Successful Treatment of Porokeratosis With Ablative Fractional Carbon Dioxide Laser and Vitamin C, E, and Ferulic Acid Serum

Porokeratosis is a rare disorder of epidermal keratinization that encompasses several clinical forms, characterized by erythematous, annular plaques with an atrophic center and hyperkeratotic ridge-like border. The histopathological hallmark of porokeratosis is the cornoid lamella, a thin column of parakeratotic corneocytes embedded within the stratum corneum. There is no standard treatment regimen for porokeratosis. Current therapeutic modalities include topical agents, systemic medications, and surgical interventions that have variable efficacy. Here, we report a case of a patient with localized porokeratosis lesions on the face and extremities that resolved after one treatment session with carbon dioxide laser resurfacing combined with topical antioxidant serum containing L-ascorbic acid, alpha tocopherol, and ferulic acid. The diagnosis of porokeratosis was supported by the clinical presentation, dermoscopy, and in vivo skin imaging with optical coherence tomography and reflectance confocal microscopy. This case highlights the utility of using carbon dioxide laser to ablate porokeratosis lesions, as well as the clinical advantages offered by new noninvasive skin imaging modalities to examine, diagnose, and follow up skin pathologies. J Drugs Dermatol. 2019;18(11):1174-1176.