Porokeratosis (Mibelli): treatment with topical 5-fluorouracil

Eruptive Pruritic Papular Porokeratosis (EPPP) Presenting as a Rare Facial Manifestation Associated With COVID-19: A Case Report

This case report presents a rare instance of Eruptive Pruritic Papular Porokeratosis (EPPP) in a 71-year-old Chinese male, emerging on atypical sites (face, scalp, and ears) following a COVID-19 infection, and explores the potential link between viral infections and EPPP onset. The patient's lesions, characterized by annular brown patches with hyperkeratotic ridges, showed significant improvement following treatment with Baricitinib and Acitretin. This case underscores the need for awareness of unusual presentations of EPPP and suggests the potential efficacy of Janus Kinase (JAK) inhibitors in treatment, prompting further research into the pathophysiological connections between EPPP and viral infections. Adherence to the SCARE 2023 guidelines ensures a comprehensive and transparent case presentation.

Porokeratoses-A Comprehensive Review on the Genetics and Metabolomics, Imaging Methods and Management of Common Clinical Variants

Porokeratosis is a heterogeneous group of keratinising disorders characterised by the presence of particular microscopic structural changes, namely the presence of the cornoid lamella. This structure develops as a consequence of a defective isoprenoid pathway, critical for cholesterol synthesis. Commonly recognised variants include disseminated superficial actinic porokeratosis, disseminated superficial porokeratosis, porokeratosis of Mibelli, palmoplantar porokeratosis (including porokeratosis palmaris et plantaris disseminata and punctate porokeratosis), linear porokeratosis, verrucous porokeratosis (also known as genitogluteal porokeratosis), follicular porokeratosis and porokeratoma. Apart from the clinical presentation and epidemiology of each variant listed, this review aims at providing up-to-date information on the precise genetic background, introduces imaging methods facilitating the diagnosis (conventional and ultraviolet-induced fluorescence dermatoscopy, reflectance confocal microscopy and pathology), discusses their oncogenic potential and reviews the literature data on the efficacy of the treatment used, including the drugs directly targeting the isoprenoid-mevalonate pathway.

Porokeratosis: An enigma beginning to unravel

Porokeratosis is a keratinization disorder with unclear etiopathogenesis, varied clinical presentation and characteristic histopathology, and is usually unresponsive to current therapeutic options. Until now, it was considered to be a clonal disorder with immunity, ultra violet radiation and other factors playing important roles in etiopathogenesis. It is now known that abnormalities in the mevalonate pathway are responsible for this clonal keratinization abnormality. New variants of porokeratosis like eruptive bullous, pruriginous, lichen planus like, follicular variants and porokeratoma have been described. While the cornoid lamella is the classical histopathologic feature, dermoscopy and reflectance confocal microscopy make the diagnosis clearer. Development of malignancy in a few variants is a concern. Linear, disseminated superficial actinic and giant lesions are most prone to developing malignancies. Bowen's disease, squamous cell carcinoma, basal cell carcinoma and even melanoma have been reported in cases of long-standing porokeratosis. Newer modalities of therapy such as photodynamic therapy, ingenol mebutate and HMGCoA inhibitors may play a role in the future.

Photochemistry and electrochemistry of anticancer uracils

The redox mechanism and electronic absorption behavior of a commercial anticancer drug, 5-fluorouracil (5-FU) and two potential anticancer drugs, 2-thiouracil (2-TU) and dithiouracil (DTU) have been investigated in a wide pH range by UV-Vis spectroscopy, cyclic voltammetry and differential pulse voltammetry. The effect of electrolytes, substituents, successive sweeps and potential scan rate on the voltammetric response of uracils was examined. Organized structure-activity relationships of these drugs were established on the basis of the results obtained from electronic absorption spectroscopy and cyclic voltammetry. The electrode reaction mechanism was suggested using the experimentally determined electrochemical parameters. The DNA binding propensity of uracils was found greater than the classical intercalator, proflavin and clinically used drug, epirubicin. Moreover, the results obtained through ab initio calculations for the oxidation potential of the three uracil derivatives were found in good agreement with the electrochemical results.

Facial follicular porokeratosis: a case report

Porokeratosis is a disorder of keratinization, characterized clinically by a peripheral keratotic ridge and histologically by the cornoid lamella. We describe a patient with follicular porokeratosis with a distinctive clinical presentation. We believe that follicular porokeratosis is a unique histopathologic variant of porokeratosis, with cornoid lamellae centered in follicular infundibula. Further, this is the only report of follicular porokeratosis involving the face exclusively.

