Dermatology - Disseminated Superficial Actinic Porokeratosis
Disseminated superficial actinic porokeratosis is the predominant type of the exceedingly uncommon porokeratoses, exhibiting a higher prevalence in males compared to females, and often manifesting in individuals in their sixth decade of life. Patients may experience slight itching and have aesthetic worries. The extremities exhibit symmetrical distribution of uniformly tiny, annular flat papules measuring 2 to 5 mm in diameter. These papules are primarily found in sun-exposed areas. The lesions exhibit a well defined and thickened border, often less than 1 mm in height, and are marked by a distinctive longitudinal furrow that encircles the whole lesion. As the lesions advance, the core area undergoes atrophy and loses its ability to sweat. The palms, soles, and mucous membranes are usually unaffected. The diagnosis is primarily based on clinical assessment and can pose challenges. The differential diagnosis comprises Darier disease, heat rash (miliaria rubra), papular urticaria, scabies, dermatitis herpetiformis (characterized by grouped and symmetric lesions), Pityrosporum or eosinophilic folliculitis, insect bites, and medication eruptions. Apply Class I topical glucocorticoids directly to the lesions and cover them for a period of 4 hours. Systemic administration of oral glucocorticoids and dapsone has demonstrated efficacy, although relapses may occur upon discontinuation. Phototherapy with UVB or photochemotherapy can be beneficial for patients who do not show a response to topical glucocorticoids when applied under occlusion. Isotretinoin has been employed in patients that have not responded to other treatments.
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