Disseminated verrucous porokeratosis successfully treated with 5-FU followed by oral isotretinoin- a case report

Abstract

Introduction: Multiple clinical variants of porokeratosis are known. The verrucous variant is usually confined to the buttocks (porokeratosis ptychotropica) and is one of the less commonly reported entities. Case description: We report a case of disseminated verrucous porokeratosis involving almost any area of the body, mostly the upper trunk, successfully treated with oral retinoids following topical 5-FU. Discussion: Histological examination is crucial for the diagnosis. The observation of multiple cornoid lamellae and the absence of other characteristic findings establish the diagnosis. Several therapeutic modalities have been described; therefore the approach to treatment must be individualized. Our case adds to the growing list of porokeratosis' variants and suggests that oral retinoids following topical 5-FU is a good therapeutic alternative in the treatment of the disease.

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

“…Treatment with 5-FU 5% cream failed to improve the disease course in six VP cases [6,465,484,494,517,518], yet was able to achieve a temporal anti-pruritic effect in four of them. Partial VP remission was observed in one VP case at week 2, but the treatment was discontinued due to local irritation [519].…”

“…The responses to topical application were generally poor. Tretinoin 0.05% cream was reported to control recurrence in two cases [465,496], whereas tretinoin 0.025-0.075% cream [61,201,463,494,503,518,520], topical tazarotene 0.1% [191] topical retinoic acid [496,497] and unspecified retinoids [488,508,513,519] failed to achieve any durable effect, and in one case, were discontinued due to irritation [463]. Oral acitretin (25 mg daily [0.3 mg/kg] for 6 months, then tapered to 10 mg daily for additional 3 months) provided an excellent outcome in regard to lesion count, pruritus and irritation in one VP case [477], a moderate improvement in three cases (10-20 mg daily) [58,495,521] and a poor effect in two (30 mg daily for 2 months; and unknown regimen) [488,494].…”