143 A new case of multiple warty dyskeratomas of the scalp: effectiveness of acitretine.

B. Matard, P. Reygagne. Sabouraud Center.Saint Louis Hospital. Paris.France.

Multiple warty dyskeratoma(WD) is clinicaly and histologicaly a very characteristic disease which is very rare and little known. We report here a new case where acitretine has been effective. Case report: A 60- year-old man without any personal nor familial medical history presented with about thirty hyper keratotic cutaneous nodules, with central plugs for some of them, scattered on the scalp, mostly on the right parietal area. These lesions were appeared when he was about 40 and were asymptomatic. The rest of clinical examination was normal. Histologically, a characteristic aspect with dyskeratosis and acantholysis was seen. 20mg/24h of acitretine during one month had caused the disappearance of about 90% of the lesions. This result was maintained for the four following month with a dose of 10 mg/24h. Since then, the patient has not been seen. Comments: DV is a rare epidermal benign tumor most often isolated, usualy seen in middle aged and elderly adult. Multiple formes are exceptional(1) (less than 10 cases in the medical litterature). It seem to affect specialy the air follicle as it is suggested by the frequent localisation on the scalp in the multiple and isolated forme.Clinicaly, it is typicaly a nodular flesh colored lesion, itchy or asymptomatic, composed of a raised margin and a crateriform center filled with keratotic plug. Histologically there is characteristic focal acantholysis and dyskeratosis. Although the cause of WD is unknown, a link with Darier disease could exist as it is suggested by the histological aspect and the case report of a multiple WD associated with a Darier disease in a father and his daughter(2). The treatment of isolated form is surgical exision. In the multiple form Acitretine was effective at a low dose in our patient (10 mg/24h) and 40mg/24h in a Vakilzadeh’s patient(2). References: -1. T.W.GRIFFITHS and all. Multiple warty dyskeratomas of the scalp. Clinical and Experimental Dermatology 1997; 22: 189-191 -2. F.VAKILZADEH and all. Dyskeratomatosis verruciformis: an unusual manifestation of Darier disease. Eur J Dermatol 1995; 5: 358-60