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June 2009
By Kirkland Lau, DO, and Stephen M. Schleicher, MD
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CASE:
A 61-year-old man with a history of chronic sun exposure is concerned about the erythematous, slightly scaly patches on his forearms and ankles. These have been increasing in number over the past several years. Most are asymptomatic; however, on occasion some become tender or pruritic. The patient believes his father was similarly affected. He denies any history of skin cancer.
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This patient has disseminated superficial actinic porokeratosis, an autosomal dominant disorder with a low risk of malignant transformation. Lesions typically are red to brown, slightly keratotic, annular macules arising on sun-exposed areas. Other exacerbating factors include immunosuppression and use of tanning beds. Treatment options include topical fluorouracil, retinoids, diclofenac gel, imiquimod, and calcipotriene, all of which produce variable results. Strict avoidance of sunlight is mandatory.
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Dr. Lau is an associate with a division of the DermDx Centers for Dermatology in Reading, Pennsylvania. Dr. Schleicher is director of the DermDOX Center in Hazelton, Pennsylvania, a clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine and Kings College in Wilkes-Barre, Pennsylvania, and an associate professor of medicine at the Commonwealth Medical School in Scranton, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 41(6):23-24, 2009
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