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Gori N, De Luca E, Chiricozzi A, Sfregola S, Di Stefani A, Peris K. Successful Use of Dupilumab in the Treatment of Acquired Perforating Dermatosis Associated with Atopic Dermatitis. Case Rep Dermatol Med 2024; 2024:6265608. [PMID: 38939121 PMCID: PMC11208807 DOI: 10.1155/2024/6265608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/13/2024] [Accepted: 06/05/2024] [Indexed: 06/29/2024] Open
Abstract
Acquired reactive perforating collagenosis is a rare cutaneous disorder characterised by the extrusion of abnormal connective tissue trough epidermidis and/or follicular units. Reactive perforating collagenosis is often associated with systemic diseases in which pruritus is a common symptom (e.g., diabetes and chronic kidney disease). Less commonly, it has been associated with chronic inflammatory dermatoses, including atopic dermatitis, as in this case. In this report, we describe the exceptional case of a 35-year-old man affected by acquired reactive perforating collagenosis associated with atopic dermatitis who was resistant to conventional topical and systemic treatment and experienced complete resolution of clinical signs and symptoms after 12 weeks of treatment with dupilumab. In our patient, the severe pruritus induced by atopic dermatitis likely contributed to the development of acquired perforating collagenosis lesions, which are thought to be a reactive response to chronic scratching and repetitive injury to the skin. Chronic pruritus in atopic dermatitis is known to be driven by type 2 cytokines, including IL-4 and IL-13, and dupilumab, a monoclonal antibody inhibiting IL-4 and IL-13 signalling, has been shown to be effective in the treatment of moderate to severe atopic dermatitis as well as other type 2-driven pruritic dermatological conditions. This case supports the potential use of dupilumab for the treatment of reactive perforating dermatosis.
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Affiliation(s)
- Niccolò Gori
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- U.O.C. Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora De Luca
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- U.O.C. Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Chiricozzi
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- U.O.C. Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefania Sfregola
- Sezione di Anatomia Patologica, Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Unità di Anatomia Patologica, Dipartimento di Scienze della Salute della Donna, de Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Di Stefani
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- U.O.C. Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ketty Peris
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- U.O.C. Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Vázquez-López F, Reyes-García S, Carrero-Martín J, Núñez-Domínguez Á, López-Pando M, Kiecis E, González-Vela MC, González-López MA. Risk of systemic cancer in patients with acquired perforating dermatosis. A double case-control retrospective study. Arch Dermatol Res 2024; 316:335. [PMID: 38844613 DOI: 10.1007/s00403-024-02962-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/20/2024] [Accepted: 04/26/2024] [Indexed: 06/27/2024]
Affiliation(s)
- Francisco Vázquez-López
- Dermatology Department, Hospital Universitario Central de Asturias, University of Oviedo, Avenida de Roma, s/n, Oviedo, Asturias, 33011, Spain
- GRIDER (Dermatology Investigation Group of Asturias, University of Oviedo), Oviedo, Spain
| | - Sebastian Reyes-García
- Dermatology Department, Hospital Universitario Central de Asturias, University of Oviedo, Avenida de Roma, s/n, Oviedo, Asturias, 33011, Spain
| | - Jimena Carrero-Martín
- Dermatology Department, Hospital Universitario Central de Asturias, University of Oviedo, Avenida de Roma, s/n, Oviedo, Asturias, 33011, Spain
| | - Álvaro Núñez-Domínguez
- Dermatology Department, Hospital Universitario Central de Asturias, University of Oviedo, Avenida de Roma, s/n, Oviedo, Asturias, 33011, Spain
| | - Marta López-Pando
- Dermatology Department, Hospital Universitario Central de Asturias, University of Oviedo, Avenida de Roma, s/n, Oviedo, Asturias, 33011, Spain
| | - Edgars Kiecis
- Dermatology Department, Hospital Universitario Central de Asturias, University of Oviedo, Avenida de Roma, s/n, Oviedo, Asturias, 33011, Spain
| | - M Carmen González-Vela
- Pathology Department, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Avenida de Valdecilla s/n, Santander, Cantabria, 39008, Spain
| | - Marcos A González-López
- Dermatology Department, Department of Medicine and Psychiatry, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Avenida de Valdecilla s/n, Santander, Cantabria, 39008, Spain.
