Topical Lovastatin/Cholesterol as a Potential Field-Directed Therapy for Disseminated Superficial Actinic Porokeratosis: A Case Report

Abstract

Disseminated superficial actinic porokeratosis (DSAP) is the most common subtype of porokeratoses, a rare group of disorders characterized by abnormal keratinization. Although the exact etiology is not fully understood, DSAP has been linked to genetic mutations in the mevalonate biosynthesis pathway. Based on this association, topical therapy with a combination of lovastatin and cholesterol has recently emerged as a promising treatment option. In this case study, we present a patient with extensive lower-extremity DSAP and a history of unsuccessful treatment with multiple traditional modalities, who was successfully treated with a 2% lovastatin/cholesterol formulation.

Keywords: disseminated superficial actinic porokeratosis (dsap); field directed; keratinocytic; mevalonate; mevalonate pathway; porokeratosis; topical; topical cholesterol; topical lovastatin.

Figure 1. Patient’s legs prior to treatment with lovastatin/cholesterol ointment

The circle indicates the site of SCC-IS arising from a porokeratotic lesion. SCC-IS: squamous cell carcinoma in situ

Figure 2. Patient’s shins prior to treatment with lovastatin/cholesterol ointment

Black arrows indicate several DSAP lesions. The circle indicates the site of SCC-IS arising from a porokeratotic lesion. DSAP: disseminated superficial actinic porokeratosis; SCC-IS: squamous cell carcinoma in situ

Figure 3. Patient’s feet prior to treatment with lovastatin/cholesterol ointment

Black arrows indicate several DSAP lesions. DSAP: disseminated superficial actinic porokeratosis

Figure 4. Patient’s legs and dorsum of the feet after one year of treatment with lovastatin/cholesterol ointment

Figure 5. Patient’s left foot after one year of treatment with lovastatin/cholesterol ointment

Figure 6. Patient’s right foot after one year of treatment with lovastatin/cholesterol ointment