Porokeratosis Treatment & Management

  • Author: Linda V Spencer, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 7, 2010
 

Medical Care

The approach to treatment must be individualized, based on the size of the lesion and the anatomical location, the functional and aesthetic considerations, the risk of malignancy, and the patient's preference. Protection from the sun, use of emollients, and watchful observation for signs of malignant degeneration may be all that is needed for many patients. If lesions are widespread and medical treatment is desired, several medications have potential benefit.

Topical 5-fluorouracil

Topical 5-fluorouracil can induce remission in all forms of porokeratosis.[23, 24] Treatment must be continued until a brisk inflammatory reaction is obtained. Enhancement of penetration, which heightens the response, may be achieved by occlusion or the addition of topical tretinoin, tazarotene, or salicylic acid.[25] Recurrences may be seen.

Topical vitamin D-3 analogues

Both calcipotriol and tacalcitol have been shown to be effective after 3-6 months of treatment of disseminated superficial actinic porokeratosis (DSAP).[26, 27]

Immunomodulators

Topical imiquimod 5% cream has been shown to be effective for treating classic porokeratosis of Mibelli (PM).[28]

Oral retinoids

The use of oral retinoids (isotretinoin, etretinate, and acitretin) in patients who are immunosuppressed, who are at higher risk for malignant degeneration, may reduce the risk of carcinoma in porokeratotic lesions.

  • Oral isotretinoin at 20 mg daily combined with topical 5-fluorouracil is reported to be effective for DSAP and porokeratosis palmaris et plantaris disseminata (PPPD), but it causes burning, itching, and painful erosions.
  • Prior to the removal of etretinate from the US market, conflicting reports of etretinate efficacy were published. Reports of etretinate efficacy are conflicting. Etretinate at doses of 75 mg/d for 1 week followed by 50 mg/d was shown to be helpful in linear porokeratosis and symptomatic PM. Higher doses of 1 mg/kg/d were reported to exacerbate lesions of DSAP after 4-6 weeks of treatment.[29] Even when etretinate therapy is successful, relapses may occur. Digitate keratoses were reported to develop after the use of etretinate for DSAP.[30]
  • Acitretin, a second-generation monoaromatic retinoid that is the active metabolite of etretinate, is likely to have results similar to those of etretinate. However, a case of systematized linear porokeratosis with good response to acitretin has been reported.[31]
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Surgical Care

Surgical treatment is essential for porokeratosis lesions that have undergone malignant transformation. No studies showing the value of prophylactic nonexcisional surgical treatment in reducing the incidence of malignancy within porokeratosis have been reported. Surgical modalities other than excision may improve cosmesis and/or function but are frequently followed by relapses.

  • Excision is most appropriate when malignant degeneration develops.
  • Cryotherapy is helpful for porokeratosis lesions with minimally raised cornoid lamellae, such as DSAP and PPPD. It is a minimally invasive method of inducing resolution for large numbers of lesions.
  • Electrodesiccation and curettage can be used to treat small lesions or when cryosurgery is ineffective.
  • Diamond fraise dermabrasion has been used with conflicting reports of efficacy. It was effective in improving the appearance of linear porokeratosis in one patient, but a child with a large PM lesion had recurrence after treatment.[32]
  • Various types of laser therapy have been used. A rapid recurrence reportedly followed carbon dioxide laser ablation. The 585 nm flashlamp-pumped pulsed dye laser was shown to help one patient with linear porokeratosis. Another patient with PM with an underlying hemangioma had good improvement of the hemangioma but no change in the porokeratosis after treatment. The frequency-doubled Nd:YAG laser was shown to be helpful for one patient with disseminated superficial porokeratosis (DSP). The Q-switched ruby laser has been reported to be effective in the treatment of DSAP.[33]
  • Ultrasonic surgical aspiration was shown to be effective in the treatment of vulvar porokeratosis in one patient.
  • Photodynamic therapy with methyl aminolevulinate has been reported to be successful for DSAP and linear porokeratosis.[34]
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Contributor Information and Disclosures
Author

Linda V Spencer, MD  Consulting Staff, Department of Dermatology, St Clare Medical Center

Linda V Spencer, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, and Indiana State Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Marjan Garmyn, MD, PhD  Professor, Faculty of Medicine, Katholieke Universiteit Leuven, Belgium; Chair and Adjunct Head, Department of Dermatology, University of Leuven, Belgium

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD  Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Consulting fee Consulting; Celgene Honoraria Safety monitoring committee; GSK - Glaxo Smith Kline Consulting fee Consulting; TenXBioPharma Consulting fee Safety Monitoring committee

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Porokeratosis of Mibelli on the lower leg in a renal transplant recipient.
Disseminated superficial actinic porokeratosis on the lower legs of a female patient.
A 42-year-old woman with multiple lesions on the pretibial aspects of the legs.
A young boy with a linear lesion of porokeratotic eccrine ostial and dermal duct nevus extending onto the nailbed, causing pterygium formation.
 
 
 
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