|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 2 | Page : 170-171
Porokeratoma: An uncommon entity
Piyush Kumar1, Hiral Shah2, Anupam Das3
1 Department of Dermatology, Katihar Medical College and Hospital, Katihar, Bihar, India
2 Department of Dermatology, Baroda Medical College, Vadodara, Gujarat, India
3 Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
|Date of Submission||09-Jan-2020|
|Date of Decision||30-Jan-2020|
|Date of Acceptance||14-Apr-2020|
|Date of Web Publication||31-Mar-2021|
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Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kumar P, Shah H, Das A. Porokeratoma: An uncommon entity. Indian J Paediatr Dermatol 2021;22:170-1
Porokeratoma (porokeratotic acanthoma), a rare entity, is a tumor-like acanthoma with features of porokeratosis (cornoid lamellation), commonly found over extremities, head and neck, chest, buttocks. We hereby present a case of a 13-year-old boy who presented with a solitary plaque on the right arm. He presented with a slightly painful lesion on the upper extremity of the right side, present for the preceding 5 years and gradually increasing in size. He had applied some over-the-counter ointments (details not available), without any benefit. Cutaneous examination revealed a solitary plaque (2.5 cm × 10 cm) on the posterior aspect of the right arm [Figure 1]. The central part of the plaque showed scaling and hyperkeratosis, and the border was well defined and raised. There were no similar lesions elsewhere. Biopsy was done from the lesion. Histology showed orthokeratosis, acanthosis, papillomatosis, and multiple cornoid lamellae overlying hypogranulosis [Figure 2] and [Figure 3]. Based on the clinicopathological correlation, a diagnosis of porokeratoma was reached. The patient was prescribed betamethasone dipropionate 0.05% cream and levocetirizine 5 mg.
|Figure 2: Photomicrograph showing orthokeratosis, acanthosis, papillomatosis, and multiple cornoid lamellae (H and E, ×40)|
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|Figure 3: Photomicrograph showing cornoid lamellae. Note the presence of hypogranulosis and occasional dyskeratotic cells (H and E, ×100)|
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Porokeratoma needs to be differentiated from porokeratosis of Mibelli. Clinically, porokeratoma presents with scaly plaques (consistent with our case), nodules with central hyperkeratosis, verrucous plaques, etc. However, lesions of porokeratosis manifest with scaly annular plaques with ridgelike hyperkeratotic edges, central hypopigmentation, and atrophy. Moreover, on histology, porokeratoma lacks central epidermal atrophy (unlike porokeratosis), and cornoid lamellae are present throughout the stratum corneum instead of being present only at the borders (in porokeratosis).,,
Porokeratoma has been considered as a part of various entities such as hyperkeratotic porokeratosis, genitogluteal porokeratosis, follicular porokeratosis, and porokeratosis ptychotropica. Verrucous porokeratosis has been proposed as an umbrella term for all the entities. Porokeratoma is usually solitary and does not have any underlying systemic abnormalities. Rarely, it can be associated with ankylosing spondyloarthritis, human papilloma virus infection, and immunosuppression.,
Malignant transformation has not yet been reported in porokeratoma. Therapeutic options include topical steroids, topical 5-fluorouracil, and Vitamin D analogs. Excision and close follow-up are advisable in immunocompromised patients.,
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]