Disseminated superficial porokeratosis and anetoderma developing after acute pancreatitis
Pratyusha Kolanuvada, Chankramath Sujatha, Hariharasubramony Ambika
Nasza Dermatologia Online
Sir, Disseminated superficial Porokeratosis is a heterogeneous group of disorders characterized by a distinct clinical finding of keratotic ridge with central groove that corresponds to cornoid lamella in histology. Anetoderma is characterised by localised loss of elastic tisssue resulting in herniation of subcutaneous tissue. We describe a rare association of disseminated superficial porokeratosis and anetoderma, which was developed after an episode of acute pancreatitis. A 56yr old male
... t, farmer by occupation, was presented with multiple asymptomatic hyperpigmented annular lesions over the trunk since 8 months and multiple discrete yellowish sac like protrusions over trunk since 6 months. He gives h/o acute pancreatitis 10 months back for which he was treated conservatively. On examination there were multiple discrete annular hyperpigmented plaques of varying sizes with hyperkeratotic grooved borders over anterior and posterior aspects of the trunk and both the upper limbs and neck (Fig. 1) . Multiple discrete yellowish sac like protrusions of sizes varying from 5mm to 10mm were seen over both the flanks and posterior aspect of the trunk. Button hole sign was positive (Fig. 2) .Routine blood investigations and biochemical investigations were within normal limits. HIV and HBS Ag was negative. Histopathology of keratotic plaques showed foci of epidermal invagination filled with keratin and parakeratotic coronoid lamella ,dermis showed a mild to moderate infiltrate of lymphocytes and evidence of pigment incontinence which was consistent with porokeratosis (Fig. 3) . Histopathology of sac like protrusions showed decreased elastic fibres in the papillary and reticular dermis. Staining with verhoeff-van Gieson was consistent with anetoderma ( Fig. 4) . With the above clinical and histopathological findings the diagnosis of disseminated superficial porokeratosis and anetoderma was confirmed. For larger lesions were treated with topical 5-flurouracil was given and smaller lesions with topical Tretinoin 0.05% cream. Significant improvement was seen within 3 months.