Chronic papules on the back and extremities
The most successful treatment option is systemic use of retinoids, most often acitretin (Soriatane).1,5 This medication, like isotretinoin (Accutane), requires meticulous monitoring and counseling. Women of childbearing age should be instructed to use 2 birth-control methods and, according to current recommendations, instructed not to conceive for 3 years following cessation of treatment (2 years in Europe). Cyclosporine may be used to control acute, severe flares.
Laser excision, excision and grafting, and dermabrasion have been used to treat hypertrophic lesions.1,5 More recently, photodynamic therapy (using photosensitizers in conjunction with a source of visible light) was also used in the treatment of Darier’s disease.7
Keep in mind that patients with Darier’s disease are more susceptible to cutaneous infections with bacteria, herpes simplex virus, and poxvirus. Awareness of this susceptibility can facilitate early diagnosis and treatment.8
Corresponding author
Amor Khachemoune, MD, CWS, Georgetown University Medical Center, Division of Dermatology, 3800 Reservoir Road, NW, 5PHC, Washington, DC 20007. E-mail: amorkh@pol.net.
Submissions
Richard P. Usatine, Editor, Photo Rounds, University of Texas Health Sciences Center at San Antonio, Dept of Family and Community Medicine, MC 7794, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900. E-mail: usatine@uthscsa.edu.
