Allogeneic bone marrow transplantation possibly induces a localized type of porokeratosis

Tatsuya Yamashita, Toshio Ohtani

Article ID: 1299
Vol 5, Issue 2, 2021

VIEWS - 1361 (Abstract) 355 (PDF)


A 15-year-old girl underwent allogenic bone marrow transplantation for neuroblastoma. A few years later, she noticed a round lesion on her left buttock. Since the lesion had been asymptomatic and never grown, more than 20 years had passed before she saw a local doctor to consult about it. Although the lesion was suspected to be tinea corporis, no fungi were found on microscopic examination. Subsequently, administered topical corticosteroids were not effective. She was referred to our hospital for further evaluation, and a skin biopsy confirmed the diagnosis of porokeratosis. There was a possibility that chemotherapy, total body radiation, or immunosuppressive therapy associated with allogeneic bone marrow transplantation was involved in the development of porokeratosis. Numerous cases of acquired porokeratosis in immunocompromised status have been observed; as for those after allogenic bone marrow transplantation, 12 cases have been reported in the English literature, 4 of which had only one or a few lesions on a limited area of body surface. Our case was relatively uncommon in that the lesion was solitary and comparatively large. In a localized type of porokeratosis, it was suggested that a malignant skin tumor developed earlier than in other types. Careful follow-up for malignant transformation is especially required.


Porokeratosis; Localized Type; Bone Marrow Transplantation; Immunosuppression; Malignant Transformation

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1. Kanitakis J. Porokeratoses: an update of clinical, aetiopathogenic and therapeutic features. European Journal of Dermatology 2014; 24(5): 533–544. doi: 10.1684/ejd.2014.2402

2. MacMillan AL, Roberts SOB. Porokeratosis of Mibelli after renal transplantation. British Journal of Dermatology 1974; 90(1): 45–51. doi: 10.1111/j.1365-2133.1974.tb06361.x

3. Alexis AF, Busam K, Myskowski PL. Porokeratosis of Mibelli following bone marrow transplantation. International Journal of Dermatology 2006; 45(4): 361–365. doi: 10.1111/j.1365-4632.2006.02509.x

4. Schamroth JM, Zlotogorski A, Gilead L. Poroker-atosis of Mibelli. Overview and review of the liter-ature. Acta Dermato-venereologica 1997; 77(3): 207–213. doi: 10.2340/0001555577207213

5. Otsuka F, Someya T, Ishibashi Y. Porokeratosis and malignant skin tumors. Journal of Cancer Research and Clinical Oncology 1991; 117(1): 55–60. doi: 10.1007/BF01613197

6. Raychaudhuri SP, Smoller BR. Porokeratosis in immunosuppressed and nonimmunosuppressed pa-tients. International Journal of Dermatology 1992; 31(11): 781–782. doi: 10.1111/j.1365-4362.1992.tb04242.x

7. Feuerman EJ, Sandbank M. Disseminated superfi-cial porokeratosis in patients with pemphigus vul-garis treated with steroids. Acta Dermato-venereologica. Supplementum 1979; 59(85): 59–61.

8. Romaní J, Pujol RM, Casanova JM, et al. Dissemi-nated superficial porokeratosis developing after electron-beam total skin irradiation for mycosis fungoides. Clinical and Experimental Dermatology 1996; 21(4): 310–312. doi: 10.1111/j.1365-2230.1996.tb00105.x

9. Stewart L, Howat A, Coulson I. Disseminated su-perficial porokeratosis secondary to immunosup-pression induced by etanercept for extensive psori-asis. Archives of Dermatology 2010; 146(10): 1193–1194. doi: 10.1001/archdermatol.2010.298

10. Kanitakis J, Misery L, Nicolas JF, et al. Dissemi-nated superficial porokeratosis in a patient with AIDS. British Journal of Dermatology 1994; 131(2): 284–289. doi: 10.1111/j.1365-2133.1994.tb08507.x

11. Zhang S, Jiang T, Li M, et al. Exome sequencing identifies MVK mutations in disseminated superfi-cial actinic porokeratosis. Nature Genetics 2012; 44(10): 1156–1160. doi: 10.1038/ng.2409.

12. Zhang Z, Li C, Wu F, et al. Genomic variations of the mevalonate pathway in porokeratosis. Elife 2015; 4: e06322. doi: 10.7554/eLife.06322.

13. Kubo A, Sasaki T, Suzuki H, et al. Clonal expan-sion of second-hit cells with somatic recombina-tions or C>T transitions form porokeratosis in MVD or MVK mutant heterozygotes. Journal of Investigative Dermatology 2019; 139(12): 2458–2466.e9. doi: 10.1016/j.jid.2019.05.020

14. Lederman JS, Sober AJ, Lederman GS. Immuno-suppression: a cause of porokeratosis? Journal of the American Academy of Dermatology 1985; 13(1): 75–79. doi: 10.1016/s0190-9622(85)70146-6

15. Gilead L, Guberman D, Zlotogorski A, et al. Im-munosuppression-induced porokeratosis of Mibelli: complete regression of lesions upon cessation of immunosuppressive therapy. Journal of the Euro-pean Academy of Dermatology and Venereology 1995; 5(2): 170–172.

16. Cha SH, Park HJ, Lee JY, et al. Atypical poroker-atosis developing following bone marrow trans-plantation in a patient with myelodysplastic syn-drome. Annals of Dermatology 2010; 22(2): 206–208. doi: 10.5021/ad.2010.22.2.206

17. Pini M, Balice Y, Tavecchio S, et al. Eruptive dis-seminated porokeratosis following bone marrow transplantation for acute lymphoblastic leukemia in a child. Journal of Dermatology 2012; 39(4): 403–404. doi: 10.1111/j.1346-8138.2011.01332.x

18. Gracia-Cazaña T, Vera-Álvarez J, García-Patos V, et al. Imiquimod and photodynamic therapy are useful in the treatment of porokeratosis in children with bone marrow tansplantation. Pediatric Derma-tology 2015; 32(6): e291–e293. doi: 10.1111/pde.12654

19. Shima T, Yamamoto Y, Okuhira H, et al. A patient with refractory psoriasis who developed sebaceous carcinoma on the neck during cyclosporine therapy and showed rapid progression. Case Reports in Dermatology 2016; 8(2): 136–141. doi: 10.1159/000446342.

20. Dantal J, Hourmant M, Cantarovich D, et al. Effect of long-term immunosuppression in kidney-graft recipients on cancer incidence: randomised com-parison of two cyclosporin regimens. Lancet (Lon-don, England) 1998; 351(9103): 623–628. doi: 10.1016/S0140-6736(97)08496-1.



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