Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2024;14(4):e2024246 1

Disseminated Superficial Actinic Porokeratosis 
Treated with Topical Simvastatin: Evaluation  
of Therapeutic Response with Dermoscopy

Horacio Cabo1, Emilia Cohen Sabban2, Rosario Peralta2, Gabriel Salerni3

1 Dermatology Deparment, Universidad de Buenos Aires, Argentina

2 Dermatology Department, Instituto de Investigaciones Médicas “A. Lanari”, Universidad de Buenos Aires, Argentina

3 Dermatology Department, Hospital Provincial del Centenario de Rosario, Universidad Nacional de Rosario, Rosario, Argentina

Key words: Disseminated superficial actinic porokeratosis, Simvastatin, Dermoscopy

Citation: Cabo H, Sabban EC, Peralta R, Salerni G. Disseminated Superficial Actinic Porokeratosis Treated with Topical Simvastatin: 
Evaluation of Therapeutic Response with Dermoscopy. Dermatol Pract Concept. 2024;14(4):e2024246. DOI: https://doi.org/10.5826/
dpc.1404a246

Accepted: June 15, 2024; Published: October 2024

Copyright: ©2024 Cabo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding Author: Peralta Rosario, MD, 3150 Combatientes de Malvinas, CP 1427, Ciudad Autónoma de Buenos Aires, Argentina. 
Tel: (+54) 011-5287-3788, Email: rosarioperalta@yahoo.com

Case Presentation

A 66-year-old woman presented since 2016 with lesions on 

both legs, with clinical, dermoscopic, and histopathologic 

diagnosis of disseminated superficial actinic porokeratosis 

(DSAP). She was treated with different local treatments with-

out good response.

Teaching Point

Lovastatin, an HMG-CoA receptor inhibitor, has been found 

to stop progression and promote regression of porokeratosis 

lesions. Lovastatin 2% cream has been shown to improve 

DSAP, alone or with the addition of 2% cholesterol [1]. We 

treated this patient with simvastatin 2% cream once a day 

for 15 days (Figure 1). The number of lesions, erythema, and 

scales improved, but they did not disappear completely after 

six months of follow-up. Simvastatin inhibition of HMG-

CoA reductase in the mevalonate pathway blocks the ac-

cumulation of toxic intermediate metabolite formation in 

mutated cells. Simvastatin as monotherapy could be an al-

ternative treatment for DASP, while dermoscopy represents a 

reliable approach to assess the therapeutic response.



2 Image Letter | Dermatol Pract Concept. 2024;14(4):e2024246

References

1. Santa Lucia G, Snyder A, Lateef A, et al. Safety and Efficacy of 

Topical Lovastatin Plus Cholesterol Cream vs Topical  Lovastatin 

Cream Alone for the Treatment of Disseminated Superficial 

Actinic Porokeratosis:  A Randomized Clinical Trial.  JAMA 

Dermatol. 2023;159(5):488-495. DOI:10.1001/jamadermatol 

.2023.0205. PMID: 36947042.

2. Zaar O, Polesie S, Navarrete-Dechent C, Errichetti E, Akay BN,  

Jaimes J, Cabo H, Cohen Sabban E, Paoli J. Dermoscopy of 

porokeratosis: results from a multicentre study of the Inter-

national Dermoscopy Society. J Eur Acad Dermatol Venereol. 

2021 Oct;35(10):2091-2096. DOI: 10.1111/jdv.17439. PMID: 

34077570.

Figure 1. Before treatment: (A) clinical image with many irritated DSAP lesions; (B) dermoscopic 

image with the typical double keratin rim [2]. After treatment: (C) clinical view where DSAP lesions 

are less visible and without inflammation; (D) dermoscopic image showing much less inflamma-

tion and very subtle dermoscopic features. (Clinical and dermoscopy images with high-definition 

 Medicam 1000 Fotofinder System).