Treating linear porokeratosis with topical lovastatin/cholesterol cream

Linear porokeratosis is a rare variant of porokeratosis that is characterized by unilateral lesions along the lines of Blaschko. Like all variants of porokeratosis, linear porokeratosis is characterized by the histopathologic finding of cornoid lamellae bracketing the lesion. The underlying pathophysiology involves a two-hit post-zygotic knockdown of genes involved in mevalonate biosynthesis in embryonic keratinocytes. Although there is currently no standard or effective treatment, therapies targeted to rescue this pathway and restore keratinocyte cholesterol availability are promising. Presented here is a patient with a rare, extensive case of linear porokeratosis treated with compounded 2% lovastatin/2% cholesterol cream leading to partial resolution of the plaques.

 

Comments：

Linear porokeratosis is a rare skin condition characterized by unilateral linear lesions that follow the lines of Blaschko. The condition is caused by a genetic mutation that affects the mevalonate biosynthesis pathway in embryonic keratinocytes. This leads to the formation of cornoid lamellae, which are characteristic of all forms of porokeratosis.

Currently, there is no standard treatment for linear porokeratosis, but there are promising therapies that aim to restore keratinocyte cholesterol availability and rescue the mevalonate biosynthesis pathway. One such therapy is compounded 2% lovastatin/2% cholesterol cream.

Lovastatin is a medication that is commonly used to lower cholesterol levels in patients with high cholesterol. It works by inhibiting the mevalonate pathway, which is also involved in the development of linear porokeratosis. By inhibiting this pathway, lovastatin can reduce the formation of cornoid lamellae and improve the symptoms of the condition.

Cholesterol is an important component of the skin's barrier function and is essential for the proper function of keratinocytes. Compounded creams containing cholesterol can help to restore the skin's barrier function and improve the symptoms of linear porokeratosis.

In the case presented, the patient with extensive linear porokeratosis was treated with compounded 2% lovastatin/2% cholesterol cream. The treatment led to partial resolution of the plaques, indicating that this therapy may be a promising option for patients with this condition.

It is important to note that the use of compounded creams should be done under the guidance of a healthcare provider. Compounded medications may have different formulations and dosages than commercially available medications, and their safety and efficacy may not be well established.

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