Porokeratosis ptychotropica: a diagnostic and therapeutic challenge

Porokeratosis ptychotropica: a diagnostic and therapeutic challenge SirThe porokeratoses are characterized by the formation of cornoid lamellae. Porokeratosis ptychotropica (PP) is a rare form first described by Lucker, where the dyskeratotic skin changes are mainly located around the gluteal cleft or genital area.A 56‐year‐old man presented with mildly pruritic symmetrical hyperkeratotic brown plaques with subtle fine scaling, and smaller satellite plaques, affecting both buttocks and partially the intergluteal cleft (Fig. a). The plaque began a year before on the right buttock, and a second plaque followed on the left. Treatment with emollients, antifungals and topical steroids was unsuccessful. He was otherwise healthy.(a) Symmetrical hyperkeratotic plaques on the buttocks. (b) Verrucous epidermal hyperplasia with hyperkeratosis alternating with several columns of parakeratosis or cornoid lamella, originating from a shallow depression of the epidermis where several dyskeratotic keratinocytes were found. (c) Pustular reaction after the application of IM. d) Partial response observed with IM after 3 weeks.Histology revealed verrucous epidermal hyperplasia with hyperkeratosis alternating with columns of parakeratosis or cornoid lamella consistent with PP (Fig. b).Given the poor response reported and the potential for malignant transformation, we decided to treat with ingenol mebutate (IM). After promising results in a 5 × 5 cm area with the 500 mg/g gel (Picato® Gel; LEO® Pharma, Denmark), we http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of the European Academy of Dermatology & Venereology Wiley
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Publisher
Wiley Subscription Services, Inc., A Wiley Company
Copyright
Copyright © 2018 European Academy of Dermatology and Venereology
ISSN
0926-9959
eISSN
1468-3083
D.O.I.
10.1111/jdv.14600
Publisher site
See Article on Publisher Site

Abstract

SirThe porokeratoses are characterized by the formation of cornoid lamellae. Porokeratosis ptychotropica (PP) is a rare form first described by Lucker, where the dyskeratotic skin changes are mainly located around the gluteal cleft or genital area.A 56‐year‐old man presented with mildly pruritic symmetrical hyperkeratotic brown plaques with subtle fine scaling, and smaller satellite plaques, affecting both buttocks and partially the intergluteal cleft (Fig. a). The plaque began a year before on the right buttock, and a second plaque followed on the left. Treatment with emollients, antifungals and topical steroids was unsuccessful. He was otherwise healthy.(a) Symmetrical hyperkeratotic plaques on the buttocks. (b) Verrucous epidermal hyperplasia with hyperkeratosis alternating with several columns of parakeratosis or cornoid lamella, originating from a shallow depression of the epidermis where several dyskeratotic keratinocytes were found. (c) Pustular reaction after the application of IM. d) Partial response observed with IM after 3 weeks.Histology revealed verrucous epidermal hyperplasia with hyperkeratosis alternating with columns of parakeratosis or cornoid lamella consistent with PP (Fig. b).Given the poor response reported and the potential for malignant transformation, we decided to treat with ingenol mebutate (IM). After promising results in a 5 × 5 cm area with the 500 mg/g gel (Picato® Gel; LEO® Pharma, Denmark), we

Journal

Journal of the European Academy of Dermatology & VenereologyWiley

Published: Jan 1, 2018

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