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I read the communication from Hernandez and colleagues¹ in the December 2000 issue of the ARCHIVES in which they report a case of disseminated porokeratosis and add to the list of diseases associated with this unusual keratosis. Although textbooks have considered the disease to be a disorder of keratinization or a chromosomal defect,² I believe that it is clear at this point that porokeratoses are actually manifestations of viral infection.

What is the evidence? First, the associated diseases share the common feature of immunosuppression. Sunlight, renal disease, corticosteroid use, human immunodeficiency virus infection, organ transplantation, psoralen plus UV-A therapy, and cancer chemotherapy are all recognized to be immunosuppressive.^1-2 Second, autotransplantation experiments demonstrate that a fragment of porokeratosis will regenerate an entire round lesion, which strikes me as the sort of thing a wart might do.³ Third, a lesion partially removed as a biopsy specimen will regrow its old border in . . . [Full Text of this Article]

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