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THROUGH THE LENS
Year : 2018  |  Volume : 9  |  Issue : 6  |  Page : 469-470  

Exclusive facial actinic porokeratosis


Department of Dermatology, Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Dharwad, Karnataka, India

Date of Web Publication5-Nov-2018

Correspondence Address:
Naveen Kikkeri Narayanasetty
Department of Dermatology, No 14, Skin OPD, Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Sattur, Dharwad - 580 009, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_76_18

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How to cite this article:
Hegde SK, Panchagavi A, Narayanasetty NK. Exclusive facial actinic porokeratosis. Indian Dermatol Online J 2018;9:469-70

How to cite this URL:
Hegde SK, Panchagavi A, Narayanasetty NK. Exclusive facial actinic porokeratosis. Indian Dermatol Online J [serial online] 2018 [cited 2018 Dec 13];9:469-70. Available from: http://www.idoj.in/text.asp?2018/9/6/469/245017



Two healthy siblings aged 16 years and 13 years born out of consanguineous marriage presented with complaints of lesions over the face of 5 years and 3 years duration, respectively. The lesions initially started as a small black dot on the nose and then gradually increased in number and size to involve the paranasal area and the cheeks [Figure 1] and [Figure 2]. There was history of pruritus on exposure to sunlight. No other parts of the body were affected. None of the family members gave history of similar complaints. On examination, multiple tan colored flat topped macules to plaques of varying sizes with a thready border were seen on the nose, cheeks, and eyelids. Dermoscopic examination done using a Dermlite DL1 dermoscope with 15× magnification showed a flat center showing dots and globules with a white double marginated keratotic border that represents the coronoid lamella [Figure 3]a and [Figure 3]b. They were clinically diagnosed to have porokeratosis (PK). Biopsy done from the lesion on the face showed stratified squamous epithelium with focal keratin filled invagination. Dermis showed melanin clumps and dense lymphocytic infiltrate. The features were all consistent with actinic PK [Figure 4].
Figure 1: Porokeratotic lesions on the nose and left infraorbital region of the older patient

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Figure 2: Porokeratotic lesions seen over the nose and cheek in the younger patient

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Figure 3: Well-demarcated lesions showing a skin colored central part with a hyperpigmented border on dermoscopy (a) (black arrow) (non-polarized mode) and white coronoid lamella seen as double track and dark brown dots and globules in the center seen on dermoscopy (b) (white arrow) (polarized mode)

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Figure 4: Histopathology features from the peripheral raised edge showing the coronoid lamella with parakeratotic cells in focal keratin filled invagination and the absent granular layer beneath it with lymphocytic infiltrate (H and E, ×10)

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Both the patients were prescribed topical sunscreen during the day and 0.025% Tretinoin to be applied at bed time.

PK first described by Mibelli in 1893 includes a heterogeneous group of disorders of epidermal keratinization characterized by annular plaques with an atrophic center and hyperkeratotic edges, histologically showing coronoid lamella. Several types have been documented.[1] Exclusive facial PK that is a rare entity was described by Nabai and Mehregan in 1979.[2] It typically presents as single to multiple plaques on the distal part of the nose ranging from 0.1 cm to several centimeters in size surrounded by a keratotic rim.[3]

On dermoscopy, all variants of PK reveal a well-defined, whitish yellow peripheral annular structure, with a brownish pigmentation in the inner side also described as ''the outlines of a volcanic crater as observed from a high point.''[4],[5] Typically, the central area is seen as dots and globules, and the border that is the coronoid lamella has been described as diamond necklace or white track.[6]

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.
Gutierrez EL, Galarza C, Ramos W, Tello M, De Paz PC, Bobbio L, et al. Facial porokeratosis: A series of six patients. Australas J Dermatol 2010;51:191-4.  Back to cited text no. 1
    
2.
Lee Y, Choi EH. Exclusive facial porokeratosis: Histopathologically showing follicular cornoid lamellae. J Dermatol 2011;38:1072-5.  Back to cited text no. 2
    
3.
Dedhia AR, Someshwar SJ, Jerajani HR. Facial solar porokeratosis. Indian J Dermatol Venereol Leprol 2016;82:337-9.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Delfino M, Argenziano G, Nino M. Dermoscopy for the diagnosis of porokeratosis. J Eur Acad Dermatol Venereol 2004;18:194-5.  Back to cited text no. 4
    
5.
Panasiti V, Rossi M, Curzio M, Bruni F, Calvieri S. Disseminated superficial actinic porokeratosis diagnosed by dermoscopy. Int J Dermatol 2008;47:308-10.  Back to cited text no. 5
    
6.
Jha AK, Sonthalia S, Lallas A. Dermoscopy of porokeratosis of mibelli. Indian Dermatol Online J 2017;8:304-5.  Back to cited text no. 6
[PUBMED]  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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