Focal actinic porokeratosis over nose successfully treated with topical tacrolimus

Porokeratosis is an uncommon clonal disorder of keratinisation. Classically, five clinical variants have been described: porokeratosis of Mibelli, disseminated superficial porokeratosis, disseminated superficial actinic porokeratosis linear porokeratosis. Medical modalities have varying success rates and surgical or ablative options are usually chosen for solitary lesions.1 We hereby report a case of facial porokeratosis with a good response to topical tacrolimus ointment 0.1%. A 22-year-old male presented with a few asymptomatic and erythematous crusted plaques over the nose for a 6-month duration. In addition, he had iron deficiency anaemia (Hb: 6.5 g/dl) and a history of weight loss of 8 kg in the last 6 months. Four well-defined, skin coloured to erythematous annular plaques of size ranging from 1 x 1 cm to 1.5 x 2 cm with an atrophic depigmented centre, follicular plugging, and prominently raised margins with yellowish heaped-up crust over the superior margins were present bilaterally over the ala of the nose [Figures 1a and 1b]. Dermoscopy showed red dots, follicular plugging, whitish structureless areas, and a prominent raised margin [Figure 1c]. Histopathology of the