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Li J, Zhou C. Recalcitrant Reactive Perforating Collagenosis Successfully Treated with Dupilumab: A Case Report. Clin Cosmet Investig Dermatol 2024; 17:1329-1332. [PMID: 38864026 PMCID: PMC11166152 DOI: 10.2147/ccid.s465766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/28/2024] [Indexed: 06/13/2024]
Abstract
Reactive perforating collagenosis (RPC) is the most common form of the perforating dermatoses, which include RPC, elastosis perforans serpiginosa (EPS), perforating folliculitis (PF), and Kyrle disease (KD). In RPC, altered collagen of the dermis is extruded through the epidermis, which can be misdiagnosed as other skin diseases, such as vasculitis or prurigo nodularis. RPC is associated with a number of conditions, including diabetes mellitus, hepatitis, and renal failure, and thus the management of the coexisting diseases is important. There is currently no standardized and effective treatment method for RPC. Here, we report a patient with RPC who was resistant to topical corticosteroids, oral loratadine, and thalidomide, and responded well to dupilumab without significant side effects.
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Affiliation(s)
- Jiecheng Li
- Department of Dermatology, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Cheng Zhou
- Department of Dermatology, Peking University People’s Hospital, Beijing, People’s Republic of China
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2
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Viejo-Boyano I, López-Romero LC, Martínez-i-Cózar V, Soldevila-Orient A, Hernández-Jaras J. Acquired perforating dermatosis in patients on peritoneal dialysis: a report of 3 cases. AME Case Rep 2023; 7:46. [PMID: 37942044 PMCID: PMC10628411 DOI: 10.21037/acr-23-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/13/2023] [Indexed: 11/10/2023]
Abstract
Background Acquired perforating dermatosis (APD) is a heterogeneous group of unfrequented diseases (2.5 cases for 100,000 habitants) associated with multiple pathologies like end-stage renal disease and other concomitant conditions such as diabetes mellitus (DM). Case Description We described 3 cases of APD in patients on peritoneal dialysis (PD), one of them with a giant variant of reactive perforating collagenosis (RPC). The first case is a 28-year-old man with chronic kidney disease on PD and a lousy control of disturbances of calcium and phosphorus metabolism that develops an APD. The second case is a 44-year-old man with DM, chronic kidney disease (CKD) on PD, and poor control of disturbances of calcium and phosphorus metabolism that develops an RPC. The third case is a 58-year-old man with DM, rheumatoid arthritis, hypothyroidism, CKD and bad control of calcium and phosphorus metabolism that develops a giant variant of RPC with poor evolution. Conclusions CKD and concomitant conditions such as DM present an increased risk of developing APD. Poor control of calcium and phosphorus metabolism is frequently found in patients with CKD and seems to be related to the development of APD in our cases. With the description of these cases, we want to emphasize the importance of knowing this rare disease, in order to promptly refer to Dermatology and start treatment.
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Affiliation(s)
- Iris Viejo-Boyano
- Nephrology Department, University and Polythechnic La Fe Hospital, Valencia, Spain
| | | | - Vicent Martínez-i-Cózar
- Pathological Anatomy Department, University and Polythechnic La Fe Hospital, Valencia, Spain
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Imran N. Acquired Perforating Dermatosis as a Paraneoplastic Feature: A Case Report, Literature Review, and Novel Association. Case Rep Nephrol Dial 2023; 13:36-44. [PMID: 37384123 PMCID: PMC10294214 DOI: 10.1159/000530756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/07/2023] [Indexed: 06/30/2023] Open
Abstract
Kyrle's disease is an uncommon form of acquired transepidermal elimination dermatosis frequently associated with diabetes mellitus and chronic kidney disease. An association with malignancy has been sporadically reported in the literature. Here, we describe the clinical course of a diabetic patient with end-stage renal disease who developed this disorder as a herald to a regionally advanced renal cell carcinoma. We provide a focused literature review and rationale for the definitive categorization of acquired perforating dermatosis as a potential paraneoplastic manifestation of systemic malignancies. Clinicopathological correlation and prompt communication among clinicians for occult malignancies are always warranted. Furthermore, we describe a novel association of one of the subtypes of acquired perforating dermatosis with such malignancies.
