Punctate Porokeratosis

A 38-year-old African American man presented with a 10-year history of a solitary “wart” that had not responded to over-the-counter acid treatments. No other lesions were noted on the patient. Based on the clinical appearance, punctate porokeratosis was diagnosed. Dr Raymond T. Kuwahara of Memphis, Tenn, writes that punctate porokeratosis is an autosomal dominant skin disorder that is characterized by thickening of the stratum corneum at the cornoid lamella. The lesions are typically mistaken for warts or calluses. Treatment is by excision, cryotherapy, electrodesiccation, dermabrasion,or carbon dioxide laser. The choice of modality is based on the lesion’s size and location as well as the patient’s aesthetic requirements. Lesions located at the interphalangeal joint, as in this patient, are especially difficult to treat. The porokeratosis was pared with a razor (alternatively, a no.15 scalpel may be used) and then frozen with liquid nitrogen. This patient’s lesion was successfully eradicated after 3 visits.