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LETTER TO EDITOR
Year : 2021  |  Volume : 22  |  Issue : 2  |  Page : 170-171

Porokeratoma: An uncommon entity


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 Submission09-Jan-2020
Date of Decision30-Jan-2020
Date of Acceptance14-Apr-2020
Date of Web Publication31-Mar-2021

Correspondence Address:
Anupam Das
Building “Prerana” 19 Phoolbagan, Kolkata - 700 086, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_67_20

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How to cite this article:
Kumar P, Shah H, Das A. Porokeratoma: An uncommon entity. Indian J Paediatr Dermatol 2021;22:170-1

How to cite this URL:
Kumar P, Shah H, Das A. Porokeratoma: An uncommon entity. Indian J Paediatr Dermatol [serial online] 2021 [cited 2021 Apr 18];22:170-1. Available from: https://www.ijpd.in/text.asp?2021/22/2/170/312814



Sir,

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.[1] 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 1: Solitary plaque on the posterior aspect of the right arm

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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.[2] 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).[3],[4],[5]

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.[2],[3]

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.[6],[7]

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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Batalla A, Rosón E, De la Torre C. Porokeratoma: A different entity or a variant of verrucous (hyperkeratotic) porokeratosis? Indian J Dermatol 2013;58:158.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Caseiro Silverio P, Pham XC, Kaya G. Porokeratoma: A possible association with human papillomavirus infection. Dermatopathology (Basel) 2015;2:43-5.  Back to cited text no. 2
    
3.
Kanitakis J, Rival-Tringali AL, Chouvet B, Vignot E, Claudy A, Faure M. Porokeratoma (porokeratotic acanthoma): Immunohistological study of a new case. J Cutan Pathol 2009;36:804-7.  Back to cited text no. 3
    
4.
Tan Q, Tan C. Porokeratotic acanthoma. J Dtsch Dermatol Ges 2015;13:151-3.  Back to cited text no. 4
    
5.
Chen AM, Gao YL, Li N. A case report of porokeratoma. Chinese J Dermatol 2013;46:191-2.  Back to cited text no. 5
    
6.
Walsh SN, Hurt MA, Santa Cruz DJ. Porokeratoma. Am J Surg Pathol 2007;31:1897-901.  Back to cited text no. 6
    
7.
Available from: https://www.dovemed.com/diseases-conditions/porokeratoma/. [Last accessed on 2020 May 08].  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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