Clinical Study of Porokeratosis Associated with Immunosuppressive Therapy
Porokeratosis (PK) is a specific keratinization disorder, and is histologically characterized by the presence of a cornoid lamella, a thin column of closely stacked, parakeratotic cells that extend through the stratum corneum. Clinically, the basic lesion is sharply demarcated and hyperkeratotic, and may be annular with central linear or punctate atrophy. Five clinical variants are recognized, namely, PK Mibelli, PK palmaris et plantaris disseminata, linear PK, punctate PK, and disseminated superficial PK (DSP) and disseminated superficial actinic PK (DSAP).
The etiologies of the different PK variants have not been established, but they are certainly multi- factorial. Additional factors are presumed to trigger clinical manifestations in genetically disposed skin.
Irradiation with ultraviolet (UV) light and systemic immunosuppression have been considered to be factors that trigger lesion development in several cases, and it has been suggested that this occurs due to an impairment of the immune surveillance function of Langerhans cells. A significant number of PK cases have been reported to be associated with chemotherapies administered due to malignancy, organ transplantation, or systemic corticosteroid therapy, and more recently due to human immunodeficiency virus infection. In particular, two large series of renal transplant recipients, found PK prevalences of 0.34% and 10.68%. The clinical pattern of PK associated with immunosuppression was DSAP in most patients, though a recent report found that the mixed pattern of PK Mibelli and DSAP was most prevalent. vardenafil 20 mg
Overseas, multiple case reports and series have described the development of PK in the setting of immunosuppression, which is widely recognized following solid organ transplantation. To the best of our knowledge, only three cases of PK following renal or heart transplantation have been reported in the Korean dermatological literature.
|YW Han, et al.|
Here we report the clinical characteristics of 9 cases with PK associated with immunosuppressive therapy in renal transplant recipients who were treated at our hospital over the last 6 years. In addition, we include a review of the medical literature concerning the association between PK and immunosuppression.