Treatment of porokeratosis of Mibelli with ingenol mebutate: a possible new therapeutic option.

Report of a Case Awoman in her 50s presentedwith an 8-year history of an annular plaque in the left perioral area. Physical examination showeda thick hyperkeratotic annular plaque with elevated edges and an atrophic center (Figure 1).Histopathologic examinationof the lesion revealedacornoid lamella, anunderlyingepidermisdevoidof agranular layer, and a lymphocytic infiltration in the upper dermis. The clinical andhistopathologic featureswere consistentwith adiagnosis of porokeratosis of Mibelli. Thepatient had receiveddiverse consecutive treatments since 2008, including photodynamic therapy with aminolevulinic acid, electrocoagulation, an 8-week course of fluorouracil cream, topical treatmentwith the2-compoundformulationbetamethasone(50 μg/g)andcalcipotriol (0.5mg/g), carbondioxide laser, and2courses of imiquimod, 5%, for 6 weeks. None of the treatments had been successful. Significanthypopigmentation, possibly triggeredby the strong inflammatoryresponse,wasobserved inthe lesionafter treatmentwith fluorouracil cream.Thishypopigmentation remainedunchangedat last follow-up. Thepatientwasalso treatedwithpulseddye laser in 2012 andwith diclofenac sodium, 3%, gel applied twice daily for3months in2013.Neitherof these treatmentsachievedpartial or total remission of the lesion.