Bilateral Linear Porokeratosis Treated With Topical Cholesterol 2%/Lovastatin 2%

Abstract

Linear porokeratosis is a cutaneous disorder that typically presents in a unilateral linear formation. While the exact cause of linear porokeratosis is unknown, it is thought to be a downstream effect of disrupted cholesterol synthesis and mevalonate accumulation.Our patient is a 61-year-old male with an unusual case presentation of bilateral linear porokeratosis. He had failed numerous standard therapies. Pathologic examination of a skin biopsy was consistent with bilateral linear porokeratosis. Through a PubMed search, there have been limited reported cases of unilateral linear porokeratosis, but there have not been any reported cases of bilateral linear porokeratosis.There are currently limited therapies with satisfactory outcomes for variants of porokeratosis. While there are some studies on the topical application of cholesterol/lovastatin, limited studies have been performed on the linear form. Our study evaluates the efficacy of compounded topical cholesterol 2%/lovastatin 2% ointment on bilateral linear porokeratosis. The patient demonstrated a significant reduction of porokeratotic lesions on the treated arm compared to the untreated arm. Cholesterol/lovastatin is alternative therapy that can be considered in the treatment of linear porokeratosis and other porokeratosis variants.

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

“…Non-histaminic itch mediators, such as thymic stromal lymphopoietin, periostin and interleukin 31, were locally upregulated, suggestive of Th2 response involvement, whereas no increase in eosinophils or mastocytes were observed in this particular case [379]. Six-month therapy with topical calcipotriene 0.005% cream and diclofenac 1% gel was reported to be ineffective in LP [429].…”

“…As a cholesterol biosynthesis pathway is involved in the pathogenesis of porokeratoses, statin use has been proposed to manage LP. Topical lovastatin 2%/cholesterol 2% cream, aimed at supplementing the deficient mevalonate pathway end products, was well tolerated and moderately effective in five cases of LP [115,391,429,431]. Contrarily, a poor outcome has been reported in five cases treated with simvastatin 2%/cholesterol 5% ointment and 10% urea cream (twice daily for at least 4 weeks) [412].…”

Bilateral Linear Porokeratosis Treated With Topical Lovastatin 2% Monotherapy

“…A biopsy revealed a coronoid lamellae. Diep et al published the histopathologic presentation confirming the diagnosis of linear porokeratosis in the same patient [6]. Following his diagnosis, he was prescribed topical clobetasol ointment but was unable to tolerate this treatment due to a painful burning sensation upon application.…”

“…Subsequently, the patient was started on a trial of cholesterol 2%/lovastatin 2% ointment on his right arm twice a day. After 12 weeks of treatment with this regimen, he noted improvement in the erythema and scaling of the lesions [ 6 ].…”

“…The patient had previously demonstrated success with using topical cholesterol 2%/lovastatin 2% ointment to treat the linear porokeratosis lesions on his right arm, which served as our control [ 6 ]. To our knowledge, topical lovastatin 2% monotherapy has never been directly compared to the efficacy of topical cholesterol 2%/lovastatin 2% therapy in a split study in linear porokeratosis.…”