary evaluation with dermoscopy may reveal annular, keratotic papules with central tan-brown globules and a “white-track” periphery that accentuates with the application of Gentian violet.3
Effective treatment of disseminated superficial actinic porokeratosis with chemical peels – customary treatment for a rare disease
Published in Journal of Dermatological Treatment, 2020
Berenice M. Lang, Adriane Peveling-Oberhag, Sebastian Zimmer, Joanna Wegner, Anna Sohn, Stephan Grabbe, Petra Staubach
Therapeutic efficacy is known to be difficult with multiple topical approaches while systemic treatment especially with retinoids may be effective but could come along with numerous side effects. Due to the rareness of the disease, randomized controlled trials are missing so far and only case reports and series are available. As a result, there is no authority-approved medication available and sufficient treatment protocols are missing. A resent review showed that multiple approaches to treat DSAP have been published, most of them with little success but all only in small numbers of patients (7). Most data are available for PDT. A case series with 13 patients treated with MAL-PDT and red light irradiation showed clinical response defined as reduction of more than 75% of lesions in 19% of patients (11). Fernandez-Guarino et al. reported six patients also treated with MAL-PDT. Here, only a slight reduction in roughness was seen in four patients (12). Aird et al. reviewed MAL-PDT treatment for DSAP and concluded that PDT was an unsuccessful treating modality showing only 33.3% improvement but comes along with multiple side effects (13). New PDT modalities include the use of daylight instead of red light. Two case series consisting of two patients each were published recently and showed good results but treatment regimens differed in the mentioned cases (14,15). For topical retinoids only one case report is available for DSAP reporting a modest effect after 3 months of treatment (16); systemical treatment with acitretin for 3 months was used in a child with disseminated porokeratosis as a clinical appearance of graft-vs.-host disease showing disease control for more than a year (17). Alitretinoin was reported to be effective in DSAP in a 4-month and a 7-month course (18). Arun et al. reported a complete remission of the disease with imiquimod 5% after one cycle of five times per week for 4 weeks but unfortunately follow-up was only 8 weeks (19). Ingenol mebutate 0.05% was reported to reduce symptoms in one patient (20). A case series with two patients showed good response to cryosurgery but the downside of this treatment option is that no larger area can be treated adequately (21). Slightly larger numbers of treated subjects are available in the literature for topical diclofenac (25 patients in two case series) and topical vitamin D3 analogs (eight patients in five case reports and one case series) but those options did not show any better outcome (7). The reported cases and case series are in line with the previous treatments of our patients who presented with a mean of four different previous therapies (range 2–6). While most topical remedies (imiquimod, ingenol mebutate, tretinoin) and cryosurgery did not show enough or long-lasting efficacy, systemic retinoids delivered good results but had to be stopped due to side effects such as depression, sicca syndrome and muscle pain in one of our patients.