PDT represents a moderately effective treatment modality in AC. Optimization of treatment procedure and protocols is still needed for higher response rates to be achieved. Moreover, the high treatment cost should be given consideration. Further long-term follow-up studies are needed for assessment of clinical and histological very late recurrences that could be expected after PDT.

Our study shows that ALA-PDT and 5% IMIQ cream are both attractive treatment options for upper extremities AKs with comparable efficacy and cosmetic outcomes.

Oral pemphigus most likely represents an initial stage of a disease that can become generalized. Administration of moderate doses of steroids alone is effective in controlling the disease.

According to our observations a fluence rate between 25 and 50 mW/cm2 is effective and better tolerated by patients treated with topical 5-ALA PDT for AKs.

rare manifestation of this dermatosis. The interesting observation was the rapid development of protruding striae with the transudation of the fluid. It was probably due to a compromised dermal integrity. Some authors suggested that hormonal factors were related to critical changes in the resistance of collagen to stretch. 6 Other authors observed sequential changes of elastolysis accompanied by mast cell degranulation and influx of activated macrophages that enveloped fragmented elastic fibers. 7 The aetiology and pathophysiology of SD are not completely elucidated, and more studies are necessary. We present an exuberant case which demonstrates that despite SD are a very common dermatosis, they can present variations and they are cause of morbidity.RCT Cordeiro,* AM de Moraes