Entry posted by Sasi Attili
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Many a time in life we take things for granted because that is what we have been taught to believe. The human mind is too bogged down by events in daily life that we do not ponder to question what is already believed to be 'known'.
Take the case of Porokeratosis. What is it?
Porokeratosis is defined by the presence of the pathognomonic coronoid lamella, a finding certainly not specific to porokeratosis, found in a number of other inflammatory and neoplastic conditions. So essentially the 'coronoid lamella' may be regarded as a tissue reaction pattern like 'lichenoid dermatitis' or a 'spongiform pustule'. Not all lichenoid dermatitidis are lichen planus and not all spongiform pustules are a manifestation of psoriasis.
Yes there are familial forms of porokeratosis which are proven to be genodermatosis, some inherited autosomal dominantly. But there are a number of other acquired forms, of unknown etiopathogenesis. However are these all really related enough for us to call them all variants of 'porokeratosis'? The only thing they have in common is a 'coronoid lamella', which is just a tissue reaction pattern!
Porokeratosis has been described to show various inflammatory changes, ranging from a superficial perivascular inflammatory infiltrate to a dense band like lichenoid infiltrate mimicking lichen planus. I recently had a case where a middle aged lady presented with pigmented plaques on the face which in the absence of a coronoid lamella (present clinically!) one would suspect either DLE or LP. Histopathological examination revealed a lichenoid dermatitis associated with a coronoid lamella. Do I now sign this out as LP with a coronoid lamella or accept the inflammatory changes to be part of porokeratosis (since someone has already described and labelled these changes to be part of the porokeratotic process) and call this porokeratosis?
Given that the 'coronoid lamella' is just a tissue reaction pattern I am more inclined to call this 'LP with a coronoid lamella'. I am well aware that others might defer. But would be interested in the counter argument.
Take the case of Porokeratosis. What is it?
Porokeratosis is defined by the presence of the pathognomonic coronoid lamella, a finding certainly not specific to porokeratosis, found in a number of other inflammatory and neoplastic conditions. So essentially the 'coronoid lamella' may be regarded as a tissue reaction pattern like 'lichenoid dermatitis' or a 'spongiform pustule'. Not all lichenoid dermatitidis are lichen planus and not all spongiform pustules are a manifestation of psoriasis.
Yes there are familial forms of porokeratosis which are proven to be genodermatosis, some inherited autosomal dominantly. But there are a number of other acquired forms, of unknown etiopathogenesis. However are these all really related enough for us to call them all variants of 'porokeratosis'? The only thing they have in common is a 'coronoid lamella', which is just a tissue reaction pattern!
Porokeratosis has been described to show various inflammatory changes, ranging from a superficial perivascular inflammatory infiltrate to a dense band like lichenoid infiltrate mimicking lichen planus. I recently had a case where a middle aged lady presented with pigmented plaques on the face which in the absence of a coronoid lamella (present clinically!) one would suspect either DLE or LP. Histopathological examination revealed a lichenoid dermatitis associated with a coronoid lamella. Do I now sign this out as LP with a coronoid lamella or accept the inflammatory changes to be part of porokeratosis (since someone has already described and labelled these changes to be part of the porokeratotic process) and call this porokeratosis?
Given that the 'coronoid lamella' is just a tissue reaction pattern I am more inclined to call this 'LP with a coronoid lamella'. I am well aware that others might defer. But would be interested in the counter argument.
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