Porokeratosis Treatment Options

Treatment of Porokeratosis

• Porokeratosis lesions are chronic, slow progressing, and usually asymptomatic, but can include intense pruritus.
• Typically intervention isn't needed, and standard disease surveillance is recommended.
• If lesions are problematic, treatment options include: potent topical steroids, keratolytics, topical retinoids, topical 5-fluorouracil, imiquimod 5%, calcipotriol, anthralin, cryotherapy, carbon dioxide laser, pulsed dye laser, or Nd:YAG laser.
• Tacrolimus 0.1% has been effective for treating linear porokeratosis.
• Electrochemotherapy with intralesional bleomycin has been successful in treating SCCs associated with linear porokeratosis.
• Ablative measures reaching the middermis are needed to prevent residual lesions or recurrence.
• Curettage, excision, and dermabrasion have been used with varying success.
• Oral retinoids provide the most reproducible results, but recurrence is typical after discontinuation.
• Closer disease surveillance and a lower threshold for biopsy of suspicious lesions is recommended for giant porokeratoses, linear lesions, and in immunosuppressed individuals, due to the association with malignancy.

Course and Prognosis of Porokeratosis

• Porokeratoses are generally chronic and progressive, with lesions increasing in size and number over time.
• This process typically occurs over decades in PM, but may be rapid in DSAP, especially after sun exposure.
• In cases of immune compromise, fluctuations in severity may parallel the state of immune competence, with reports of remission after removal of primary malignancy.
• The disease is generally benign, but malignant degeneration may occur.
• Malignancy is thought to arise in 7% to 11% of individuals, although it is likely overestimated.
• SCC is the most frequently associated tumor and may be invasive.
• Bowen disease and basal cell carcinoma have also been reported.
• Spontaneous resolution of lesions has been reported, although it is exceptionally rare.