Publications

NTRODUCTION

Porokeratosis (PK) is a rare disorder characterised by non-neoplastic clonal expansion of keratinocytes. The classical form was described by Mibelli in 1893, subsequently, descriptions of superficial and disseminated forms of PK, linear porokeratosis (LP), disseminated superficial actinic porokeratosis (DSAP), disseminated palmoplantar PK and punctate PK were reported. Existing literature highlights the risk of progression to squamous cell carcinoma (SCC) in 6.4–16.4% of cases of PK.[1] Hence, it is imperative that clinical knowledge of this rare dermatosis is needed to differentiate it from clinically similar skin lesions for early diagnosis and screening.

CASE REPORT

A 58-year-old female presented with a 10-year history of progressively worsening, linear plaques on her left lower extremity. The eruption began as a single, tender papule on the foot that evolved into a verrucous, hyperplastic lesion. Over time, similar lesions developed proximally in a linear fashion, reaching the mid-thigh. These plaques were occasionally hypertrophic and discharged pus, especially with prolonged standing or exercise, but improved with antibiotics and steroids. Two prior skin biopsies were suggestive of PK, leading to treatment and mild resolution with oral acitretin and cyclosporine. On examination, linear hyperkeratotic plaques with irregular borders and a central furrow were present along the left lower limb, with some areas exhibiting verrucous changes and discharge [Figure 1]. Skin biopsies were performed again from multiple sites, followed by antibiotic therapy based on culture results. Based on the skin biopsy and soft-tissue ultrasound reports, a consultation with surgical oncology was obtained for further evaluation and management. The condition was finally managed with surgical excision and radiation therapy.