DISSEMINATED SUPERFICIAL ACTINIC POROKERATOSIS

By Gary M. White, MD

Disseminated superficial actinic porokeratosis


Disseminated superficial actinic porokeratosis (DSAP) is a condition in which multiple small, circular lesions develop on the arms and legs. Each lesion has a peripheral ridge which histologically is called a cornoid lamella. This cornoid lamella is thought to represent a spreading clone of abnormal cells.

Clinical

Multiple, red or brown, oval or circular lesions on the extensor arms and legs of a middle-aged woman is characteristic. A peripheral ridge defines the edge of each lesion. The term actinic is often inserted as ultraviolet light may exacerbate the condition. AD inheritance may occur. SCCs are an uncommon complication. Porokeratosis may occur almost anywhere, including the penis vulva and oral cavity [Indian J Dermatol Venereol Leprol 2017;83:244-6].

Treatment

Treatment is usually disappointing. Counseling the patient on sun avoidance and monitoring for any suspicious lesion is appropriate. One may try to destroy each individual lesion with cryotherapy or electrocautery. 5-FU, tretinoin, and calcipotriol may be given topically.

Tacalcitol 0.0004% once daily eliminated lesions in one patient after 5 months [JAAD 1999;40;479]. For lesions with increased erythema, one might consider the pulsed dye laser (such was helpful in one case of linear porokeratosis [Cutis 1999;63;265]). One 80-year-old was nearly cleared after 2 months with daily use of topical calcipotriol/betamethasone gel [Wien Med Wochenschr. 2016 Jul 28].

Additional Pictures

Round to oval, red, ridged lesions on the extremities.
Disseminated superficial actinic porokeratosis Disseminated superficial actinic porokeratosis

Disseminated superficial actinic porokeratosis Disseminated superficial actinic porokeratosis

Disseminated superficial actinic porokeratosis Disseminated superficial actinic porokeratosis

DSAP in a darker-skinned patient.
Disseminated superficial actinic porokeratosis Disseminated superficial actinic porokeratosis

Disseminated superficial actinic porokeratosis

References

DSAP involving the penis. JAAD Case Reports September 2015 Volume 1, Issue 5, Pages 277–2793

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