Topical Calcipotriol: A Ray of Hope for Clear Cell Acanthoma?
"Could this Vitamin D-based treatment offer a non-surgical solution for a rare skin condition?"
Clear cell acanthoma (CCA), while not frequently diagnosed, has always piqued the interest of dermatologists. This benign skin growth often goes unnoticed until a biopsy because its appearance can vary so much.
Thankfully, dermoscopy, a skin examination technique using magnification, has significantly improved how accurately doctors can identify typical CCA. Features like pinpoint blood vessel patterns and a scaly ring around the edge of the growth are now easier to spot.
Traditionally, treatment for CCA involves removing or destroying the growth through surgery or cryotherapy (freezing). However, a recent study explores a different approach: topical calcipotriol, a cream applied directly to the skin. The results suggest it could completely eliminate CCA within a couple of months, with no return a year later. This opens up an exciting possibility for a less invasive treatment option.
Calcipotriol: A Non-Invasive Treatment Option for Clear Cell Acanthoma?
A 78-year-old man presented with a solitary, palpable, erythematous, dome-shaped, 8-mm papule on his left leg, which had been present for a few months. The lesion was asymptomatic. The patient had no personal or family history of psoriasis. Dermoscopy revealed dotted vessels organized as “strings of pearls” and keratinized collarette, which are indicative patterns of CCA. Given these clear signs and the patient's history, psoriasis was reasonably ruled out.
- After 15 days of therapy: A yellowish, irregular, star-shaped area appeared in the center.
- After 30 days of therapy: A scaly collarette emerged, with a few dotted vessels remaining and the central yellowish area becoming more prominent.
- After 45 days of therapy: The lesion was no longer palpable, replaced by a pink to light brown area lacking vascular structures but covered with fine white scales. A few small, brown-red crusts/microerosions were noted.
- After 60 days of therapy: Only a light brown pigmentation remained on a slightly pinkish background, with no visible vessels, leading to treatment interruption.
- Twelve months after stopping therapy: No recurrence appeared, with only a slightly hypochromic area visible both dermoscopically and clinically.
Looking Ahead: A Promising Alternative?
This case presents a promising alternative for treating clear cell acanthoma, particularly for patients who may not be suitable candidates for surgery or cryotherapy. While further studies with larger groups are needed to confirm these findings, the rapid and progressive improvement observed with topical calcipotriol suggests it acts effectively against CCA. This could pave the way for a less invasive and more patient-friendly approach to managing this skin condition.