Acrokeratosis Neoplastica Medication

Author: Cary Chisholm, MD; Chief Editor: William D James, MD more...

Updated: Mar 21, 2012

What would you like to print?

Medication Summary
Antipsoriatic Agent, Systemic
Antipsoriatic Agent, Topical
Topical Skin Product
Dietary Supplements
Corticosteroids
Mineral, Parenteral
Show All

Medication Summary

The goal of pharmacotherapy in acrokeratosis neoplastica is to improve scaly lesions, reduce morbidity, and prevent complications.

Antipsoriatic Agent, Systemic

View full drug information

Acitretin (Soriatane)

Metabolite of etretinate and related to both retinoic acid and retinol (vitamin A). Mechanism of action unknown. However, thought to exert therapeutic effect by modulating keratinocyte differentiation, keratinocyte hyperproliferation, and tissue infiltration by inflammatory cells.

Antipsoriatic Agent, Topical

View full drug information

Salicylic acid topical

By dissolving the intercellular cement substance, salicylic acid produces desquamation of the horny layer of skin while not affecting structure of viable epidermis.

Hydrate skin and enhance effects of medication by soaking affected area in warm water for 5 min prior to use. Remove any loose tissue with brush, wash cloth, or emery board and dry thoroughly. Improvement should generally occur in 1-2 wk.

Topical Skin Product

View full drug information

Calcipotriene (Dovonex)

Synthetic vitamin D-3 analog that regulates skin cell production and development. Inhibits epidermal proliferation, promotes keratinocyte differentiation, and has immunosuppressive effects on lymphoid cells. Used in the treatment of moderate plaque psoriasis. Use 0.005% cream, ointment, or solution.

Dietary Supplements

View full drug information

Cholecalciferol (Delta-D, Vitamin D-3)

Stimulates absorption of calcium and phosphate from small intestine and promotes release of calcium from bone into blood. Antiproliferative and anti-inflammatory effects on skin.

Corticosteroids

View full drug information

Betamethasone topical (Diprolene, Betatrex)

For inflammatory dermatosis responsive to steroids. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability.

Mineral, Parenteral

View full drug information

Zinc

Cofactor for more than 70 types of enzymes. Plays a role in many metabolic processes. Higher requirement may be indicated in pregnancy.

Use the sulfate or gluconate zinc salts. Zinc sulfate 4.4 mg = 1 mg of elemental zinc. Zinc gluconate 7.1 mg = 1 mg of elemental zinc.

Proceed to Follow-up

Contributor Information and Disclosures

Author

Cary Chisholm, MD Resident Physician, Department of Pathology, Texas A&M Health Science Center College of Medicine

Cary Chisholm, MD is a member of the following medical societies: College of American Pathologists, Texas Medical Association, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel D Bennett MD, Assistant Professor

Daniel D Bennett is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Dermatology Foundation, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Jean-Hilaire Saurat, MD Chair, Professor, Department of Dermatology, University of Geneva, Switzerland

Jean-Hilaire Saurat, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

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

Disclosure: Nothing to disclose.

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

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Karen Allen, MD, to the development and writing of this article.

References

Taher M, Grewal P, Gunn B, Tonkin K, Lauzon G. Acrokeratosis paraneoplastica (Bazex syndrome) presenting in a patient with metastatic breast carcinoma: possible etiologic role of zinc. J Cutan Med Surg. Mar-Apr 2007;11(2):78-83. [Medline].
Karabulut AA, Sahin S, Sahin M, Eksioglu M, Ustün H. Paraneoplastic acrokeratosis of Bazex (Bazex's syndrome): report of a female case associated with cholangiocarcinoma and review of the published work. J Dermatol. Dec 2006;33(12):850-4. [Medline].
Taher M, Grewal P, Gunn B, Tonkin K, Lauzon G. Acrokeratosis paraneoplastica (Bazex syndrome) presenting in a patient with metastatic breast carcinoma: possible etiologic role of zinc. J Cutan Med Surg. Mar-Apr 2007;11(2):78-83. [Medline].
Valdivielso M, Longo I, Suarez R, Huerta M, Lazaro P. Acrokeratosis paraneoplastica: Bazex syndrome. J Eur Acad Dermatol Venereol. May 2005;19(3):340-4. [Medline].
Crucitti A, Feliciani C, Grossi U, La Greca A, Porziella V, Giustacchini P. Paraneoplastic acrokeratosis (bazex syndrome) in lung cancer. J Clin Oncol. Dec 20 2009;27(36):e266-8. [Medline].
Ljubenovic MS, Ljubenovic DB, Binic II, Jankovic AS, Jovanovic DL. Acrokeratosis paraneoplastica (Bazex syndrome). Indian J Dermatol Venereol Leprol. May-Jun 2009;75(3):329. [Medline].
Chapireau D, Adlam D, Cameron M, et al. Paraneoplastic syndromes in patients with primary oral cancers: A systematic review. Br J Oral Maxillofacial Surg. 2009;epub ahead of print.
da Rosa ACM, Pinto GM, Bortoluzzi JS, et al. Three simultaneous paraneoplastic manifestations (ichthyosis acquisita, Bazex syndrome, and Leser-Trelat sign) with prostate adenocarcinoma. J Am Acad Dermatol. 2009;61:538-540.
Sator PG, Breier F, Gschnait F. Acrokeratosis paraneoplastica (Bazex's syndrome): association with liposarcoma. J Am Acad Dermatol. Dec 2006;55(6):1103-5. [Medline].
Chave TA, Bamford WM, Harman KE. Acrokeratosis paraneoplastica associated with recurrent metastatic thymic carcinoma. Clin Exp Dermatol. Jul 2004;29(4):430-2. [Medline].
Ali M, Keir M, Dodd H, Cerio R. Flexural Bazex syndrome associated with tonsillar adenocarcinoma. J Drugs Dermatol. Sep-Oct 2004;3(5):557-9. [Medline].
Cabanillas M, Perez-Perez L, Sanchez-Aguilar D, Fernandez-Redondo V, Toribio J. [Acrokeratosis paraneoplastica with bullous lesions associated with esophageal squamous cell carcinoma]. Actas Dermosifiliogr. Apr 2006;97(3):196-9. [Medline].
Fasanmade A, Farrell K, Perkins CS. Bazex syndrome (acrokeratosis paraneoplastica): persistence of cutaneous lesions after successful treatment of an associated oropharyngeal neoplasm. Br J Oral Maxillofac Surg. Mar 2009;47(2):138-9. [Medline].
Medenica L, Gajic-Veljic M, Škiljevic D, et al. Acrokeratosis paraneoplastica Bazex syndrome associated with eophageal squamocellular carcinoma. Vojnosanit Pregl. 2008;65:485-487.

