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Sultan Q, Massey B, Cotter DG. A Case of Disseminated Superficial Actinic Porokeratosis Successfully Treated With Topical Lovastatin/Cholesterol Gel. Cureus 2023; 15:e40582. [PMID: 37469822 PMCID: PMC10352470 DOI: 10.7759/cureus.40582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2023] [Indexed: 07/21/2023] Open
Abstract
Disseminated superficial actinic porokeratosis (DSAP) is a disorder of abnormal keratinization for which there is no standard treatment. Treatment modalities that have traditionally been utilized with varying success include ablative therapies, topical pharmacologic treatments, surgical excision, and retinoids. The underlying pathophysiology of DSAP is secondary to genetic mutations in the mevalonate biosynthesis pathway, and thus topical lovastatin/cholesterol presents a promising treatment modality for this condition. We present a case of familial DSAP successfully treated with topical lovastatin/cholesterol gel and provide a brief review of the existing literature surrounding this novel therapy.
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Affiliation(s)
- Qiret Sultan
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, Las Vegas, USA
| | - Blaine Massey
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, Las Vegas, USA
| | - David G Cotter
- Department of Dermatology, Las Vegas Dermatology, Las Vegas, USA
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, Las Vegas, USA
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Reyna-Rodríguez IL, García-Lozano JA, Ocampo-Candiani J. Pigmented disseminated superficial actinic porokeratosis in dark-skinned patients: Clinical, dermoscopic, and histopathologic features. J Cosmet Dermatol 2021; 20:3054-3056. [PMID: 33576038 DOI: 10.1111/jocd.13998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Irving Llibrán Reyna-Rodríguez
- Dermatology Department, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - José Alberto García-Lozano
- Dermatology Department, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Jorge Ocampo-Candiani
- Dermatology Department, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
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Lu JD, Mufti A, Sachdeva M, Rahat S, Lansang RP, Yeung J. Drugs associated with development of porokeratosis: A systematic review. Dermatol Ther 2020; 34:e14560. [PMID: 33210788 DOI: 10.1111/dth.14560] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/01/2020] [Accepted: 11/14/2020] [Indexed: 01/07/2023]
Abstract
Porokeratosis is a rare disorder characterized by atrophic macules or patches, with a well-defined ridge-like hyperkeratotic border called cornoid lamella. Although the exact pathogenesis is unknown, drug associated cases have recently been reported in the literature. As such, we systematically reviewed and identified drugs associated with drug-induced porokeratosis, their resultant effects, and whether there was a casual relationship between the use of a drug and the development of porokeratosis. We searched for articles which reported drug-induced porokeratosis in MEDLINE and Embase in June 2020. After full-text review, 25 studies were included for analysis. We identified 26 patients with drug-induced porokeratosis. The most common therapies associated with development of porokeratosis is biologic use, phototherapy, and radiotherapy. The most common clinical variants were the disseminated superficial or actinic types (60%), which occurred in psoriasis patients undergoing phototherapy, and eruptive disseminated type (24%) which occurred in the context of biologic therapies. The Naranjo score ranged from possible to probable for the identified treatments. Clinicians should consider drug reactions as possible triggering events for porokeratosis, especially for patients taking biologics, phototherapy, and radiotherapy. Large-scale studies are required to confirm our findings and further explore the pathogenesis for drug-induced porokeratosis.