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Edek YC, Aypek Y, Öğüt B, Erdem Ö, Adışen E. Acquired Perforating Dermatosis: Clinical and Histopathological Analysis of 95 Patients From One Center. Dermatol Pract Concept 2024; 14:dpc.1402a100. [PMID: 38810077 PMCID: PMC11135951 DOI: 10.5826/dpc.1402a100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Acquired perforating dermatosis (APD) is a disease group characterized by transepidermal elimination of dermal connective tissue materials such as collagen, elastic fibers, and keratin through the epidermis and observed with pruritic skin lesions. OBJECTIVES In this study, we aim to clarify the clinical, histopathological, and dermoscopic characteristics of APD, identify the associated systemic disease, and figure out treatment options. METHODS This study was designed as a single-center retrospective, observational, cross-sectional study. We evaluated all accessible APD cases between January 2004 and June 2022 in a tertiary care hospital. RESULTS A total of 95 patients with confirmed APD were included in the study. Sixty percent of the patients were women and 40% were men. The median age at diagnosis was 63.1 years (35-85 years). The most common site of lesions was the lower extremities which were detected in 86.31% of the patients. The concomitant systemic disease was identified in 84.21% of the patients. The most common systemic disease was type 2 diabetes mellitus (65.26%). Antihistamines and topical corticosteroids were the most commonly prescribed treatment agents. CONCLUSIONS Transepidermal elimination of dermal connective tissue components is a feature of APD and the disease usually presents with pruritic papules and nodules with central keratotic crust or plug. The diagnosis of APD requires a clinical examination and histological investigation. APD is usually accompanied by systemic comorbidities. There are several topical and systemic medications available for APD, however, sometimes the therapy might be challenging.
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Affiliation(s)
- Yusuf Can Edek
- Department of Dermatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Yağmur Aypek
- Department of Dermatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Betül Öğüt
- Department of Pathology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Özlem Erdem
- Department of Pathology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Esra Adışen
- Department of Dermatology, Gazi University Faculty of Medicine, Ankara, Turkey
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Bohdanowicz M, Bradshaw SH. Perforating Gout: Expanding the Differential for Transepidermal Elimination. Dermatopathology (Basel) 2023; 10:207-218. [PMID: 37489453 PMCID: PMC10366899 DOI: 10.3390/dermatopathology10030029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023] Open
Abstract
Perforating dermatoses are dermatologic disorders with transepidermal elimination (TE) of dermal substances. While TE is typically associated with collagen and elastin, it can also occur as a secondary event in other processes, and it is important to keep a broad differential. We present a case of perforating tophaceous gout, which underscores the need for a thoughtful approach to perforating disorders. An updated review of recent literature is also presented.
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Affiliation(s)
- Michal Bohdanowicz
- Department of Medicine, Sunnybrook Campus, University of Toronto, 2075 Bayview Ave., Toronto, ON M4N 3N5, Canada
| | - Scott H Bradshaw
- Department of Medicine, Sunnybrook Campus, University of Toronto, 2075 Bayview Ave., Toronto, ON M4N 3N5, Canada
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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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Gao L, Gu L, Chen Z, Cao S. Doxycycline Combined with NB-UVB Phototherapy for Acquired Reactive Perforating Collagenosis. Ther Clin Risk Manag 2020; 16:917-921. [PMID: 33061396 PMCID: PMC7522401 DOI: 10.2147/tcrm.s271058] [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: 07/10/2020] [Accepted: 08/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background Acquired reactive perforating collagenosis is a rare skin disease characterized by the discharge of collagen fibers through the epidermis. There is no standard treatment for this disease currently. Here, we report a case of ARPC that has been successfully treated and cured. Case Description A 32-year-old man developed severe itching papules on his torso and limbs for 3 months. Skin lesions were keratotic papules scattered on the limbs and trunk, with a diameter of 3 to 12 mm. Some lesions had umbilical recesses and the shape of a crater with positive isomorphic reactions. The patient scratched his severe itching lesions which merged into large ones. This patient had histories of hypertension and dilated cardiomyopathy with mild congestive heart failure. The clinical presentation and histopathology of skin lesions met Faver’s diagnostic criteria for ARPC. Treatment Oral Doxycycline 100mg/d, NB-UVB phototherapy 3 times a week with initial dose 400mJ/cm2, gradually increased to 1200mJ/cm2(total cumulative dose 16700J/cm2). Outcomes After a week of treatment, the patient’s itching symptoms were significantly reduced and stopped presenting any new skin lesions. Most of the lesions healed in 6 weeks of treatment. Lessons Doxycycline combined with NB-UVB may be an effective treatment for ARPC.
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Affiliation(s)
- Limu Gao
- Department of Dermatology, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, People's Republic of China
| | - Lixiong Gu
- Department of Dermatology, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, People's Republic of China
| | - Zhen Chen
- Department of Dermatology, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, People's Republic of China
| | - Shuanglin Cao
- Department of Dermatology, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, People's Republic of China
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