A case of inflammatory disseminated superficial porokeratosis in a colon cancer patient

Disseminated superficial porokeratosis (DSP) is a specific disorder of keratinization. Genetic studies show that DSP is an autosomal dominant trait. Clinically, the lesions show a sharply demarcated and hyperkeratotic plaque with central atrophy. The lesions appear mainly in the extremities and generally develop with bilateral symmetry. Unusual cases of DSP accompanied by severe pruritus have been reported as "eruptive pruritic papular porokeratosis" or "inflammatory DSP." Histopathologically, inflammatory DSP is characterized by the presence of cornoid lamella with a dense infiltration of eosinophils and lymphocytes in the perivascular area of the upper dermis. Here we report a case of inflammatory DSP in a 84-year-old man with colon cancer who presented with multiple hyperpigmented atrophic macules.

Successful treatment of disseminated superficial actinic porokeratosis with Q-switched ruby laser

Porokeratosis, a cutaneous disorder that is characterized histologically by the presence of a "cornoid lamella", is a progressive disease with limited therapeutic modalities. We report a case of a 61-year-old man suffering from disseminated superficial actinic porokeratosis, one of the clinical types of porokeratosis, treated with Q-switched ruby laser, commonly used for the treatment of pigmented skin diseases. The laser therapy provided striking improvement and no clinical recurrence was noted.

Giant verrucous porokeratosis of Mibelli mimicking psoriasis in a patient with psoriasis

Porokeratosis of Mibelli is a disorder of epidermal keratinization characterized by annular plaques with an atrophic center surrounded by a keratotic wall. We report a case of a giant verrucous porokeratosis of Mibelli mimicking psoriasis that developed in a patient with psoriasis and therefore went unrecognized for a long time. Histologically the lesion combined features of porokeratosis at the periphery and of psoriasis at its center, a picture recently described as "psoriasis encircled by porokeratosis." The possible pathogenetic relationship between psoriasis and the development of porokeratosis is also discussed.

A case of the hyperkeratotic variant of porokeratosis Mibelli

Herein, we report a case of the hyperkeratotic variant of porokeratosis Mibelli. A 58-year-old woman presented with two brownish verrucous plaques on the buttock for 20 years, and extremely hyperkeratotic verrucous nodules and brownish macules on the right foot for 1 year. Histopathological findings of the buttock were typical of porokeratosis. However, histopathological findings of the right foot were atypical for porokeratosis, including extreme hyperkeratosis and an increased number of and unusual sized cornoid lamellae.

Porokeratosis of Mibelli: Successful treatment with topical 5% imiquimod cream

A 77-year-old woman with a large porokeratosis of Mibelli on the left shin was successfully treated with topical 5% imiquimod cream applied to the entire lesion once daily without occlusion three times a week. A strong inflammatory reaction was achieved in 6 weeks of treatment. The lesion had been present for approximately 6 years and prior treatments included curettage and electrocautery, cryotherapy and topical 5-fluorouracil under occlusion. At the end of treatment with topical 5% imiquimod cream, punch biopsy was negative for porokeratosis. The lesion healed without scarring. At 24-month follow up there had been no sign of clinical recurrence.

Treatment of lichen amyloidosis (LA) and disseminated superficial porokeratosis (DSP) with frequency-doubled Q-switched Nd:YAG laser

BACKGROUND

Under normal practice, the full thickness of the epidermis is peeled off when treating pigmented lesions with a frequency-doubled Nd:YAG laser. Based on this observation, it is postulated that this laser may be effective for treating lichen amyloidosis (LA) and disseminated superficial porokeratosis (DSP) for which the pathologic changes are limited to the epidermis and papillary dermis.

OBJECTIVE

To investigate the clinical effect of frequency-doubled Nd:YAG laser treatment for one patient with LA and for one patient with DSP.

METHODS

Frequency-doubled 532 nm Nd:YAG laser pulses were delivered to the lesions on the limbs of a patient with LA and the face and forearms of a patient with DSP. Lesions of LA were treated two or three times, and those of DSP were treated four times, treatment sessions being 1 month apart. For this investigation, biopsies were taken from untreated lesions prior to treatment, lesions immediately after laser treatment, and lesions present at a 9-month follow-up investigation.