Acrokeratosis neoplastica. A 67-year-old woman presented with scaly plaques of the hands, feet, ears, and nose associated with esophageal squamous cell carcinoma. The eruption resolved with resection of the cancer. Image courtesy of Ronald Grimwood, MD.

Bazex syndrome. Acquired palmar keratoderma in a woman with a history of breast cancer and recent primary lung cancer. Courtesy of Jeffrey J. Meffert, MD.

Bazex syndrome. Violaceous psoriasiform dermatitis on the ankles. Lung cancer appeared to be in remission; both keratoderma and psoriasiform plaques resolved quickly with clobetasol ointment. Courtesy of Jeffrey J. Meffert, MD.

At this power, a patchy lichenoid infiltrate of predominantly lymphocytes can be seen underneath an epidermis with psoriasiform hyperplasia and serum crust in the parakeratotic cornified layer (hematoxylin and eosin, 100X).

Focal vacuolar interface change is seen with associated pigment incontinence and exocytosis of lymphocytes (hematoxylin and eosin, 200X).

View Table List

Read more about Acrokeratosis Neoplastica on Medscape

About Medscape Reference

[ CLOSE WINDOW ]

About Medscape Reference

Medscape Reference is the most authoritative and accessible point-of-care medical reference for physicians and health care professionals. All content is available free of charge, both online and via mobile devices.

Medscape Reference articles represent the expertise and practical knowledge of top physicians and pharmacists from leading academic medical centers in the US and worldwide. In addition, our rigorous literature survey process allows us to rapidly integrate new practice-changing information into the relevant topics by systematically reviewing the major medical and pharmacy journals, news announcements, and important practice guidelines.

Medscape Reference provides comprehensive coverage across more than 30 medical specialties and is composed of the following areas:

Diseases and Conditions

More than 6,300 evidence-based and physician-reviewed disease and condition articles are organized to rapidly and comprehensively answer clinical questions, as well as to provide in-depth information in support of diagnosis, treatment, and other clinical decision-making. Topics are richly illustrated with more than 30,000 clinical photos and radiographic images.

Procedures

More than 650 clinical procedure articles provide clear, step-by-step instructions, and include instructional videos and images to allow clinicians to master the newest techniques or to improve their skills in procedures they have previously performed.

Drugs

More than 2,100 monographs, including prescription and over-the-counter drugs, plus over 5,000 corresponding brand-name drugs, herbals, and supplements, are provided. Drug images and pricing are also included. In addition, a Drug Interaction Checker provides rapid access to tens of thousands of interactions between brand and generic drugs, over-the-counter drugs, and herbals and supplements.

Anatomy

More than 70 anatomy articles feature clinical images and diagrams of the major human body systems and organs. The articles assist with the understanding of the anatomy involved in treating specific conditions and performing procedures. They can also facilitate physician-patient discussions.

Special Features
Best Evidence

This email newsletter features current and clinically relevant journal citations that are selected via our rigorous literature survey review process. These same citations are incorporated into the relevant Medscape Reference articles. This newsletter serves as a quick and easily accessible way to stay up to date with clinically relevant journal articles that impact clinical practice.

Case Studies

These challenging and classic case presentations provide a quick way for practicing physicians to sharpen their diagnostic and patient-management skills. Each case starts with how the patient presented in the clinic and then using a question and answer format, progresses through diagnosis and on to treatment and includes follow up information about outcome for the patient.

Image collections

Image collections are a visually-engaging presentation of both common and uncommon diseases, case presentations, and current controversies in medicine. They are presented in an image rich, slideshow format and are designed to challenge and expand physicians' knowledge of clinically important topics.

Medscape is the leading online destination for healthcare professionals for clinical information. In addition to clinical reference tools, Medscape also offers:

Medscape News Learn more
Medscape Education Learn more