Disseminated superficial actinic porokeratosis improved with fractional 1927-nm laser treatments

Abstract

Disseminated superficial actinic porokeratosis (DSAP) is an inherited disorder of keratinization readily diagnosed through clinical and histologic examination. While generally benign in nature, the lesions can have profound psychosocial implications for patients. Although no cure exists, a number of treatment modalities, from topical medications to laser and light devices, have been reported with variable success. The authors report two cases of DSAP treated with the 1927-nm thulium fiber fractional laser along with a review of the treatment literature for DSAP. This therapy is convenient and safe with nearly no downtime or morbidity associated with pigment or textural changes.

Two cases of disseminated superficial actinic porokeratosis (DSAP) and treatment literature review

“…Oral retinoids [20][21][22] and cryotherapy [15] were used in the past with no any satisfied results. Newer treatment of photodynamic therapy (PDT) [2,9,[23][24][25] and lasers [3,[26][27][28][29][30][31][32] have been introduced in the recent years with some desirables results. A literature review was conducted five years ago assessing the level of evidence for some therapeutic modalities.…”

“…PDT therapy showed poor outcome in several studies (e.g. six out of nine patients had none or minimal response with MAL-PDT, all patients had no response with ALA-PDT and Hypericin-PDT), thus it is not recommended frequently [2,9,[23][24][25][26][27][28][29][30][31][32][33][34][35].…”

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

“…There are scarce data on the use of vitamin A derivates in DSAP. Topical tretinoin 0.1% once daily was modestly effective in one case of DSAP/LP [45], but ineffective in another [145], whereas topical tazarotene 0.1% gel used once daily provided a complete remission in 4 weeks in four patients [146], and was ineffective in one [147]. The use of oral retinoids in the treatment of DSAP appears to be promising but there are not enough data on their efficacy and safety.…”

The uses of tranexamic acid in dermatology: a review

“…Laser‐assisted drug delivery is one of the more promising future treatments for patients with melasma and other pigmentary disorders because laser therapy can target the destruction of pigment directly and facilitate the delivery of topical medications to the skin. Fractional lasers create microscopic columns of thermal injury from low‐energy treatment settings, which leaves the surrounding healthy tissue intact and avoids morbidity that is usually seen with ablative lasers 44 . Tawfic et al., a group in Egypt, conducted a randomized comparative split‐face study that included 30 patients who received topical TXA or intradermal TXA injections combined with low power fractional CO 2 laser for melasma in which both groups had significantly lower MASI scores, but there was no statistical difference between treatments and control 45 .…”