Acquired perforating dermatoses show increased levels of cutaneous advanced glycation end-products

Specialty Certificate Examination case for general dermatology and dermatology in primary health care

A 53-year-old male patient was referred from the nephrology department with a 5-week history of an intensely pruritic rash affecting his trunk and the extensor surfaces of his arms and legs.

Dupilumab improve acquired reactive perforating collagenosis characterized by type 2 inflammation

Background

Acquired reactive perforating collagenosis (ARPC) is a clinically challenging disease with an unclear pathogenesis.

Objective

To evaluate the efficacy and safety of dupilumab for the treatment of ARPC, and analyze the expression of type 2 inflammation-related molecules in ARPC lesions.

Methods

This retrospective cohort study included 20 patients with ARPC; 10 received dupilumab and 10 received conventional therapy. The efficacy and safety of dupilumab were evaluated at 12 weeks. Immunohistochemical and immunofluorescence analyses of T- and B-cell markers, and type 2 inflammation-related cytokines, were performed on skin samples from ARPC patients, atopic dermatitis (AD) patients, and healthy controls.

Results

Significantly more patients showed improvements in the Investigator Global Assessment score (100% vs. 0%; p < 0.0001) and itching (90%/8.33%, P =.001) in the dupilumab group compared to the conventional group at 12 weeks. There were no adverse effects in the dupilumab group. The ARPC lesions showed enhanced dermal infiltration of CD3+ T-cells, with a predominance of Th2 cells, similar to AD lesions. IL-4 and IL-13 were co-localized with GATA3 in ARPC lesions.

Conclusion

Dupilumab improved ARPC charaterized with type 2 inflammation.

Miscellaneous annular diseases

Annular lesions represent a unique macro-morphologic pattern in various skin disorders that may be found in pityriasis rotunda, elastosis perforans serpiginosa, subacute nodular migratory panniculitis, keratolysis exfoliativa, neutrophilic eccrine hidradenitis, hemophagocytic lymphohistiocytosis, and intentionally induced annular lesions. This group is highly heterogenous and variable in clinical presentation. Whereas some are benign self-limiting disorders like pityriasis rotunda, others such as hemophagocytic lymphohistiocytosis follow a chronic course or have a potential of being life-threatening. Epidemiology, pathogenesis, histopathology, clinical presentation and diagnosis, differential diagnosis, and treatment are discussed.

Generalized Lesions of Kyrle’s Disease: A Rare Case

Kyrle’s disease (KD) is a rare type of acquired perforating dermatosis (APD) associated with various systemic diseases, particularly chronic kidney disease and diabetes mellitus (DM). It most commonly occurs at the lower extremities. Generalized lesions of KD are rare. We report a case of generalized KD in a 29-year-old woman with chronic kidney disease and DM. Physical examination revealed multiple hyperkeratotic and hyperpigmented papules, plaques, and nodules with central umbilication and keratotic plugs on almost all parts of the body. Histopathological examination showed keratinized epithelial layer with acanthosis and hyperkeratosis, invagination with the formation of keratin plugs, and basophilic cell debris accompanied by parakeratosis and abnormal keratinization of epithelial cells. These histopathological findings fulfilled the Constantine and Carter criteria for KD. This condition is characterized clinically by umbilicated, round, erythematous or hyperpigmented papules and nodules with central crusts or keratotic plug, predominantly involving the extensor surfaces of the extremities and the trunk. Although uncommon, it may also involve the face or the scalp. Nevertheless, generalized lesions involving faces are rarely found in KD.