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Affiliation(s)
- Nashat Imran
- Internal Medicine Department, Wayne State University School of Medicine, Detroit, MI, USA
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Kollipara H, Satya RS, Rao GR, Attili SK. Acquired Reactive Perforating Collagenosis: Case Series. Indian Dermatol Online J 2022; 14:72-76. [PMID: 36776193 PMCID: PMC9910515 DOI: 10.4103/idoj.idoj_373_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 12/30/2022] Open
Abstract
Acquired reactive perforating collagenosis (ARPC) is one of the four acquired perforating dermatoses. The condition is characterized by transepidermal elimination of altered collagen. These are rare and underdiagnosed clinical entities and a few studies are available in the Indian literature. The present study described 15 patients of ARPC with underlying comorbidities and clinical response to systemic antihistamines, doxycycline, and topical clobetasol propionate. Of total 15 patients, 10 were men and the other five were women. Except two patients, diabetes mellitus was seen in 13 patients. Three patients had mild proteinuria. Four patients were known hypertensive. Itchy, papular, nodular lesions with central keratotic plug were seen commonly on the limbs and trunk. In another five patients, lesions were seen other than limbs and trunk, on the abdomen, chest, and back. In one case, giant plaques of more than 2 cm were present on the abdomen and limbs. In another patient, psoriasis lesions were concomitantly seen with ARPC lesions. Koebner's phenomenon was observed in six patients. The histopathological features of skin lesions in all 15 patients were consistent with ARPC. In all the patients, the lesions regressed within 4-6 weeks with topical clobetasol propionate and antihistamines. In three patients, systemic doxycycline was found to hasten the regression of lesions. Recurrences were observed in six patients during the follow-up period of 3 months.
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Affiliation(s)
- Haritha Kollipara
- Department of DVL, GITAM Medical College, Visakhapatnam, Andhra Pradesh, India
| | - Ruttala S. Satya
- Department of DVL, Consultant Dermatologist, Surya Skin Care Clinic, Visakhapatnam, Andhra Pradesh, India
| | - Gandikota R. Rao
- Department of DVL, Consultant Dermatologist, Surya Skin Care Clinic, Visakhapatnam, Andhra Pradesh, India,Address for correspondence: Dr. Gandikota R. Rao, Consultant Dermatologist, Surya Skin Care & Research Centre, 15-1-2, Nowroji Rd, Maharani Peta, Visakhapatnam, Andhra Pradesh - 530 002, India. E-mail:
| | - Sasi K. Attili
- Consultant Pathology, L. D. Path Lab, Visakhapatnam, Andhra Pradesh, India
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5
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Kusutani N, Arai S, Imanishi A, Maekawa N, Fukai K. A giant variant of acquired reactive perforating collagenosis. Int J Dermatol 2021; 61:e250-e252. [PMID: 34302354 DOI: 10.1111/ijd.15797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Nao Kusutani
- Department of Dermatology, Osaka City General Hospital, Osaka, Japan
| | - Sakurako Arai
- Department of Dermatology, Osaka City General Hospital, Osaka, Japan
| | - Akiko Imanishi
- Department of Dermatology, Osaka City General Hospital, Osaka, Japan
| | - Naoki Maekawa
- Department of Dermatology, Osaka City General Hospital, Osaka, Japan
| | - Kazuyoshi Fukai
- Department of Dermatology, Osaka City General Hospital, Osaka, Japan
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Gaglani B, Logan I, Kubba F. Necrotic plaques in an elderly male. JRSM Open 2021; 12:2054270420981452. [PMID: 33628453 PMCID: PMC7882765 DOI: 10.1177/2054270420981452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Reactive perforating collagenosis is commonly recognised as an unusual form of transepithelial elimination of collagen and elastin fibres which are extruded through the epidermis in patients with a genetic predisposition or underlying diseases, such as diabetes mellitus or renal diseases. We present the unusual case of an 87-year-old diabetic male with a giant form of reactive perforating collagenosis and review the available literature.
