Skin keratinisation disorders are known to form layers of crusted epithelium, which are not only problems of esthetic and comfort, but also of cancer potential. This group of disorders with abnormal keratinisation are known as porokeratosis. The most common form of porokeratosis is the disseminated superficial actinic porokeratosis (DSAP), which afflicts patients through accelerated keratinisation of the skin, thickening it further, especially in the third to fourth decade of life. This specific variant of actinic keratosis warrants an efficient medical attention to prevent the development of cancer. According to a study, the overall management of this condition has not been maximized in varying aspects, including access to field treatments, therapeutic approach, and referral rates from primary health care physicians.
Besides an inadequate cost-benefit treatment plan, actinic porokeratosis is often misdiagnosed due to the similarity of its clinical picture with other dermatologic manifestations. As sun exposure is contributory to the prominence of the skin lesions, it is often mistaken as other skin conditions. Misdiagnosis brings about erroneous treatment plans that can aggravate the current condition of the patient.
Pathophysiology. How does it develop?
In general, DSAP is a genetic disease inherited through autosomal dominant fashion, which means that if just one parent passes on the defective gene, the child will be affected. While the evolution of the lesions are unclear, some etiology are suspected including exposure to radiation, immune-mediation, and even infection. As the sites of affectation have been observed in areas with sun exposure, it is suspected that solar radiation significantly contributes to the incidence of DSAP, growing multiple reddish or colored annular hyperkeratotic lesions, presenting as macules, papules, and plaques surrounded by edges of increased keratinisation with an atrophic centre. This has been widely observed in Australians who have had an increase in sun exposure throughout their lifetime.
Pharmacological and integrative treatment: Why do we need help from mycotherapy?
The current standard practice has no definitive evidence-based treatment for any form of actinic porokeratosis. This dermatologic condition has been studied in previous cases which used retinoid creams, 5-fluoriouracil, iquimoid cream, ingenol mebutate gel and other topical treatments as the primary management. Here is where mycotherapy can help, by addressing solutions for this unsolved problem.
As incidences are directed to general practitioners, the DSAP has been one of the subjects of misdiagnosis as clinical presentation is uncanny, with practitioners ending up with a final diagnosis of rashes or other skin lesions. Healthcare professionals should be educated on the incidence and prevalence of porokeratosis, especially in areas with higher cases. If treatment of these type of lesions is not correctly approached, they may progress to skin cancer, whether squamous cell carcinoma, or basal cell carcinoma, and with a smaller incidence, melanoma as well.
In this context, mycological approaches are being studied in order to improve the standard therapy and offer complementary tools against hyperkeratosis and malignant potential of DSAP.
Chaga mushrooms.
 Inonotus obliquus is discovered to have betulinic acid initially isolated back in 1788 [6]. Upon extraction from the outer bark of white birch trees, this has been found to induce programmed cell death in pre-cancerous cells, such as the ones that can be present in actinic porokeratosis. In previous studies, betulin from Chaga mushrooms has resulted in significant tumor regression, with minimal toxicity to healthy cells.
Reishi mushrooms
Ganoderma lucidum has been used for decades due to its multiple benefits and its high content in terpenoids. Besides, polysacharides and other bioactive molecules, more than 200 triterpenes have been identified from the fruiting bodies, spores, and mycelia of this mushroom. Studies show that these terpenoids exhibit anti-cancer, antioxidant and antiinflammatory properties, which can be very useful in dermatological conditions like actinic porokeratosis [7].
Turkey tail
Along with Reishi, Coriolus versicolor has been noted to have significant amounts of terpenoids that are active in reprogramming the capacity of the cell to undergo apoptosis. In fact, a Turkey tail extract was found to inhibit the mitotic potential of cells that underwent mutation due to radiation exposure, and also by reduction of the tumor size.
Along with these mushrooms, other natural remedies, with more limited evidence of effectiveness, have been used to improve the standard treatment of actinic keratosis including apple cider vinegar, virgin coconut oil, tea tree oil, and even green tea.
Conclusion
Actinic keratosis has been highly prevalent through the years and has been an important basis of skin cancer because of its neoplastic potential. This condition requires medical and integrative management plans that can significantly reduce the development of cancer and other complications and should have been prioritized in the current setting. This is where mycotherapy should be looked into, further studying their bioactive substances to deal with the hyperkeratosis and to prevent the progression of cancer.
In addition, patient education in complementary therapies as adjuvants and in prevention should be also addressed.