Successful treatment of widespread, hyperkeratotic skin lesions with topical tretinoin 0.05% |
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Successful treatment of widespread, hyperkeratotic skin lesions with topical tretinoin 0.05%

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A report describes a case of a 23-year-old, female who had widespread skin lesions present since the age of 2.5 years. She gave a history of developing a brown macular lesion on her right buttock 20 years back. The lesion gradually became hyperkeratotic and subsequently started spreading through the posterior aspect of her right leg. It later started to involve the right side of the trunk and the right arm. 

Similar lesions were noted by her on her left arm and leg when she turned 9 years old. But she observed no new skin lesions after she turned 13 years old. She rendered no family history of similar lesions.

Examination revealed numerous linear and whorled, reddish-brown, hyperkeratotic plaques, with central atrophy and raised borders, following Blaschkos lines on all of the extremities. These lesions on the extremities were seen extending to the dorsum of the hands and feet. 

Hyperkeratotic lesions were even observed on the pressure points of both of the soles, but with no palm involvement. The number of lesions observed on the right side was greater than that of its left counterpart. 

Lesions appeared as Reddish-brown annular plaques with central atrophy and raised borders, observed in zosteriform configuration, along with numerous individual 2-3-mm erythematous lichenoid papules were identified on the right side of the thorax and the right inguinal region. No face, scalp, or mucous membrane involvement was seen. 

The right hands second and fifth fingernails and the left hands third fingernail showed nail dystrophy with longitudinal ridges and pterygium. The right foots all nails and the left foots first and fifth toenails showed dystrophic changes with subungual keratosis. The patient was otherwise in good health. 

Biopsy specimens were taken from a hyperkeratotic plaque and a lichenoid papule demonstrated an epidermal invagination with angulated parakeratotic tier, denoting cornoid lamella. The epidermis underneath the cornoid lamella showed vacuolization and an absence of the granular layer. The adjacent epidermis was atrophic and showed hydropic degeneration within the basal cell layer. Dermis showed a nonspecific, mild, chronic, inflammatory cell infiltrate, telangiectatic vessels, and pigment-laden macrophages. These findings were consistent with linear porokeratosis. Microscopic examinations and mycologic cultures of the nails rendered negative results. The investigators observed the patients refusal to the systemic therapy with retinoids, which they earlier decided. So, she was given topical tretinoin 0.05% to be applied once a day. Hyperkeratosis showed a marked improvement through the first 4 weeks of treatment and remained plateaued at 8 weeks. Further, the lesions almost disappeared after the 10 weeks treatment. But the investigators continued the applications every other day. After a year of follow-up, the patient remained stable with the application of topical tretinoin 0.05% twice a week and was satisfied with the final appearance. She further continued her follow up.

Source: Dervis E, Demirkesen C. Generalized linear porokeratosis. Int J Dermatol. 2006 Sep;45(9):1077-9. doi: 10.1111/j.1365-4632.2004.02490.x. PMID: 16961514.

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