Refractory facial Darier’s disease treated with daylight photodynamic therapy

Darier’s disease (DD) is an infrequent autosomal dominant skin disorder caused by a mutation of the ATP2A2 gene on chromosome 12 [1]. Mutations in this gene result in abnormalities in keratinocyte cell-cell adhesion producing an alteration of the keratinization of the skin, which clinically presents with dyskeratotic papules mostly affecting seborrheic and intertriginous areas. Palmoplantar and nail involvement is often present [1–3]. As a wide range of treatments have been proposed for this skin disorder with different results, the management of this disease is still a challenge for the dermatologist. A woman in her forties, with a medical history of DD diagnosed histopathologically 28 years previously, presented with repetitive flare-ups of coalescent reddish-brown papules and plaques affecting the upper back, forehead, ears, neck and submammary folds. She reported a similar family history for her mother and brother. No other medical history of cutaneous or systemic diseases were reported. The patient had previously undergone topical therapies with steroids, antibiotics and retinoids and oral intermittent treatment with acitretin and isotretinoin, with poor control of the disease. Daily use of masks due to the COVID-19 pandemic, had also exacerbated midfacial lesions in the patient. Clinical Letter