We describe a case of linear porokeratosis with associated bone resorption in a 17-year-old female with marked improvement after 2% cholesterol/2% lovastatin ointment application. Porokeratosis is a heterogenous group of keratinization disorders characterized by a cornoid lamella, consisting of focal dyskeratotic cells in the granular layer and columns of parakeratosis. The pathogenesis of porokeratosis is not fully elucidated; however, germline mutations have recently been identified in the mevalonate pathway which can lead to a buildup of metabolites that could play a role in dysmaturation. There has only been one prior report of an affected distal digit with underlying bone resorption in association with linear porokeratosis.
A 59-year-old man with diabetes mellitus, hypertension, coronary artery disease, and gout presented to the dermatology clinic with an 18-month history of a pruritic widespread rash (Fig 1 ½F1 Q3 ). Dull, erythematous, arcuate, and serpiginous smooth plaques, involving the chest, abdomen, arms, and back with a few scattered, scaly, erythematous plaques intermixed were observed.
Q4Episodes of the rash lasted for several months at a time, had no clear triggers, and resolved spontaneously. Previous treatments included triamcinolone 0.1% cream, fluconazole 150 mg weekly for 4 weeks Q5 , and terbinafine 1% cream without improvement. He denied sexual
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