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CASE REPORT
Year : 2011  |  Volume : 56  |  Issue : 5  |  Page : 576-577
Disseminated superficial and warty type of porokeratosis: A rare coexistence


Department of DNB Resident, Vydehi Institute of Medical Science and Research Center, Bangalore, India

Date of Web Publication4-Nov-2011

Correspondence Address:
Kusumika Kanak
NC-1,56, Vijaya Enclave Aprts, Bilekhahalli, Off Bannerghatta Road, Bangalore-560 076
India
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DOI: 10.4103/0019-5154.87160

PMID: 22121283

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   Abstract 

A 60-year-old male presented with hyperpigmented annular plaques with raised keratotic wall and central groove along with warty plaque involving the trunk and the extremities, respectively. A provisional diagnosis of porokeratosis was made which was confirmed histopathologically. Herein, we report a case of rare coexistence of disseminated superficial and warty porokeratosis.


Keywords: Disseminated superficial porokeratosis, rare coexistence, warty porokeratosis


How to cite this article:
Kanak K, Jaiswal A K, Reddy P. Disseminated superficial and warty type of porokeratosis: A rare coexistence. Indian J Dermatol 2011;56:576-7

How to cite this URL:
Kanak K, Jaiswal A K, Reddy P. Disseminated superficial and warty type of porokeratosis: A rare coexistence. Indian J Dermatol [serial online] 2011 [cited 2014 Sep 3];56:576-7. Available from: http://www.e-ijd.org/text.asp?2011/56/5/576/87160



   Introduction Top


Mibelli described classical porokeratosis in 1893. [1] Different clinical types have been reported: superficial disseminated, disseminated actinic, porokeratosis of Mibelli, punctate and hypertrophic and porokeratosis palmaris et plantaris disseminata. There are also reports of atypical presentation like hypertrophic, warty and nodular variety. [2] Mucous membrane, palms, soles, axillary vault and inguinal folds are not commonly involved. [1]


   Case Report Top


A 60-year-old male presented with multiple itchy, hyperpigmented annular plaques over trunk, extremities, scalp, oral mucosa of 40 years duration and warty lesions on lower extremities of 10 years duration. To begin with, the lesions were small keratotic hyperpigmented papules which gradually enlarged to form a ring-like plaque with central atrophy surrounded by discrete ridge. On family screening, it was found that two of his four children had similar lesions.

Cutaneous examinations revealed multiple well-defined erythematous and hyperpigmented annular scaly plaques of size ranging from 1.5 to 5 cm, distributed on the scalp, face, axillae, trunk and extensor surface of the extremities [Figure 1]. Scalp lesions were associated with cicatricial alopecia. Buccal mucosa lesions showed maceration [Figure 2]. Some lesions had slightly raised keratotic wall with central groove that became accentuated by application of gentian violet. Hyperkeratotic warty plaques with minute ulcerations and post-inflammatory hypopigmentation were seen on extensor aspect of lower extremities.
Figure 1: Hyperpigmented keratotic scaly annular plaques and warty plaques with minute ulcerations on extensor aspect on lower extremities

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Figure 2: Maceration seen over buccal mucosa

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A provisional diagnosis of disseminated superficial porokeratosis along with warty type was made, which was confirmed histopathologically [Figure 3]. Routine blood investigations and biochemistry were within normal limits. Blood for HIV was negative.
Figure 3: Hyperkeratosis, parakeratosis, cornoid lamella, and absence of granular layer below the cornoid lamella (H and E staining, ×40)

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   Discussion Top


Disseminated superficial form was first described by Respighi. [3] It usually starts in third and fourth decades and is progressive over the years. Females are more commonly affected than males. [1],[3] Areas such as cornea, oral mucosa and perianal region have been associated with porokeratosis. [4],[5],[6]

Atypical forms like warty porokeratosis have been described in literature. [7] There are also reports of disseminated porokeratosis with linear type and porokeratosis of Mibelli. [8],[9],[10]

The interesting feature of this case report is simultaneous occurrence of disseminated superficial porokeratosis and warty porokeratosis.To the best of our knowledge; this is the second case report of rare coexistence of disseminated superficial porokeratosis and warty porokeratosis. [11]

 
   References Top

1.Elisabeth CI, Schreiner W. Porokeratosis. In: Fitzpatrick's Dermatology in General medicine. 5 th ed. New York: Mc Grawhill Publication; 1999. p. 624-8.  Back to cited text no. 1
    
2.Pavithran K. Disorders of keratinisation. In: Valia RG, Valia AR, editors. IADVL Textbook and atlas of dermatology. 3 rd ed. Mumbai: Bhalani Publishing House; 2008. p. 1007-8.  Back to cited text no. 2
    
3.Griffiths WA, Judge MR. Disorders of keratinisation: In: Chapion RH, Burton JL, Burns DA, Breathnach SM, editors. Rook/Wilkinson Ebling textbook of dermatology. 6 th ed. Oxford: Blackwell Sciences; 1998. p. 1552-4.  Back to cited text no. 3
    
4.Kiessling W. Porokeratosis with involvement in the cornea of the eye. Dermatol Wochenschr 1952;126:1168-70.  Back to cited text no. 4
    
5.Darling MJ, Lambiase MC, Viernes J. Porokeratosis: A solitary oral lesion. J Drug Dermatol 2005;4:89-91.  Back to cited text no. 5
    
6.Rosün E, Garcia-Doval I, De La Torre C, Losada A, Rodriguez T, Ocampo C, et al . Disseminated superficial porokeratosis with mucosal involvement. Acad Derm Venereol 2001;81:64-5.  Back to cited text no. 6
    
7.Rajendran N. Warty porokeratosis. Indian J Dermatol Venerol Leprol 1989;55:59-60.  Back to cited text no. 7
    
8.Sundareshwar B, Reddy P. Porokeratosis-Report of three unusual cases. Indian J Dermatol Venerol Leprol 1998;64:286-8.  Back to cited text no. 8
    
9.Freyschmidt-Paul P, Hoffmann R, König A, Happle R. Linear Porokeratosis superimposed on disseminated superficial actinic porokeratosis: Report of two cases exemplifying the concept of type 2 segmental manifestation of autosomal dominant skin disorders. J Am Acad Dermatol 1999;41:644-7.  Back to cited text no. 9
    
10.Hanumanthayya K, Magavi S, Tophakhane R, Rathod R. Coexistence of disseminated superficial and giant porokeratosis of Mebilli with squamous cell carcinoma. Indian J Dermatol Venerol Leprol 2003;69:296-9.  Back to cited text no. 10
    
11.Mukhopadhyay AK. Simultaneous occurrence of disseminated superficial, linear and hypertrophic verrucous forms of porokeratosis in a child. Indian J Dermatol Venerol Leprol 2004;70:364-6.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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    Abstract
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