Medication Summary
These medications have proven the most efficacious for the treatment of hyperkeratosis lenticularis perstans (Flegel disease).
Topical cytotoxic agents
Class Summary
Inhibit cell growth and proliferation.
Fluorouracil topical (Efudex, Fluoroplex)
Fluorouracil has been in clinical use since the 1960s. Systemic absorption is limited to approximately 6% of the applied dose and is selectively higher in abnormal skin. Fluorouracil interferes with pyrimidine metabolism by inhibiting thymidylate synthetase, thus inhibiting DNA synthesis.
It is available as 5% (Efudex) or 1% (Fluoroplex) cream, 2% or 5% solution (both Efudex), or 1% solution (Fluoroplex).
If applied with the fingers, wash hands immediately after application.
Fluorouracil is FDA approved for the treatment of actinic keratosis and superficial basal cell carcinomas.
Vitamins
Class Summary
Essential for normal DNA synthesis.
Calcipotriene (Dovonex)
Calcipotriene is a synthetic vitamin D-3 derivative that possesses therapeutic properties similar to vitamin D-3, including inhibition of epidermal proliferation, induction of differentiation, and anti-inflammatory effects.
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Clinical photograph of the upper thigh showing numerous red-brown papules with sparing of the inguinal crease.
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A higher-powered view of the patient seen in the previous image. Photograph of the upper thigh demonstrates 1- to 4-mm, noncoalescing keratotic papules.
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Hematoxylin and eosin-stained section, low magnification. Epidermal hyperplasia with rete elongation surmounted by a thickened, compact, hyperkeratotic scale. A bandlike lymphoid infiltrate expands the papillary dermis.
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Hematoxylin and eosin-stained section, medium magnification. The lateral edge of the lesion demonstrates abrupt hyperkeratosis and a combination of epidermal atrophy and acanthosis.
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Hematoxylin and eosin-stained section, high magnification. The section shows mostly orthokeratotic scale, thinning of the epidermis with a diminished granular cell layer, and an infiltrate of lymphocytes in the superficial dermis, which approximate the dermal-epidermal interface.