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Affiliation(s)
- Bindi Gaglani
- Department of Dermatology, Ealing Hospital, Southall, UB1 3HW, UK
| | - Ian Logan
- Department of Dermatology, Ealing Hospital, Southall, UB1 3HW, UK
| | - Faris Kubba
- Department of Dermatology, Ealing Hospital, Southall, UB1 3HW, UK
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Gore Karaali M, Erdil D, Erdemir VA, Gurel MS, Koku Aksu AE, Leblebici C. Evaluation of clinicopathological and treatment characteristics of 80 patients with acquired perforating dermatosis. Dermatol Ther 2020; 33:e14465. [PMID: 33112028 DOI: 10.1111/dth.14465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/13/2020] [Accepted: 10/23/2020] [Indexed: 12/22/2022]
Abstract
Acquired perforating dermatosis (APD) is a group of a rare dermatological disorder characterized by elimination of dermal connective tissue through epidermis. We aimed to evaluate the characteristics of patients diagnosed with APD and to determine the differences in comorbidities according to subtypes of APD. A retrospective, observational, cross-sectional study was designed. Patients diagnosed with APD between January 2008 and January 2019 were reviewed. Eighty patients were included in the study. 61.2% (n = 49) of the patients were female and 38.8% (n = 31) were male with a mean age of 58.4 ± 12.5 years. 82.5% (n = 66) of the patients were diagnosed with reactive perforating collagenosis (RPC) and 17.5% (n = 14) of perforating folliculitis (PF). The most common concomitant disease was diabetes mellitus (82.5%). 5.0% of the patients had malignancy. The comorbidity rate in RPC group was higher than PF (P < .05). Topical steroid was the most frequently (90.0%) used treatment. Complete response was obtained 55.0% of patients. Exitus was observed in 23.8% (n = 19) of patients in a mean 17.6 ± 25.7 months follow-up period. APD may be associated with many diseases. Comorbidities are more frequent in RPC group. This situation warns us to evaluate patients with RPC in more detail for underlying diseases. High mortality rate related to the underlying systemic diseases suggests being careful in terms of mortality in patients diagnosed with APD.
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Affiliation(s)
- Muge Gore Karaali
- Department of Dermatology, Mengücek Gazi Training and Research Hospital, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Duygu Erdil
- Department of Dermatology, University of Health Science (HSU) Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Vefa Aslı Erdemir
- Department of Dermatology, Göztepe Training and Research Hospital, Medeniyet University, Istanbul, Turkey
| | - Mehmet Salih Gurel
- Department of Dermatology, Göztepe Training and Research Hospital, Medeniyet University, Istanbul, Turkey
| | - Ayse Esra Koku Aksu
- Department of Dermatology, University of Health Science (HSU) Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Cem Leblebici
- Department of Pathology, University of Health Science (HSU) Istanbul Training and Research Hospital, Istanbul, Turkey
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Silva LD, S Lokuhetty MD. Giant variant of acquired perforating dermatosis, clinically masquerading as a sarcoma: A report of a rare case. INDIAN J PATHOL MICR 2020; 63:128-130. [PMID: 32031142 DOI: 10.4103/ijpm.ijpm_837_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acquired perforating dermatosis is a group of disease characterized by transepidermal elimination of altered dermal constituents of unknown pathogenesis. The giant variant was first described in 2006, as an emerging entity with seven reported cases to date. Here is an 83-year-old male presented with a 4-year history of gradually enlarging soft tisssue mass with ulcerartions at the left knee joint. Imaging revealed an extra-articular, single, heterogeneous, multinodular mass, suspicious for a soft tissue sarcoma. Wide local excision of the mass showed fleshy, hemorrhagic nodules communicating with epidermal ulcers. Microscopy showed cystic spaces straddling dermis and subcutis, containing eosinophilic, amorphous, granular material extruding through epidermal craters, surrounded by exuberant myofibroblastic proliferation. Trichrome and van-Gieson stains confirmed that the extruded material is collagen and the histology was compatible with the giant variant of acquired perforating collagenosis. Awareness of histological appearance prevents misdiagnosis and overtreatment of this entity, masquerading as a sarcoma clinically.
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Affiliation(s)
- Lalani De Silva
- Department of Pathology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - M D S Lokuhetty
- Department of Pathology, Faculty of Medicine, University of Colombo, Sri Lanka
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Hasbún C, Sandoval M, González-Bombardiere S. Case for diagnosis. Hyperpigmented and excoriated papules and nodules in a diabetic patient. An Bras Dermatol 2020; 95:757-759. [PMID: 33036808 PMCID: PMC7672397 DOI: 10.1016/j.abd.2020.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/04/2020] [Indexed: 11/29/2022] Open
Abstract
Reactive perforating collagenosis is a rare perforating dermatosis clinically characterized by intensely pruritic hyperpigmented papules, plaques, and nodules with a central keratotic plug. Histopathology reveals transepidermal elimination of collagen fibers. Its pathophysiology is still under investigation, but the acquired form has been linked to systemic conditions such as diabetes mellitus and chronic kidney disease. However, it has also been described as a paraneoplastic syndrome. The authors present the case of a 65-year-old diabetic patient in which a myeloproliferative neoplasm was suspected.
