Abatacept-Induced Disseminated Superficial Porokeratosis
Abstract
CLINICAL IMAGE Disseminated superficial porokeratosis (DSP) presents as atrophic papules with a keratotic ridge. Drug-induced porokeratosis has been reported in association with several classes of medications, most notably immunosuppressants. To our knowledge, we report the first case of abatacept-induced DSP. A 66-year-old woman with rheumatoid arthritis was treated with abatacept after partial response and loss of efficacy over time to hydroxychloroquine, methotrexate, golimumab, certolizumab pegol, and adalimumab. After her fourth dose of abatacept, she developed a pruritic, scaly rash that worsened with subsequent injections. The patient denied recent changes to other medications, which included low-dose aspirin, calcium carbonate–vitamin D3, dexlansoprazole, and ergocalciferol. On physical examination, scattered pink papuleswith a double-ridged border of peripheral scale limited to the bilateral upper and lower extremities were observed (Fig. 1). A skin biopsy revealed cornoid lamella in a follicular infundibulum, characteristic of porokeratosis (Fig. 2). Abatacept was discontinued and the patient began both systemic and topical corticosteroids with continual improvement 4 months after her last dose of abatacept. The keratinocyte abnormalities characteristic of porokeratosis are thought to be related to either faulty maturation of keratinocytes or an acceleration of epidermopoiesis. A gene locus identified for DSP, for instance, has been mapped to the same…
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