[2 % Simvastatin/2 % cholesterol cream in disseminated superficial actinic porokeratosis effectively and safely used long-term : Case report and retrospective survey of 14 patients].

Disseminated superficial actinic porokeratosis (DSAP) is a rare, UV-associated keratinization disorder that causes significant cosmetic impairment. In recent years, a new pathogenesis-based therapeutic approach using topical formulations containing statins and cholesterol has been introduced. We report on a 56-year-old woman who had DSAP on both forearms and lower legs for 6 years. Clinically, she presented with multiple, extensor-surfaced, pale erythematous, flat plaques with collarette-like scaling. Previous treatments with topical tretinoin and photodynamic therapy had not resulted in any significant improvement. After 4 months of treatment with a 2% simvastatin/2% cholesterol cream (SC cream) applied twice daily, the lesions had nearly completely resolved. The findings improved on the Investigator Global Assessment (IGA) scale from 3/5 to 1/5. Over a 15-month follow-up period, the improvement remained stable with continued therapy. The patient did not experience any side effects. The favorable clinical course prompted a retrospective evaluation of all DSAP patients treated with SC cream at our institution. A total of 14 patients were surveyed using questionnaires regarding efficacy, tolerability, and satisfaction. The mean duration of treatment was 9 months; 12 patients were treated for at least 6 months, and 5 patients for at least 12 months. With the exception of 1 patient, all reported clinical improvement. The average subjective improvement was over 50% after 6 months and approximately 70% after 12 months. No loss of efficacy was observed. One patient developed mild, self-limiting contact dermatitis without discontinuing therapy. Laboratory tests in 6 patients revealed no clinically relevant abnormalities. Our observations support the sustained efficacy and good tolerability of the SC cream during prolonged use. At the same time, potential contact dermatitis should be considered as a relevant adverse drug reaction. These observations are consistent with the recently published results of the Mainz working group led by Prof. Staubach-Renz, which are also discussed in our article.