• 16
    Feb
  • Clinical Study of Porokeratosis Associated with Immunosuppressive Therapy: RESULTS

Table 1 summarizes the clinical characteristics of the 9 renal transplant recipients with PK. At dermatological examinations, patient ages ranged from 38 to 67 years (mean age: 52 years). There were eight men and one woman, and no patient had previous or family history of PK. All patients had received renal allograft transplantation because of chronic renal failure. After renal transplantation, they received multi-drug regimens comprised of two or three immunosuppressive agents, namely, steroids, cyclosporine, azathioprine, mycophenolate mofetil, and/or tacrolimus. History taking revealed that all lesions developed after transplantation. Times between transplantation and lesion onset ranged from 2 to 9 years (mean: 4.1 years). The most commonly associated skin disease was verruca (4), and the others were recurrent herpes simplex infection (1), actinic keratosis (1), and cutaneous B cell lympho- ma (1).

Table 1. Clinical characteristics of the 9 renal transplant recipients with porokeratosis

No.

Sex/Age

Interval between renal

Number

of lesions

Location of

Type of lesions

Associated skin

Immunosuppressive

(yr)

tansplantation

lesions

diseases

agents used

and PK (yr)

1

M/59

2

6

Forearm, leg DSAP

None

CS, steroid

2

M/49

4

5

Arm

DSAP

Verruca

CS, AZP, steroid

3

F/38

3

4

Leg

DSAP

Condyloma

TCLM, MMF, steroid

4

M/57

3

>10

Trunk, leg

Mibelli, DSAP

Verruca

CS, MMF, steroid

5

M/67

4

2

Arm

Mibelli

H.simplex, recurrent

CS, steroid

6

M/55

9

2

Arm, leg

Mibelli

Actinic keratosis

CS, MMF

7

M/42

6

1

Arm

Mibelli

Verruca

CS, steroid

8

M/49

2

8

Trunk, leg

Mibelli, DSAP

Verruca, lymphoma

CS, steroid

9

M/50

4

7

Neck, arm

Mibelli, DSAP

None

CS, steroid

Clinically, the lesions were characterized by well- demarcated hyperkeratotic papules or plaques with slightly elevated peripheries. Cases 1, 2, and 3 had less than ten lesions, and all developed in the extremities. Lesions were 5 to 8 mm in diameter and were superficial, and annular, corresponding to DSAP. Cases 4, 8, and 9 had many lesions in the extremities and almost of all were small and superficial, corresponding to DSAP (Fig. 1). Lesions of the trunk or neck presented as large, distinct hyperkeratotic plaque, corresponding to PK Mibelli (Fig. 2). Cases 5, 6 and 7 had one or two plaques several centimeters in diameter with a highly raised periphery, corresponding to PK Mibelli.
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Fig. 1. Multiple erythematous annular

Fig. 1. Multiple erythematous annular papules and plaques with a hyperkeratotic border on the left lower leg of case 4.

Histopathologically, lesions commonly showed a keratin-filled invagination of the epidermis with a central raised parakeratotic column, the so-called cornoid lamella. In PK Mibelli, this invagination extended downward at a sleeper angle than that observed in DSAP (Fig. 3).

Fig. 2. Two large erythematous annular

Fig. 2. Two large erythematous annular plaques and a small plaque on the posterior side of the neck of case 9.

Three patients (cases 1, 2 and 8) were treated with imiquimod. In one patient (case 2) only the lesions improved slightly initially, but there was no significant overall change. The other patients refused treatment. No malignant change was observed during follow-up visits which ranged from 1 to 5 years.
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Fig. 3. The cornoid lamella arises

Fig. 3. The cornoid lamella arises from a small inden¬tation in the epidermis and extends like a thin column through the entire stratum corneum, and the underlying granular cell layer is diminished (H&E, x400).

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