Porokeratosis in different age groups: from clinical manifestations to features of patient management (clinical cases)

Abstract

Objective — to analyze the clinical manifestations of porokeratosis among patients of different age groups with emphasis on diagnostic possibilities; determine the potential risk of malignant transformation of dermatosis; choose the optimal therapeutic tactics. Materials and methods. Personal observations of clinical manifestations of porokeratosis in representatives of the adult and children’s population are described. The diagnosis based on the assessment of visual manifestations of dermatosis was verified at the department of dermatovenerology and cosmetology with a course of dermatovenerology and aesthetic medicine of the Zaporizhzhya State Medical and Pharmaceutical University. In addition, a dermatoscopy was performed at the «University Clinic» Educational and Scientific Center. Pathomorphological diagnosis is recognized as the final argument in diagnosis and the choice of further treatment tactics. Results and discussion. The first clinical case in a patient born in 1961 is represented by a pathological process in the form of papular plaque elements located along Blashko’s lines on the left thigh and the upper third of the lower leg. Single «islets» of the skin with more pronounced inflammation, infiltration, nodule formation, and the appearance of serous hemorrhagic exudate with local ulceration were recognized as clinically suspicious. For the second clinical case in a patient born in 2014 the presence of plaques with clear borders and hyperkeratotic changes on the skin of the left lower limb was characteristic. Dermatoscopic pathomorphological diagnosis in both cases provided not only verification of the diagnosis, but also disproved the suspicion of a possible malignant transformation in the lesions. The appointment of systemic retinoids in the first case and their topical form in the second case was based on the principles of a personalized approach with an assessment of the age characteristics and somatic background of the patients. Conclusions. When examining rare dermatological nosologies, clinical­dermatoscopic­morphological correlation plays the most important role in the timely and correct diagnosis of dermatosis. During the clinical examination of patients with porokeratosis of various ages, the practitioner should be alert to the formation of malignant transformation within the primary lesions, considering any dynamic changes as potentially suspicious. When developing an individual therapeutic algorithm, it is necessary to take into account not only the links of the pathogenetic mechanisms of the formation of porokeratosis but also age, social, and background comorbid conditions.