USA: Promising Treatment for Disseminated Superficial Actinic Porokeratosis (DSAP)

A recent study has found that for patients with disseminated superficial actinic porokeratosis (DSAP), topical statin and cholesterol combination therapy may be a promising treatment. The therapy had fewer side effects than traditional treatment methods. The findings from the review were published online in the Journal of Drugs in Dermatology on September 16, 2023.

"Of the 20 patients in the eight case studies, 90% experienced a clinical improvement with various forms of topical statin and cholesterol," the researchers reported.

Porokeratosis is a rare group of hereditary or acquired dermatoses characterized by annular or linear plaques with a keratotic border. The most common porokeratosis is DSAP, and lesions range from asymptomatic to pruritic circular pink to brown macules, plaques or papules surrounded by a raised border. DSAP carries about a 7.5-10% risk of malignant transformation to squamous cell carcinoma (SCC) or basal cell carcinoma (BCC).

In the past, DSAP has been widely treated with:

• Topical diclofenac
• Topical vitamin D analogue
• Ingenol mebutate
• Laser therapy
• Cryotherapy
• Retinoids
• Photodynamic therapy
• Imiquimod
• 5-fluorouracil

However, these therapies have shown limited efficacy and have caused adverse effects, including erythema, pain, hyperpigmentation, and inflammatory reactions. Recently, a formulation of topical statin and cholesterol has emerged as a new and promising treatment for DSAP, which has demonstrated clinical improvement with a tolerable adverse effect profile when compared to the current therapies.

Against the above background, Hira Ghani, Nassau University Medical Center, East Meadow, NY, and colleagues aimed to assess the effectiveness of topical statin and cholesterol therapy in patients with disseminated superficial actinic porokeratosis. For this purpose, they used data from eight case reports.

Key Findings

• Of the 20 patients in the eight case studies, 90% experienced a clinical improvement with various topical statin and cholesterol formulations.
• The adverse effects were rare, with only one major skin reaction observed after an extended 24-week application of a topical statin and cholesterol formulation, which was successfully treated with corticosteroids.
• Most other studies employed topical statin treatments for a shorter duration, typically lasting 6 to 12 weeks.

"Topical statin and cholesterol combination therapy may be a promising treatment for DSAP patients, with fewer side effects than traditional treatment methods," the researchers wrote.

"While promising, there is a need for larger randomized controlled trials to evaluate the long-term use of topical statins for DSAP," they concluded.

Reference

Ghani H, Richards E, Truong TM, Rao BK, Zhang A. A Review of the Efficacy of Topical Statins for Treating Disseminated Superficial Actinic Porokeratosis. J Drugs Dermatol. 2023 Oct 1;22(10):1053-1057. doi: 10.36849/JDD.7540. PMID: 37801522.