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Is Fraxel Repair Effective for Actinic Porokeratosis?

Cryosurgery and topical creams have been ineffective. I'm concerned cosmetically but I'm primarliy interestd in reducing the risk that precancerous lesions will become cancerous.

Doctor Answers (2)

Maybe Q Switched Ruby Laser

+1

Porokeratosis is a defect in the way in which keratin is produced. All four varieties consist of circular or ring-like growths with a raised scaling border. Dermatopathologists look for what is called a cornoid lamella. This is a piling up of immature keratin cells ( parakeratosis).

Of the four tyypes, Disseminated Superficial Actinic Porokeratosis, the type you have, is by far the most common. It is inherited and is three times more common in women than males. In fact, I have a number of mother-daughter patients with it.

DSAP usually begins in the third or fourth decade of life.

The diagnosis is quite easy to make for the experienced dermatologist. As a resident I remember marveling at the ease with which the attending dermatologists made this diagnosis. There are often hundreds of small ring-like lesions, many of which are barely visible or require special lighting. One notes the slight depression and the slight,scaling border (the cornoid lamella).

As its name implies these lesions are provoked by sun exposure. Tanning beds or sunbathing are absolutely verboten, unless you happen to be dating a dermatologist who might find these growths interesting.

Fortunately, malignant transformation is unusual. When such an evil event occurs, the type of skin cancer is a squamous cell carcinoma. Usually, squamous cell carcinomas arising from DSAP are not aggressive. According to the dermatology literature, the rate is about 3.5%. In my 28 years of practice, treating maybe 30 patients with all the forms of porokeratosis, I have encountered this phenomenon twice. Thus, I would not be overly concerned.

As Dr. Persky points out treatment is difficult. Most dermatologists keep the lesions at bay with gentle cryotherapy. My patients usually circle the lesions before their appointment, making life easier for both of us.

Also, 5 F-U. Efudex, under occlusion (saran wrap) may help. Soriatane does make many of them resolve, but they recur.

Now that you have allowed me ( or maybe you skipped the above) to expound: I could find no evidence in the literature that Fraxel Repair works. There are two studies demonstrating that the Q switched Ruby laser is effective. This is a laser which is usually used for hair removal and hyperpigmentation disorders. These were very limited studies, though the treatment did seem to work.

It is imperative that you protect your skin with sunscreens and practice sun avoidance. Nearly all my patients's DSAP remains quiescent during the Winter months and I assure you this is not a coincidence.

For now, there is no great treatment, and cryotherapy might be the best we have.


Virginia Beach Dermatologist
4.5 out of 5 stars 10 reviews

Fraxel repair and Actinic Porokeratosis

+1

Hi spotty,

I have not had any experience or have heard of the treatment of actinic porokeratosis with Fraxel repair. Here is a list of tried, but unsuccessful treatments of the condition:

Treatment of DSAP
Unfortunately in our present state of knowledge there is no very satisfactory treatment for DSAP. Over the years we have tried:

Cryotherapy
5-Fluorouracil cream
Tretinoin cream
Alpha hydroxy acid cream
Calcipotriol ointment
Oral acitretin
Photodynamic therapy
Nothing has proved very effective. Most people settle for just having the larger lesions frozen lightly and returning as necessary for further treatments, using a moisturiser to reduce the dry feeling.

Sun protection
Restriction of sun exposure by wearing long sleeves, skirts or slacks and using sunscreens on the legs and arms is believed to reduce the development of new lesions.

Sun protection is the most important thing that you can do to prevent the development of skin cancer.

You may "test spot" with Fraxel repair on a few lesions to see if there is improvement.

Good luck and be well.

Dr. P

Michael A. Persky, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.