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Affiliation(s)
- Justin D Lu
- Faculty of Medicine, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Asfandyar Mufti
- Department of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Muskaan Sachdeva
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shahmina Rahat
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | | | - Jensen Yeung
- Department of Dermatology, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada.,Probity Medical Research Inc., Waterloo, Ontario, Canada
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Atzmony L, Lim YH, Hamilton C, Leventhal JS, Wagner A, Paller AS, Choate KA. Topical cholesterol/lovastatin for the treatment of porokeratosis: A pathogenesis-directed therapy. J Am Acad Dermatol 2020; 82:123-131. [PMID: 31449901 PMCID: PMC7039698 DOI: 10.1016/j.jaad.2019.08.043] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/13/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Porokeratosis is associated with mevalonate pathway gene mutations. Therapeutic options are few and often limited in efficacy. We hypothesized that topical therapy that aims to replenish cholesterol, an essential mevalonate pathway end-product, and block the accumulation of mevalonate pathway toxic metabolites could alleviate porokeratosis. OBJECTIVE To study the efficacy of topical cholesterol/lovastatin in different variants of porokeratosis. METHODS We enrolled a series of 5 porokeratosis patients,1 with disseminated superficial actinic porokeratosis, 2 with porokeratosis palmaris et plantaris disseminata, and 2 with linear porokeratosis. Patients were genotyped before initiation of therapy. Patients then applied topical cholesterol/lovastatin twice daily to a unilaterally defined treatment area for up to 3 months. The response was evaluated and patients photographed at every visit. RESULTS Three patients had MVD mutations, and 2 patients had PMVK mutations. Treatment with topical cholesterol/lovastatin (but not cholesterol alone) resulted in near complete clearance of disseminated superficial actinic porokeratosis lesions after 4 weeks of therapy and moderate improvement of porokeratosis palmaris et plantaris disseminata lesions and linear porokeratosis lesions. There were no adverse events. LIMITATIONS Case series design with a small number of patients. CONCLUSION Topical cholesterol/lovastatin is an effective and well-tolerated therapy for porokeratosis that underscores the utility of a pathogenesis-based therapy that replaces deficient end products and prevents accumulation of potentially toxic precursors.
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Affiliation(s)
- Lihi Atzmony
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut; Department of Genetics, Yale University School of Medicine, New Haven, Connecticut; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Young H Lim
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut; Department of Genetics, Yale University School of Medicine, New Haven, Connecticut; Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Claire Hamilton
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Jonathan S Leventhal
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Annette Wagner
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Keith A Choate
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut; Department of Genetics, Yale University School of Medicine, New Haven, Connecticut; Department of Pathology, Yale University School of Medicine, New Haven, Connecticut.
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Glinos GD, Pastar I, Giubellino A, Tomic-Canic M, Miteva M, Stone RC. Novel mevalonate kinase missense mutation in a patient with disseminated superficial actinic porokeratosis. JAAD Case Rep 2018; 4:340-3. [PMID: 29693064 DOI: 10.1016/j.jdcr.2017.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Otero-Rivas MM, Rodríguez-Lojo R, Castiñeiras-Mato IM, Lueiro-Vilariño M, Juárez-Casado Y, Fernández-Díaz ML. Successful management of disseminated superficial actinic porokeratosis with diclofenac sodium 3% gel. Dermatol Ther 2016; 30. [PMID: 27859984 DOI: 10.1111/dth.12444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/15/2016] [Accepted: 10/21/2016] [Indexed: 11/29/2022]
Affiliation(s)
- María-Mercedes Otero-Rivas
- Dermatology Department, Hospital Universitario Lucus Augusti, Lugo. C /Ulises Romero no. 1 CP:, 27003, Lugo, Galicia, Spain
| | - Romina Rodríguez-Lojo
- Dermatology Department, Hospital Universitario Lucus Augusti, Lugo. C /Ulises Romero no. 1 CP:, 27003, Lugo, Galicia, Spain
| | | | - Mercedes Lueiro-Vilariño
- Dermatology Department, Hospital Universitario Lucus Augusti, Lugo. C /Ulises Romero no. 1 CP:, 27003, Lugo, Galicia, Spain
| | - Yolanda Juárez-Casado
- Dermatology Department, Hospital Universitario Lucus Augusti, Lugo. C /Ulises Romero no. 1 CP:, 27003, Lugo, Galicia, Spain
| | - María-Luisa Fernández-Díaz
- Dermatology Department, Hospital Universitario Lucus Augusti, Lugo. C /Ulises Romero no. 1 CP:, 27003, Lugo, Galicia, Spain
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