Disseminated superficial actinic porokeratosis: Difference between revisions

	Disseminated superficial actinic porokeratosis
	Classification and external resources
File:Porokeratosis DSAP.JPG
	A porokeratosis lesion in a patient with disseminated superficial actinic porokeratosis.
OMIM	175900 607728 612293 612353
DiseasesDB	33407

VisualWikitext

Revision as of 18:24, 25 September 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Overview

Disseminated superficial actinic porokeratosis (DSAP) is a non-contagious skin condition with apparent genetic origin in the SART3 gene.^[1]^:533 It most often presents in sun-exposed areas of the body. Some DSAP cases have been reported in patients with acute immune compromised situations, particularly in the elderly. For those with sun damaged skin, the lesions usually begin to appear in the patient's 20's and increase in number and visibility in the 40's or 50's. Commonly, though not always, the number and visibility of lesions is in direct proportion to the amount of sun damage to the affected area.

Lesions generally are characterized by an irregularly-shaped thread-like ring that is usually the size of a pencil eraser, though lesions vary and may be half or double that size. The thread-like ring is very thin, much like fabric thread for sewing, and raised such that it is both palpable and visible. The interior of the ring may be rough like sandpaper, or smooth. The interior is often discolored, though colors vary from patient to patient. Lesions, due to their vascular nature, can also vary according to body temperature, environmental temperatures, and other external stimuli. The internal ring color is most often reddish, purplish, pink, or brown.^[2]

Some patients report itching and irritation associated with the condition, though many report no notable sensation at all. Though no known hormonal link has been found, DSAP occurs more commonly in women.^[3]

A study in 2000 was done on a Chinese family, in which a locus for a gene was located.^[4]

Diagnosis

Physical Examination

Skin

Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.[5]

Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.[5]

Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.[5]

Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]
Porokeratosis actinic. Adapted from Dermatology Atlas.^[5]

References

↑ Freedberg, Irwin M.; Fitzpatrick, Thomas B. (2003). Fitzpatrick's Dermatology in General Medicine (6th ed.). New York: McGraw-Hill, Medical Pub. Division. p. 533. ISBN 0-07-138076-0.
↑ http://www.groups.yahoo.com/group/dsapskin
↑ http://www.aocd.org/skin/dermatologic_diseases/dsap.html
↑ Xia JH, Yang YF, Deng H; et al. (June 2000). "Identification of a locus for disseminated superficial actinic porokeratosis at chromosome 12q23.2-24.1". J. Invest. Dermatol. 114 (6): 1071–4. doi:10.1046/j.1523-1747.2000.00978.x. PMID 10844547.
↑ ^5.000 ^5.001 ^5.002 ^5.003 ^5.004 ^5.005 ^5.006 ^5.007 ^5.008 ^5.009 ^5.010 ^5.011 ^5.012 ^5.013 ^5.014 ^5.015 ^5.016 ^5.017 ^5.018 ^5.019 ^5.020 ^5.021 ^5.022 ^5.023 ^5.024 ^5.025 ^5.026 ^5.027 ^5.028 ^5.029 ^5.030 ^5.031 ^5.032 ^5.033 ^5.034 ^5.035 ^5.036 ^5.037 ^5.038 ^5.039 ^5.040 ^5.041 ^5.042 ^5.043 ^5.044 ^5.045 ^5.046 ^5.047 ^5.048 ^5.049 ^5.050 ^5.051 ^5.052 ^5.053 ^5.054 ^5.055 ^5.056 ^5.057 ^5.058 ^5.059 ^5.060 ^5.061 ^5.062 ^5.063 ^5.064 ^5.065 ^5.066 ^5.067 ^5.068 ^5.069 ^5.070 ^5.071 ^5.072 ^5.073 ^5.074 ^5.075 ^5.076 ^5.077 ^5.078 ^5.079 ^5.080 ^5.081 ^5.082 ^5.083 ^5.084 ^5.085 ^5.086 ^5.087 ^5.088 ^5.089 ^5.090 ^5.091 ^5.092 ^5.093 ^5.094 ^5.095 ^5.096 ^5.097 ^5.098 ^5.099 ^5.100 ^5.101 ^5.102 ^5.103 ^5.104 ^5.105 ^5.106 ^5.107 ^5.108 ^5.109 "Dermatology Atlas".

External links

Template:Genodermatoses-stub

[Fitz2-1] Freedberg, Irwin M.; Fitzpatrick, Thomas B. (2003). Fitzpatrick's Dermatology in General Medicine (6th ed.). New York: McGraw-Hill, Medical Pub. Division. p. 533. ISBN 0-07-138076-0.

[2] ttp://www.groups.yahoo.com/group/dsapskin

[3] ttp://www.aocd.org/skin/dermatologic_diseases/dsap.html

[4] Xia JH, Yang YF, Deng H; et al. (June 2000). "Identification of a locus for disseminated superficial actinic porokeratosis at chromosome 12q23.2-24.1". J. Invest. Dermatol. 114 (6): 1071–4. doi:10.1046/j.1523-1747.2000.00978.x. PMID 10844547.

[Dermatology_Atlas-5] 5.000 ^5.001 ^5.002 ^5.003 ^5.004 ^5.005 ^5.006 ^5.007 ^5.008 ^5.009 ^5.010 ^5.011 ^5.012 ^5.013 ^5.014 ^5.015 ^5.016 ^5.017 ^5.018 ^5.019 ^5.020 ^5.021 ^5.022 ^5.023 ^5.024 ^5.025 ^5.026 ^5.027 ^5.028 ^5.029 ^5.030 ^5.031 ^5.032 ^5.033 ^5.034 ^5.035 ^5.036 ^5.037 ^5.038 ^5.039 ^5.040 ^5.041 ^5.042 ^5.043 ^5.044 ^5.045 ^5.046 ^5.047 ^5.048 ^5.049 ^5.050 ^5.051 ^5.052 ^5.053 ^5.054 ^5.055 ^5.056 ^5.057 ^5.058 ^5.059 ^5.060 ^5.061 ^5.062 ^5.063 ^5.064 ^5.065 ^5.066 ^5.067 ^5.068 ^5.069 ^5.070 ^5.071 ^5.072 ^5.073 ^5.074 ^5.075 ^5.076 ^5.077 ^5.078 ^5.079 ^5.080 ^5.081 ^5.082 ^5.083 ^5.084 ^5.085 ^5.086 ^5.087 ^5.088 ^5.089 ^5.090 ^5.091 ^5.092 ^5.093 ^5.094 ^5.095 ^5.096 ^5.097 ^5.098 ^5.099 ^5.100 ^5.101 ^5.102 ^5.103 ^5.104 ^5.105 ^5.106 ^5.107 ^5.108 ^5.109 "Dermatology Atlas".

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@@ Line 334: / Line 334: @@
 Image:Porokeratosis actinic85.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic86.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic87.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic88.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic89.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic90.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic91.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic92.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic93.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic94.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic95.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic96.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic97.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic98.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic99.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic100.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic101.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic102.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic103.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic104.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic105.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic106.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic107.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Porokeratosis actinic86.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Porokeratosis actinic87.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Porokeratosis actinic69.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic108.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic109.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Porokeratosis actinic110.jpg|Porokeratosis actinic. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>