Medical Care
A variety of topical agents have been used to treat this disease, but none is universally effective.
Reports on the effectiveness of tacalcitol and calcipotriol conflict with another report stating they are not effective, [15] and yet another report saying calcipotriol is effective. [16]
Topical 5% fluorouracil and a synthetic vitamin D-3 derivative have been used together with effective results. [16]
The most consistently successful therapies have been the topical application of 5% fluorouracil cream (over several months), local excision, and dermabrasion (see Surgical Care). [17, 18]
In 1986, Gabrielsen reported that hyperkeratosis lenticularis perstans (Flegel disease) was effectively treated with etretinate. Initially, treatment aggravated the condition; however, after 10 weeks of treatment, the papules of hyperkeratosis lenticularis perstans (Flegel disease) nearly all resolved. [19]
Oral retinoids have been successful with continuous therapy. However, short-coarse oral retinoid therapy has also shown success in one case. [7] Patients tend to relapse when therapy is discontinued.
Tretinoin, emollients, psoralen with ultraviolet A (PUVA), and keratolytics have shown varying, but mostly unrewarding, results, even in combination. [20, 21, 22] Topical steroids have similarly shown mixed results, although betamethasone dipropionate showed a response in a 2008 case study. [23]
Surgical Care
Dermabrasion is a possible surgical modality. However, a large number of lesions, as well as lesion location, make this an impractical approach. Local excision may be successful, especially if the number of lesions is small. Cryotherapy is an additional possibility.
-
Clinical photograph of the upper thigh showing numerous red-brown papules with sparing of the inguinal crease.
-
A higher-powered view of the patient seen in the previous image. Photograph of the upper thigh demonstrates 1- to 4-mm, noncoalescing keratotic papules.
-
Hematoxylin and eosin-stained section, low magnification. Epidermal hyperplasia with rete elongation surmounted by a thickened, compact, hyperkeratotic scale. A bandlike lymphoid infiltrate expands the papillary dermis.
-
Hematoxylin and eosin-stained section, medium magnification. The lateral edge of the lesion demonstrates abrupt hyperkeratosis and a combination of epidermal atrophy and acanthosis.
-
Hematoxylin and eosin-stained section, high magnification. The section shows mostly orthokeratotic scale, thinning of the epidermis with a diminished granular cell layer, and an infiltrate of lymphocytes in the superficial dermis, which approximate the dermal-epidermal interface.
