Medication Summary
The goal of pharmacotherapy in acrokeratosis paraneoplastica is to improve scaly lesions, reduce morbidity, and prevent complications.
Antipsoriatic Agent, Systemic
Acitretin (Soriatane)
Acitretin is a metabolite of etretinate and related to both retinoic acid and retinol (vitamin A). Its mechanism of action is unknown. However, it is thought to exert its therapeutic effect by modulating keratinocyte differentiation, keratinocyte hyperproliferation, and tissue infiltration by inflammatory cells.
Antipsoriatic Agent, Topical
Salicylic acid topical
By dissolving the intercellular cement substance, salicylic acid produces desquamation of the horny layer of skin while not affecting structure of viable epidermis.
Hydrate the skin and enhance the effects of the medication by soaking the affected area in warm water for 5 minutes prior to use. Remove any loose tissue with a brush, wash cloth, or emery board and dry thoroughly. Improvement should generally occur in 1-2 weeks.
Topical Skin Product
Calcipotriene (Dovonex)
Calcipotriene is a synthetic vitamin D-3 analog that regulates skin cell production and development. It inhibits epidermal proliferation, promotes keratinocyte differentiation, and has immunosuppressive effects on lymphoid cells. It is used in the treatment of moderate plaque psoriasis. Use 0.005% cream, ointment, or solution.
Dietary Supplements
Cholecalciferol (Delta-D, Vitamin D-3)
Cholecalciferol stimulates the absorption of calcium and phosphate from the small intestine and promotes the release of calcium from bone into blood. It has antiproliferative and anti-inflammatory effects on skin.
Corticosteroids
Betamethasone topical (Diprolene, Betatrex)
Betamethasone topical is for inflammatory dermatoses responsive to steroids. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.
Mineral, Parenteral
Zinc
Zinc is a cofactor for more than 70 types of enzymes. It plays a role in many metabolic processes. A higher requirement may be indicated in pregnancy.
Use the sulfate or gluconate zinc salts. Zinc sulfate 4.4 mg = 1 mg of elemental zinc. Zinc gluconate 7.1 mg = 1 mg of elemental zinc.
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Acrokeratosis paraneoplastica. A 67-year-old woman presented with scaly plaques of the hands, feet, ears, and nose associated with esophageal squamous cell carcinoma. The eruption resolved with resection of the cancer. Image courtesy of Ronald Grimwood, MD.
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Acrokeratosis paraneoplastica. A 67-year-old woman presented with scaly plaques of the hands, feet, ears, and nose associated with esophageal squamous cell carcinoma. The eruption resolved with resection of the cancer. Image courtesy of Ronald Grimwood, MD.
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Bazex syndrome. Acquired palmar keratoderma in a woman with a history of breast cancer and recent primary lung cancer. Courtesy of Jeffrey J. Meffert, MD.
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Bazex syndrome. Violaceous psoriasiform dermatitis on the ankles. Lung cancer appeared to be in remission; both keratoderma and psoriasiform plaques resolved quickly with clobetasol ointment. Courtesy of Jeffrey J. Meffert, MD.
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At this power, a patchy lichenoid infiltrate of predominantly lymphocytes can be seen underneath an epidermis with psoriasiform hyperplasia and serum crust in the parakeratotic cornified layer (hematoxylin and eosin, 100X).
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Focal vacuolar interface change is seen with associated pigment incontinence and exocytosis of lymphocytes (hematoxylin and eosin, 200X).