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Affiliation(s)
- Catalina Hasbún
- School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mauricio Sandoval
- Department of Dermatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Zhang X, Yang Y, Shao S. Acquired reactive perforating collagenosis: A case report and review of the literature. Medicine (Baltimore) 2020; 99:e20391. [PMID: 32481426 DOI: 10.1097/md.0000000000020391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Acquired reactive perforating collagenosis (ARPC) is a rare skin disorder, which is associated with various internal diseases and even malignant neoplasms. A comprehensive knowledge of the concomitant diseases in ARPC patients is helpful to decrease the misdiagnosis. Although the treatment of ARPC is challenging, systemic assessment of existing regimens is not available. PATIENT CONCERNS A 50-year-old woman was admitted to the hospital due to cutaneous pruritus and papules all over the body. DIAGNOSIS Physical examination showed various sized papules on the lower limbs, buttocks, back, chest, and upper arms with keratotic plugs in the center. Histopathology showed typical collagenous fiber perforation. The diagnosis of ARPC was made according to histopathology, onset age and typical skin lesions. Type 2 diabetes mellitus (T2DM), chronic renal failure (CRF), and hypothyroidism simultaneously presented in this patient. INTERVENTIONS This patient was initially treated with topical corticosteroids and oral antihistamines for the skin lesion and pruritus. Medications for glucose control and recovery of renal and thyroid functions were also applied. On the second admission, the combined therapy of topical retinoic acid, Chinese medicinal herb-Qingpeng ointment, and Zinc oxide ointment was added. OUTCOMES Papules and pruritus were improved significantly after the second hospitalization. CONCLUSION We present a case of ARPC associated with T2DM, CRF, and hypothyroidism, which has rarely been described. There is no standardized treatment for ARPC. Co-administration of two or more agents for dermatologic interventions and treatment for associated diseases may help to improve skin symptoms.
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Affiliation(s)
- Xinyue Zhang
- Division of Endocrinology, Tongji Hospital, Huazhong University of Science and Technology
- Taikang Tongji (Wuhan) Hospital, Wuhan, P.R. China
| | - Yan Yang
- Division of Endocrinology, Tongji Hospital, Huazhong University of Science and Technology
| | - Shiying Shao
- Division of Endocrinology, Tongji Hospital, Huazhong University of Science and Technology
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11
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Wang MF, Mei XL, Wang L, Lin-Feng L. Clinical characteristics and prognosis of acquired perforating dermatosis: A case report. Exp Ther Med 2020; 19:3634-3640. [PMID: 32346428 PMCID: PMC7185186 DOI: 10.3892/etm.2020.8651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/05/2019] [Indexed: 11/06/2022] Open
Abstract
Acquired perforating dermatosis (APD) is an uncommon skin disease characterized by umbilicated hyperkeratotic lesions, and involves the transepidermal elimination of dermal components, including collagen and elastic fibers. The disease can affect patients with systemic disorders, especially those with chronic renal failure or diabetes mellitus. The current paper described four cases of patients with APD and investigated the clinical characteristics and prognosis of APD, as well as its possible link with systemic disorders. In each of the four cases, the patient had systemic disorders before the onset of APD, three had concomitant renal and thyroid disorders and one had hepatocirrhosis secondary to chronic hepatitis C. The results of the present study showed that APD occurred after the transient worsening of the original systemic disease. Furthermore, it was revealed that dermatosis symptoms were alleviated upon remission of the original systemic disorder, without specific dermatological treatment. Dermatosis symptoms improved in all four patients, indicating that the management of the associated systematic diseases was essential for the successful clinical outcomes of APD.
