34876 Pentoxifylline in the management of atrophic papulosis: A case report and review of the literature

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Introduction: Atrophic papulosis (AP) is a rare vasculopathy separated into a benign cutaneous form (BAP) and a malignant, potentially fatal form (MAP) with visceral organ involvement. While antiplatelets are often used in the management of BAP, no single therapy has proven effective in MAP. Single case studies suggest therapeutic benefit for pentoxifylline, an anti-inflammatory methyl-xanthine derivative, in the treatment of both forms of disease. Methods: This case report evaluated the efficacy of oral pentoxifylline and topical compounded 5% pentoxifylline cream in the management of a 38-year-old female BAP patient. In addition, a systemic literature review was conducted to identify the most common treatment options and patient response to treatment in adult atrophic papulosis. Results: Following a 3-month course of oral pentoxifylline and 1 month of topical pentoxifylline, the patient demonstrated improvement in cutaneous findings and reduction in disease spread. Literature review identified 62 cases (26 BAP, 36 MAP) of atrophic papulosis. Antiplatelets were the most frequently used treatment (42% BAP cases, 67% MAP), with a partial/complete response in 81% of BAP patients versus 42% of MAP patients. Additional therapies included vitamin A derivatives, corticosteroids, anticoagulants, antibiotics, and pentoxifylline. Partial or complete response was reported in 100% of BAP patients (3) treated with pentoxifylline versus 60% of MAP patients (5). Conclusion: No single treatment plan has been identified for the management of atrophic papulosis. While current literature supports the use of antiplatelets as a reasonable option, consideration should be given to the addition of pentoxifylline as an adjunct treatment in these patients.