Sunday, February 10, 2008

Asymptomatic annular lesions on face and hands

Submitted by Khalil Alhamdi M.D.
Associate Professor of Dermatology
Basrah, Iraq

Abstract: A 25-year old woman with 3-year history of asymptomatic annular lesions on face and hands

History: A 25-year-old woman presented with 3-year history of multiple asymptomatic annular lesions involving the face and the dorsa of both hands that gradually increase in size. She had received different modalities of treatment without improvement.

O/E: Young aged women presnted with multiple asymptomatic annular atrophied hyperpigmented patches with hyperkeratotic border that affect the face in a mask-shaped destribution and the dorsa of both hands.

Clinical Photo:

Lab: All relevant investigations were normal.

HPE: revealed features suggestive of porokeratosis

Diagnosis: Porokeratosis of Mibelli

Comments: This woman was misdiagnosed as fungal infection and lichen planus for which she received treatment without benefit. On clinical and histopathological bases we put her on topical 5Fu in addition to irregular courses of isotretnion because of poor compliance and inavailability of the latter drug in our country.

1. What is the experience of our colleagues in seeing such unusual presentation?
2. What is your treatment suggestion to help this poor lady.


  1. In my opinion, the combination therapy with oral isotretinoin and topical 5-FU has a potential to cause severe adverse effects including poainful erosions. I would advise treatment with 5-FU alone. Best regards, Shahbaz

  2. I agree also with Dr Shahbaz. Isotretinoin with topical 5-FU is good treatment in this case.

  3. omeran kaffyFebruary 20, 2008

    Thanks Dr. hamdi for this interesting case.I agree 5FU is agood option but it needs time to show marked improvement so i think retnoid induce better results althought side effects are more.

  4. Thanks for this case which is again from Iraq but i think it is superficial actinic porokeratoses rather than Miebelli type.I treat similar cases with 5FU &found it effective.

  5. samer A dhaherFebruary 27, 2008

    an interesting case of a rare disease..I observe one nearly similar case with poro on the face couple yrs ago.. she was also young poor lady who was forced to work outdoor for many hours each seems that the current case is that of superficial actinic rather than of Meibilli..although using topical 5FUis a well recognized therapy but it is not always available, alternatively destruction of abnormal clone of cells at the ridge by fine touch with electrocautery give promising results & I treat many cases by this way with remarkable results

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