ALA-PDT combined with Alpha Hydroxy Acids in the treatment of disseminated superficial actinic porokeratosis: a case report

A 45-year-old female patient complained of brown patches on her arms and thighs. The lesion had been present for 20 years, worsened after sun exposure. The patient was treated with local corticosteroids, oral antihistamines, and acitretin capsules, but there was no clinical improvement. Physical examination revealed hypertrophic brown plaques in the limbs, with bulging around and depressed center. Punch biopsies of the lesions' hyperkeratotic margins found columns of parakeratosis suggestive of cornoid lamellae. Based on the clinical and histopathological findings, the diagnosis was made of disseminated superficial actinic porokeratosis. ALA-PDT (concentration 10%-20% for 4 hours) was initiated at 2-week intervals. After 7 photodynamic therapies, the skin lesions were basically flattened and and pigmentation remained. She was further treated with 50% alpha hydroxy acids once a month. After 2 fruit acid peeling, the pigmentation was relieved. PDT combined with alpha hydroxy acids has significant efficacy on disseminated superficial actinic porokeratosis.