Systemic 5-fluorouracil producing an inflammatory response in porokeratosis

Porokeratoses-A Comprehensive Review on the Genetics and Metabolomics, Imaging Methods and Management of Common Clinical Variants

Porokeratosis is a heterogeneous group of keratinising disorders characterised by the presence of particular microscopic structural changes, namely the presence of the cornoid lamella. This structure develops as a consequence of a defective isoprenoid pathway, critical for cholesterol synthesis. Commonly recognised variants include disseminated superficial actinic porokeratosis, disseminated superficial porokeratosis, porokeratosis of Mibelli, palmoplantar porokeratosis (including porokeratosis palmaris et plantaris disseminata and punctate porokeratosis), linear porokeratosis, verrucous porokeratosis (also known as genitogluteal porokeratosis), follicular porokeratosis and porokeratoma. Apart from the clinical presentation and epidemiology of each variant listed, this review aims at providing up-to-date information on the precise genetic background, introduces imaging methods facilitating the diagnosis (conventional and ultraviolet-induced fluorescence dermatoscopy, reflectance confocal microscopy and pathology), discusses their oncogenic potential and reviews the literature data on the efficacy of the treatment used, including the drugs directly targeting the isoprenoid-mevalonate pathway.

Recalcitrant Digital Porokeratosis of Mibelli: A Successful Surgical Treatment

Context:

Porokeratosis of Mibelli (PM) is a rare, benign, asymptomatic, epidermal hyperkeratinization dermatitis that is characterized by annular plaque that expands through the edges and leaves an atrophic center. Many therapies have been attempted for the treatment of PM, but none of these have given satisfactory results. The efficacies of treatment options are limited, and currently there is no gold standard.

Case Report:

This paper reports the case of a 22-year-old female with 3-years history of PM, who had not responded to routine therapies like topical corticosteroids, topical tretinoin, topical salicylic acid, and various emollients and keratolytic agent. Cryosurgery and laser ablation did not have acceptable response. We used surgical treatment with successful cosmetic outcome.

Conclusion:

The treatment of PM should be individualized considering the aesthetic and functionality, and the patient's preferences. Complete surgical excision for isolated digital PM had good results.

Facial follicular porokeratosis: a case report

Porokeratosis is a disorder of keratinization, characterized clinically by a peripheral keratotic ridge and histologically by the cornoid lamella. We describe a patient with follicular porokeratosis with a distinctive clinical presentation. We believe that follicular porokeratosis is a unique histopathologic variant of porokeratosis, with cornoid lamellae centered in follicular infundibula. Further, this is the only report of follicular porokeratosis involving the face exclusively.

Disseminated superficial actinic porokeratosis: a treatment review

Disseminated superficial actinic porokeratosis (DSAP) is a chronic disorder of keratinization characterized by numerous papules and plaques distributed over sun-exposed sites. Treatments are poorly standardized and several investigational therapies have demonstrated limited success in treating DSAP. To our knowledge, there have been no systematic reviews of the literature regarding the treatment of this disease. Herein, we review recent studies pertaining to the treatment of DSAP and evaluate the level of evidence for each of these therapeutic modalities.

The Use of Fluor-Hydroxy Pulse Peel in Actinic Porokeratosis

BACKGROUND

The use of Fluor-Hydroxy pulse peel (Drogaderma, Sao Paulo, Brazil) was reported by Katz to treat solar damage and actinic keratosis-associated lesions.

OBJECTIVE

The objective was to use this combined treatment to produce therapeutic and cosmetic benefits in a patient with actinic porokeratosis.

METHODS

A case of actinic disseminated porokeratosis was treated with a combination of a 70% glycolic peel and a 5% 5-fluorouracil solution (Drogaderma) every 2 weeks for 4 months. A biopsy was done before and after eight treatment pulses.

RESULTS

Improvement in the appearance and texture of the treated areas and decreased dyskeratosis and epidermal atypia.

CONCLUSION

The Fluor-Hydroxy pulse peel can be an effective alternative for the treatment of actinic porokeratosis.