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Acrokeratosis Paraneoplastica Medication

  • Author: Katherine R Garrity, MD; Chief Editor: William D James, MD  more...
 
Updated: Jan 06, 2015
 

Medication Summary

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

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Antipsoriatic Agent, Systemic

Acitretin (Soriatane)

 

Acitretin is a metabolite of etretinate and related to both retinoic acid and retinol (vitamin A). Its mechanism of action is unknown. However, it is thought to exert its therapeutic effect by modulating keratinocyte differentiation, keratinocyte hyperproliferation, and tissue infiltration by inflammatory cells.

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Antipsoriatic Agent, Topical

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

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Topical Skin Product

Calcipotriene (Dovonex)

 

Calcipotriene is a synthetic vitamin D-3 analog that regulates skin cell production and development. It inhibits epidermal proliferation, promotes keratinocyte differentiation, and has immunosuppressive effects on lymphoid cells. It is used in the treatment of moderate plaque psoriasis. Use 0.005% cream, ointment, or solution.

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Dietary Supplements

Cholecalciferol (Delta-D, Vitamin D-3)

 

Cholecalciferol stimulates the absorption of calcium and phosphate from the small intestine and promotes the release of calcium from bone into blood. It has antiproliferative and anti-inflammatory effects on skin.

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Corticosteroids

Betamethasone topical (Diprolene, Betatrex)

 

Betamethasone topical is for inflammatory dermatoses responsive to steroids. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.

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Mineral, Parenteral

Zinc

 

Zinc is a cofactor for more than 70 types of enzymes. It plays a role in many metabolic processes. A 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.

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Contributor Information and Disclosures
Author

Katherine R Garrity, MD Resident Physician, Department of Dermatology, University of Wisconsin School of Medicine and Public Health

Katherine R Garrity, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel D Bennett, MD Assistant Professor, Department of Dermatology, University of Wisconsin School of Medicine and Public Health

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

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

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

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate 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, Texas Dermatological Society

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, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Karen D Allen, MD Consulting Dermatologist, Private Practice

Karen D Allen, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Cary Chisholm, MD Dermatopathology Fellow, Department of Dermatology, University of Texas Southwestern Medical Center

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.

References
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  7. Ljubenovic MS, Ljubenovic DB, Binic II, Jankovic AS, Jovanovic DL. Acrokeratosis paraneoplastica (Bazex syndrome). Indian J Dermatol Venereol Leprol. 2009 May-Jun. 75(3):329. [Medline].

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Acrokeratosis paraneoplastica. 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.
Acrokeratosis paraneoplastica. 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).
 
 
 
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