Kristine Kucera, PA-C, MPAS, DHS
Disseminated Superficial Actinic Porokeratosis
Disseminated superficial actinic porokeratosis (DSAP) is an inherited disease of disordered keratinization. Risk factors include genetics, immunosuppression, and ultraviolet light exposure. Often appearing on the arms and legs, lesions can range from 1-10mm or larger, and appear as pink to brown papules, macules, and patches with a raised scaly border. They can be asymptomatic or slightly pruritic. Most cases are seen in fair skinned women, in mid-life, with a history of significant sun exposure. Once DSAP has been diagnosed, the best thing an affected individual can do is avoid further sun damage by wearing long sleeves and using strong sunscreens.
DSAP lesions are considered precancerous with a 7.5% to 10% risk of malignant transformation to squamous cell carcinoma or basal cell carcinoma. There are many options for treatment, including topical diclofenac, photodynamic therapy (PDT), 5-fluorouracil (5-FU), imiquimod, vitamin D analogs, retinoids, and lasers. However, most of these are not satisfactory or proven effective long term.
Compounded off-label topical 2% lovastatin with or without topical cholesterol is the most promising treatment for DSAP so far described. In a recent study, patients were randomly assigned to once- or twice-daily application of lovastatin-cholesterol cream or lovastatin cream to affected areas for 12 weeks. Results showed that both formulations were equally effective. Disease severity in the lovastatin-cholesterol group decreased by 50% compared with a decrease of 51.4% in the lovastatin group with outcomes not impacted by application frequency.
Kristine Kucera, PA-C, MPAS, DHS, is Assistant Clinical Professor, University of Texas Southwestern, Medical Center PA Program, Dallas, TX. She is a member of the DEF Advisory Council.