A dyskeratosis may be defined as a disorder of epidermal proliferation. All the dyskeratoses have in common a localization of the disease process to the interfollicular epidermis or the dermal-epidermal junction. The epithelial cells lining the sweat glands and the hair follicles are not affected by the disease process. The most common example of this disorder is psoriasis, which may be present in up to 3 percent of the population of the United States. It is now more than 10 years since our first experience with partial-thickness skin excision in the treatment of one of the rarer forms of dyskeratoses, Darier-White disease, and more than 5 years since our report of the application of this concept to the treatment of psoriasis. The nonsurgical approach to these disorders remains largely symptomatic. The most aggressive forms of medical management, such as the psoralen-enhanced effect of ultraviolet light (PUVA) and oral methotrexate, continue to create significant long-term complications, such as skin cancer and lymphoma. The medical search for effective agents continues, as witnessed by the most recent report of the use of cyclosporin in the treatment of psoriasis. Recently, Kiil, Kul, and Sogaard have reported a confirmatory outpatient experience: dermatome partial excision of psoriatic plaques in 20 patients with a 2-year follow-up. The purpose of this surgical follow-up report, then, is to indicate our continuing enthusiasm partial-thickness skin excision and to document its success in additional patients with a variety of dyskeratoses.
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