RESULTS

Both the patient with LA and the patient with DSP responded well to treatment, the results of which remained unchanged at a follow-up conducted 9 months after the final treatment session.

CONCLUSION

Frequency-doubled Nd:YAG laser treatment provided excellent results for the patient with LA as for the patient with DSP. The effectiveness of this method deserves further study in a larger group of test patients.

Genitoanocrural porokeratosis following chronic exposure to benzene

Porokeratoses are disorders of epidermal keratinization, the aetiology of which remains to be elucidated. We present the uncommon case of a 70-year-old man with genitoanocrural porokeratotic lesions successfully treated by CO2 laser vaporization. The patient's occupational history and the late onset, site and multiplicity of the lesions suggest their induction by benzene, a known carcinogen.

Genital porokeratosis of Mibelli

Porokeratosis of Mibelli is a disorder of epidermal proliferation in which many different clinical forms can be distinguished. Two male patients with a localized type of porokeratosis limited to the genitalia are reported. Later in life they developed an annular skin lesion with peripheral keratotic ridge. The histological examination of a biopsy specimen showed the characteristic features of porokeratosis. There was no family history of similar skin disorders and the patients were not on any drugs. Genital porokeratosis is probably underdiagnosed and we believe that these patients should be followed up on account of the precancerous potential of this disease.

Porokeratosis of Mibelli: rapid recurrence of a large lesion after carbon dioxide laser treatment

Porokeratosis of Mibelli was diagnosed in a 9-year-old Afro-American girl. The lesion was rather large (4.1 x 2.0 cm) and had developed rapidly over the course of six months. Considering the potential for malignant transformation without neglecting the importance of cosmesis, carbon dioxide laser vaporization with curettage was chosen to ablate the lesion. Within two months the entire treated area revealed recurrent porokeratosis. Due to the aggressive nature of this lesion, complete excision was performed.

Porokeratosis of Mibelli on the penis, scrotum and natal cleft

Genital porokeratosis of Mibelli is rare. We report a patient with lesions affecting the penis, scrotum and natal cleft and discuss the aetiology, clinical presentation and treatment of the condition.

Treatment of porokeratosis of Mibelli with CO2 laser vaporization versus surgical excision with split-thickness skin graft. A comparison

BACKGROUND

Porokeratosis of Mibelli has been treated with many topical surgical modalities in the past, including cold steel surgical excision and CO2 laser excision. We report a patient with an 8 x 10 cm2 plaque of porokeratosis on the dorsum of his hand, fingers, and web spaces.

OBJECTIVE

To compare the treatment results of CO2 laser vaporization versus cold steel surgical excision with split-thickness skin graft placement.

METHOD

The portions of the lesion overlying the metacarpophalangeal joints, fingers, and web spaces were treated with CO2 laser vaporization. The remainder of the lesion covering the dorsum of the hand was excised with cold steel, followed by placement of a split-thickness skin graft over that area.

RESULTS

The portion of the porokeratosis lesion treated with CO2 vaporization healed with results cosmetically and functionally superior to the grafted area.

CONCLUSION

Carbon dioxide laser vaporization, a more superficial treatment modality than CO2 laser excision, should be the preferred treatment modality for porokeratosis lesions.

Etretinate improves localized porokeratosis of Mibelli

A 60-year-old woman with plaque-type psoriasis of 30 years' duration was treated with etretinate. The lesion resolved while the patient was on the drug and continued to resolve after she had discontinued therapy. The continuation of resolution after the patient had discontinued the drug is probably due to its long half-life.

Carbon dioxide laser treatment of porokeratosis of Mibelli

Porokeratosis of Mibelli, a disorder of keratinization, has in the past been difficult to treat, especially in its more extensive form. The carbon dioxide laser was used in the treatment of a patient with this disorder. The response was very favorable. Microscopic pathological investigation after treatment revealed no residual evidence of porokeratosis in the areas treated with the carbon dioxide laser. Thus, obliteration of this disease process using the carbon dioxide laser shows potential for future use.

Porokeratosis plantaris palmaris et disseminata

Porokeratosis plantaris palmaris et disseminata (PPPD) is a rare variant of porokeratosis. We report a second kinship with PPPD that typically appears first on the palms and soles and then gradually progresses to the extremities and trunk. We discuss clinical, histologic, pathogenetic, and therapeutic aspects of PPPD and review the literature concerning the histogenesis of cornoid lamella formation.