Treatment of angiokeratomas of Fordyce with topical rapamycin 0.25% cream

Angiokeratomas are benign vascular neoplasms clinically described as well-defined hyperkeratotic, red-to-black papules or plaques, and histologically appear as dilated blood vessels in the papillary dermis that form lacunae with associated acanthosis and rete ridge elongation. Multiple variants of angiokeratomas exist, including angiokeratoma of Fordyce (located on the genitalia, including the scrotum), angiokeratoma corporis diffusum (associated with Fabry disease), angiokeratoma of Mibelli (located on acral sites), solitary or multiple angiokeratomas (often located on lower extremities), and angiokeratoma circumscriptum (congenital and occurs on the trunk and extremities). While angiokeratomas are typically asymptomatic, they can bleed, cause pruritus or pain, and impact psychological health, ultimately driving a patient to seek care. A wide variety of therapeutic options have previously been described including surgical excision, electrodessication, cautery, cryotherapy, and laser.1 Here, we describe a patient who demonstrated a positive response to topical rapamycin (sirolimus), an unconventional method of treatment.