Back issues No.3 - 2011 / Correspondence  

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Systemic isotretinoin with topical tretinoin cream in the treatment of multiple warty dyskeratomas
Ying-Ling Kuo , Yu-Hung Wu , Ying-Jui Chang
DERMATOLOGICA SINICA 29 (2011) 106–108

A 29-year-old Taiwanese man initially presented with a painful red nodule on the right cheek for several days. A total excision was arranged. Histopathologically, the lesion demonstrated features of warty dyskeratoma (WD) characterized by a dilated cystic epidermal invagination with a hyperkeratotic and parakeratotic plug. Suprabasal acantholysis was prominent, as were acantholytic and dyskeratotic cells, corps ronds, and grains. He came to our clinic 2 years later because more lesions appeared on his face and trunk gradually over these years. Physical examination at that point revealed hundreds of keratotic papules or nodules with follicular plugging on the scalp, face, neck, and the chest (Figure 1A and B). Another skin biopsy from a scalp lesion was performed and microscopically showed similar pathological findings as the previous one, a typical WD (Figure 2). He had no personal or family history of Darier’s disease or other skin disorders. He was treated with oral isotretinoin 30mg/d in three divided doses along with topical 0.05% tretinoin cream. Both the size and number of the lesions improved significantly after 1 month of therapy (Figure 1C and D). Mild dry mouth was the only adverse reaction been complained. The patient stopped the treatment 14 weeks later because of the cost and the side effect. In the 5 months follow-up after discontinuing the medications, most of the lesions have remained as small as they were during treatment, and only a few new ones have developed (Figure 3).

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