Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor
2014:80:4;373-374
doi: 10.4103/0378-6323.136981
PMID: 25035379

Calcipotriol and adapalene therapy for disseminated superficial actinic porokeratosis

Yoshitaka Nakamura, Michiya Yamaguchi, Akiko Nakamura, Masahiko Muto
 Department of Dermatology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan

Correspondence Address:
Yoshitaka Nakamura
Department of Dermatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi - 755-8505
Japan
How to cite this article:
Nakamura Y, Yamaguchi M, Nakamura A, Muto M. Calcipotriol and adapalene therapy for disseminated superficial actinic porokeratosis. Indian J Dermatol Venereol Leprol 2014;80:373-374
Copyright: (C)2014 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Disseminated superficial actinic porokeratosis (DSAP) is a chronic disorder of keratinization characterized by numerous papules and plaques distributed on sun-exposed sites. Although various therapeutic options are available, an ideal and standardized treatment protocol for DSAP is lacking. Here, we report a case of DSAP in an otherwise healthy 63-year-old Japanese man who was successfully treated with calcipotriol and adapalene.

A 63-year-old Japanese male carpenter was referred to our department with a 10-year history of multiple, brown, occasionally itchy lesions over the extremities in a photodistributed pattern. The lesions, diagnosed as eczema by a local doctor, had not responded to topical corticosteroids. There was worsening after sun exposure and during summer and the patient used to wear long-sleeved clothes to prevent exacerbation. He was otherwise healthy and denied any history of immunosuppression, radiation therapy, or arsenic intake. His family history was negative for DSAP and other relevant dermatological diseases.

On physical examination, multiple, red-brown, annular keratotic lesions measuring up to 1 cm in diameter were symmetrically distributed on sun-exposed areas of the extremities [Figure - 1]a. Some scaly plaques were observed on the face but the trunk was not involved. Close inspection revealed that individual lesions had central atrophy and an elevated hyperkeratotic ridge. Dermoscopic examination revealed open pores with plugs and a whitish peripheral rim [Figure - 1]b. The results of routine laboratory investigations were within normal limits. A punch biopsy taken from the keratotic border of a lesion on the right lower arm revealed a characteristic keratin-filled invagination with a cornoid lamella and absence of granular layer beneath the cornoid lamella [Figure - 1]c. A diagnosis of disseminated superficial actinic porokeratosis (DSAP) was made and topical treatment with 0.005% calcipotriol ointment twice daily was started. However, after the first 3 months, only a slight improvement was observed and treatment was changed to calcipotriol once daily in the morning and topical adapalene (0.1%) gel every night. After 3 months of treatment with both calcipotriol and adapalene, the skin lesions improved substantially leaving only slight hyperpigmentation [Figure - 1]d. The treatment was well tolerated without significant adverse effects and no recurrence was seen after reducing the frequency of topical application to every other day.

Figure 1: (a) Pretreatment. Multiple red-brown, annular keratotic macules on the right lower arm. (b) Dermoscopic examination reveals open pores with plugs and a whitish peripheral rim. (c) Histopathological examination of a punch biopsy taken from the keratotic border reveals a characteristic keratin-filled invagination with cornoid lamella and absence of a granular layer beneath the cornoid lamella (H and E, ×200). (d) Clinical findings after 3 months of combination therapy. The skin lesions have improved, leaving only slight hyperpigmentation

DSAP was first described by Chernosky and Freeman. [1] Since then, various treatment options for this condition including topical diclofenac, vitamin D 3 analogs, 5-fluorouracil, retinoids, 5% imiquimod, photodynamic therapy, carbon dioxide laser and oral retinoids have been reported with varying degrees of success. [2] However, reports of DSAP treated with vitamin D 3 analogs are rare. [3] Vitamin D 3 analogs are thought to induce the transcription of genes necessary for keratinocyte differentiation such as transglutaminase and involucrin. They may also inhibit keratinocyte proliferation by inducing sphingomyelin hydrolysis and modulation of protein kinase C activity. Harrison and Stollery reported a 50-75% improvement of DSAP lesions treated with daily topical calcipotriol for 6-8 weeks; [4] however, only a limited effect was observed in our patient on treatment with topical calcipotriol alone.

There are several reports of the successful use of topical retinoids especially tretinoin for the treatment of porokeratosis. [5] The third-generation topical retinoid, adapalene has also been used effectively for various keratotic skin diseases and has the advantage of having lesser adverse effects. In addition to its strong anti-inflammatory activity, it also acts as a modulator of keratinization and cellular differentiation. Its activity is mediated through selective binding to the nuclear retinoic acid receptor which is able to normalize differentiation of follicular epithelial cells. We believe that calcipotriol and adapalene combination therapy normalizes keratinocyte differentiation and inhibits keratinocyte proliferation more effectively through two different pathways. As demonstrated by its clinical efficacy and lack of significant adverse effects in our single patient, combination topical therapy with calcipotriol and adapalene may represent a useful option for DSAP. Further studies on a larger population of patients are necessary to confirm its therapeutic benefit.

References
1.
Chernosky ME, Freeman RG. Disseminated superficial actinic porokeratosis (DSAP). Arch Dermatol 1967;96:611-24.
[Google Scholar]
2.
Skupsky H, Skupsky J, Goldenberg G. Disseminated superficial actinic porokeratosis: A treatment review. J Dermatolog Treat 2012;23:52-6.
[Google Scholar]
3.
Bakardzhiev I, Kavaklieva S, Pehlivanov G. Successful treatment of disseminated superficial actinic porokeratosis with calcipotriol. Int J Dermatol 2012;51:1139-42.
[Google Scholar]
4.
Harrison PV, Stollery N. Disseminated superficial actinic porokeratosis responding to calcipotriol. Clin Exp Dermatol 1994;19:95.
[Google Scholar]
5.
Agrawal SK, Gandhi V, Madan V, Bhattacharya SN. Topical tretinoin in Indian male with zosteriform porokeratosis. Int J Dermatol 2003;42:919-20.
[Google Scholar]

Fulltext Views
776

PDF downloads
214
Show Sections