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Affiliation(s)
- Mei-Fang Wang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Xue-Ling Mei
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Li Wang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Li Lin-Feng
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
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Garrido PM, Queirós C, Borges-Costa J, Soares-Almeida L, Filipe P. Acquired perforating dermatosis: clinicopathologic study of a 10-year period at a tertiary teaching hospital. Int J Dermatol 2019; 59:445-450. [PMID: 31876297 DOI: 10.1111/ijd.14760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/25/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Acquired perforating dermatosis (APD) comprises an uncommon group of skin disorders that develop in adulthood in association with systemic diseases. The aim of this study was to characterize clinicopathologic features and treatment outcomes in a series of patients diagnosed with APD. METHODS Retrospective study of all patients diagnosed with an APD over a 10-year period (2009-2018) at a tertiary teaching hospital in Lisbon, Portugal. RESULTS Fifty-seven patients with APD were identified. Thirty-five patients presented lesions in multiple anatomic areas (61.4%), and the lower limbs were the most common location. Forty-six patients reported pruritus (80.7%), which was classified as severe in 21 of them (36.8%). An underlying systemic disease was identified in 53 patients (93.0%). Diabetes mellitus (DM) and chronic kidney disease (CKD) were the most common associated systemic diseases, but psychiatric disorders, malignancies, and chronic infections were present in a significant number of patients. The combination of topical steroids with antihistamines was the most prescribed initial treatment, but only 37.8% of the patients had a complete response. Acitretin, systemic steroids, and phototherapy were the treatments associated with the best outcome. CONCLUSION Acquired perforating dermatosis can be associated with many systemic disorders that have pruritus as a common factor. Chronic viral infections and an occult malignancy should be sought, particularly in the absence of DM and CKD. The management of APD is challenging and is best achieved with the control of the underlying systemic diseases.
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Affiliation(s)
- Pedro Miguel Garrido
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte, EPE (CHULN), Lisboa, Portugal
| | - Catarina Queirós
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte, EPE (CHULN), Lisboa, Portugal
| | - João Borges-Costa
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte, EPE (CHULN), Lisboa, Portugal.,Unidade de Investigação em Dermatologia, Instituto de Medicina Molecular (IMM), Lisboa, Portugal.,Clínica Universitária de Dermatologia, Faculdade de Medicina da Universidade de Lisboa (FMUL), Lisboa, Portugal.,Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Luís Soares-Almeida
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte, EPE (CHULN), Lisboa, Portugal.,Unidade de Investigação em Dermatologia, Instituto de Medicina Molecular (IMM), Lisboa, Portugal.,Clínica Universitária de Dermatologia, Faculdade de Medicina da Universidade de Lisboa (FMUL), Lisboa, Portugal
| | - Paulo Filipe
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte, EPE (CHULN), Lisboa, Portugal.,Unidade de Investigação em Dermatologia, Instituto de Medicina Molecular (IMM), Lisboa, Portugal.,Clínica Universitária de Dermatologia, Faculdade de Medicina da Universidade de Lisboa (FMUL), Lisboa, Portugal
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Abstract
BACKGROUND Reactive perforating collagenosis (RPC) is a rare form of transepithelial elimination, in which altered collagen is extruded through the epidermis. There are 2 types of RPC, acquired RPC (ARPC) and inherited RPC, while the latter is extremely rare. Here we report on 1 case of ARPC. METHODS A 73-year-old female was presented with strongly itchy papules over her back and lower limbs for 3 months. She denied the history of oozing or vesiculation. A cutaneous examination showed diffusely distributed multiple well-defined keratotic papules, 4 to 10 mm in diameter, on the bilateral lower limbs and back as well as a few papules on her chest and forearm. Scratching scars were over the resolved lesions while Koebner phenomenon was negative. The patient had a history of type 2 diabetes for 15 years. Laboratory examinations showed elevated blood glucose level. Skin lesion biopsy showed a well-circumscribed area of necrosis filled with a keratotic plug. Parakeratotic cells and lymphocytic infiltration could be seen in the necrosed area. In dermis, sparse fiber bundles were seen perforating the epidermis. These degenerated fiber bundles were notarized as collagen fiber by elastic fiber stain, suggesting a diagnosis of RPC. RESULTS Then a diagnosis of ARPC was made according to the onset age and the history of diabetes mellitus. She was treated with topical application of corticosteroids twice a day and oral antihistamine once a day along with compound glycyrrhizin tablets 3 times a day. And the blood glucose was controlled in a satisfying range. Two months later, a significant improvement was seen in this patient. CONCLUSION Since there is no efficient therapy to RPC, moreover, ARPC is considered to be associated with some systemic diseases, the management of the coexisting disease is quite crucial. The patient in this case received a substantial improvement due to the control of blood glucose and application of compound glycyrrhizin tablets.
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Affiliation(s)
| | | | | | | | | | - Yuling Shi
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Correspondence: Yuling Shi, Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China (e-mail: )
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