Porokeratosis Medication

Updated: Sep 24, 2018
  • Author: Amarateedha Prak LeCourt, MD; Chief Editor: William D James, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Topically applied agents that might yield improvement in some patients include topical 5-fluorouracil, topical vitamin D-3 analogues, topical immunomodulators (imiquimod), and topical retinoids.

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Antineoplastics, Antimetabolite

Class Summary

These agents inhibit cell growth and proliferation.

Fluorouracil topical (Efudex, Carac, Fluoroplex)

Fluorouracil is preferentially taken up by cells that are dividing abnormally and rapidly; it interferes with DNA and RNA synthesis and leads to death of the abnormal cells. Fluorouracil 5% cream is most commonly used.; 1% cream may be used in thin-skinned areas.

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Vitamins, Fat-Soluble

Class Summary

These agents regulate calcium-induced keratinocyte differentiation. Tacalcitol has been used, but it is not available in the United States.

Calcipotriene cream 0.005% (Dovonex, Calcitrene, Sorilux)

Calcipotriene cream 0.005% is a synthetic vitamin D-3 analog that regulates skin cell production and development. It is approved for the treatment of psoriasis and has been reported to be helpful in DSAP.

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Retinoid-like Agents

Class Summary

These agents decrease the cohesiveness of abnormal hyperproliferative keratinocytes and may reduce the potential for malignant degeneration. They modulate keratinocyte differentiation and have been shown to reduce the risk of skin cancer formation in patients who have undergone renal transplantation.

Tretinoin topical (Retin-A, Renova, Atralin, Tretin X)

Tretinoin topical inhibits microcomedo formation and eliminates lesions. It makes keratinocytes in sebaceous follicles less adherent and easier to remove. It is used primarily to treat acne but has beneficial effects on actinic keratoses and may reduce the malignant potential of porokeratosis. Tretinoin topical is available as 0.025%, 0.05%, and 0.1% creams and 0.01% and 0.025% gels.

Isotretinoin (Amnesteem, Claravis, Myorisan, Sotrel)

Isotretinoin is an oral agent that treats serious dermatologic conditions. It is a synthetic 13-cis isomer of naturally occurring tretinoin (trans-retinoic acid). Both agents are structurally related to vitamin A. Isotretinoin decreases sebaceous gland size and sebum production. It may inhibit sebaceous gland differentiation and abnormal keratinization. It treats severe recalcitrant cystic acne and appears to help in the treatment of porokeratosis.

A US Food and Drug Administration–mandated registry is now in place for all individuals prescribing, dispensing, or taking isotretinoin. For more information on this registry, see iPLEDGE. This registry aims to further decrease the risk of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.

Acitretin (Soriatane)

Acitretin is a second-generation monoaromatic retinoid and active metabolite of etretinate. It has demonstrated clinical effects close to those seen with etretinate. Its mechanism of action is unknown. No studies have looked at its effect on porokeratosis.

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Immunomodulators

Class Summary

These agents modulate processes that promote immune reactions resulting from diverse stimuli.

Imiquimod 5% cream (Aldara, Zyclara)

Imiquimod induces the secretion of interferon-alpha and other cytokines; its mechanism of action is unknown.

Ingenol mebutate topical (Picato)

Ingenol mebutate is an extract from the sap of the noninvasive weed Euphorbia peplus. Its direct effect is related to destruction of the plasma membrane, swelling of the mitochondria, and then cell death via necrosis. It has been shown to have efficacy in the treatment of porokeratosis of Mibelli, used for 3 days for 2 cycles 1 month apart.

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Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Class Summary

Nonsteroidal anti-inflammatory drugs (NSAIDs) are most commonly used for relief of mild to moderately severe pain. Although the pain-relieving effects tend to be patient-specific, ibuprofen is usually used for initial therapy.

Diclofenac topical (Flector Transdermal Patch, Pennsaid topical solution, Solaraze Gel)

This is one of a series of phenylacetic acids that has demonstrated anti-inflammatory and analgesic properties in pharmacological studies. It is believed to inhibit the enzyme cyclooxygenase, which is essential in the biosynthesis of prostaglandins. Diclofenac gel 3% may be effective for DSAP.

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Calcineurin Inhibitors

Class Summary

These agents suppress the immune system by preventing interleukin-2 production in T cells.

Tacrolimus ointment (Protopic)

Tacrolimus is hypothesized to amplify the innate immune response in keratinocytes and prevent the proliferation of the abnormal keratinocytes, thus leading to the improvement in lesions. However, further research and controlled studies with a larger patient population and long-term follow up are needed to evaluate its true effectiveness.

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