Successful treatment of disseminated superficial actinic porokeratosis with calcipotriol.

porokeratosis with calcipotriol Editor, Disseminated superficial actinic porokeratosis (DSAP) is the most common type of porokeratosis. It is related to sun exposure and an autosomal dominant inheritance pattern is recognized. No ideal treatment of this clonal disorder of keratinization exists. We describe a patient in whom the complete resolution of lesions was achieved with topical treatment with the vitamin D3 analog calcipotriol. Thus we add more evidence on the efficacy of calcipotriol to the literature. We present a 73-year-old Caucasian woman with a 5month history of lesions on her lower legs. No subjective complaints were reported. Family history was negative. The patient had no medical history of immunosuppression, x-ray treatment, or arsenic intake. Extensive sun exposure was evident. On physical examination, multiple red–brown, annular macules were seen to be evenly distributed on the front and lateral surfaces of the lower legs (Fig. 1). Close examination showed central atrophy and an elevated hyperkeratotic ridge. Some scaly plaques were observed on the forearms. A punch biopsy specimen taken from the keratotic border disclosed the characteristic cornoid lamella, as well as atrophy of the epidermis, flattening of the rete ridges, and absence of the granular layer. Perivascular lymphocytic infiltrate was present in the upper dermis (Fig. 2). In accordance with the clinical presentation and histological findings, DSAP was diagnosed. Topical treatment with calcipotriol 0.005% cream twice daily for 3 months was started with excellent therapeutic outcome. At follow-up 6 months later, the patient was free of lesions. Disseminated superficial actinic porokeratosis was first described by Chernosky and Freeman, since then various treatment options have been described but are poorly standardized. There is a lack of controlled studies and therapy is usually empiric. It encompasses potent topical steroids, keratolytics, topical retinoids, topical 5-fluorouracil, imiquimod 5%, anthralin, cryotherapy, carbon dioxide laser, pulsed dye laser, curettage, excision, dermabrasion, and oral retinoids. A summary of therapeutic regimens for DSAP, together with their advantages and disadvantages, is given in Table 1. Treatment with calcipotriol and another vitamin D3 analog, tacalcitol, has been rarely reported. Vitamin D3 analogs induce genes critical for keratinocyte differentiation, such as transglutaminase or involucrin.