1
|
Liu J, Zhao P, Zhang X, Gao J, Han H, Qin J. Acquired reactive perforating collagenosis triggered by trauma with eosinophilia: a case report and literature review. Front Med (Lausanne) 2024; 11:1415545. [PMID: 38988359 PMCID: PMC11233541 DOI: 10.3389/fmed.2024.1415545] [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: 04/16/2024] [Accepted: 06/13/2024] [Indexed: 07/12/2024] Open
Abstract
Acquired reactive perforating collagenosis (ARPC) is a rare dermatological disorder condition defined by the perforation of altered collagen fibers through the epidermis. The presence of underlying conditions such as diabetes or renal disease is helpful in the ARPC diagnosis. Although skin rashes related to ARPC have been reported, the exact causative factors and mechanisms remain unclear. Here, we present a unique case of ARPC triggered by trauma in a 67-year-old male without concurrent systemic alterations. The diagnosis of ARPC with eosinophilia was made following comprehensive diagnostic testing, including clinical presentation, histological results, and blood tests, ruling out other possible diseases. Intriguingly, the histopathological examination revealed collagen penetration into the epidermis at different tissue sections. In addition, we reviewed existing literature on ARPC, which documented the causation. To help confirm the diagnosis, clinicians have to pay attention to traumatic triggers for ARPC and its rare manifestation with eosinophilia.
Collapse
Affiliation(s)
- Jie Liu
- The Dermatology Department of Shanxi Provincial People's Hospital, Five Hospital of Shanxi Medical University, Taiyuan, China
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Peng Zhao
- The Dermatology Department of Shanxi Provincial People's Hospital, Five Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinzhong Zhang
- The Dermatology Department of Shanxi Provincial People's Hospital, Five Hospital of Shanxi Medical University, Taiyuan, China
| | - Jie Gao
- The Dermatology Department of Shanxi Provincial People's Hospital, Five Hospital of Shanxi Medical University, Taiyuan, China
| | - Haozhi Han
- Department of Minimally Invasive Spine Surgery, The Affiliated Shanxi Provincial People's Hospital of Shanxi Medical University, Taiyuan, China
| | - Junxia Qin
- The Dermatology Department of Shanxi Provincial People's Hospital, Five Hospital of Shanxi Medical University, Taiyuan, China
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Fleming S, Byrne B, Granahan A, Andrawis M, Drumm C, Rafferty S, Carty K, Tobin AM, Connolly M. Specialty Certificate Examination case for general dermatology and dermatology in primary health care. Clin Exp Dermatol 2024; 49:648-649. [PMID: 38183661 DOI: 10.1093/ced/llae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/03/2023] [Accepted: 01/03/2024] [Indexed: 01/08/2024]
Abstract
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.
Collapse
Affiliation(s)
- Sarah Fleming
- Department of Dermatology, Tallaght University Hospital, Tallaght, Dublin
| | - Berbie Byrne
- Department of Dermatology, Tallaght University Hospital, Tallaght, Dublin
| | - Aoife Granahan
- Department of Dermatology, Tallaght University Hospital, Tallaght, Dublin
| | - Madonna Andrawis
- Department of Dermatology, Tallaght University Hospital, Tallaght, Dublin
| | - Claire Drumm
- Department of Dermatology, Tallaght University Hospital, Tallaght, Dublin
| | - Siobhan Rafferty
- Department of Dermatology, Tallaght University Hospital, Tallaght, Dublin
| | - Kieran Carty
- Department of Dermatology, Tallaght University Hospital, Tallaght, Dublin
| | - Anne-Marie Tobin
- Department of Dermatology, Tallaght University Hospital, Tallaght, Dublin
| | - Maureen Connolly
- Department of Dermatology, Tallaght University Hospital, Tallaght, Dublin
| |
Collapse
|
4
|
Liu B, Wu Y, Wu X, Zhong X, Xue R, Zhang Z. Dupilumab improve acquired reactive perforating collagenosis characterized by type 2 inflammation. Front Immunol 2023; 14:1240262. [PMID: 37638036 PMCID: PMC10449391 DOI: 10.3389/fimmu.2023.1240262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Ben Liu
- Department of Dermatology, The Eighth Affliated hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yibei Wu
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoyan Wu
- Department of Dermatology, The Eighth Affliated hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Xinyu Zhong
- Department of Dermatology, The Eighth Affliated hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Ruzeng Xue
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Zhenying Zhang
- Department of Dermatology, The Eighth Affliated hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| |
Collapse
|
5
|
Al-Bader S, El-Reshaid K, Madda J. Acquired Perforating Dermatosis: A Disorder Treatable with Mycophenolate Mofetil. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2023; 34:142-146. [PMID: 38146723 DOI: 10.4103/1319-2442.391892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
Acquired perforating dermatosis (APD) is an adult skin disease characterized by an umbilicated papulonodular rash with transepidermal elimination of dermal components such as collagen and/or elastin. It is frequently associated with multiple medications and diseases such as diabetes and chronic renal failure. It is a disabling disease with severe pruritus in 83.3% of cases and generalized ulcerating lesions that are associated with infections and scarring. Nearly 10% of renal patients are affected. Supportive measurements of disease activity and previous medications failed to halt its natural progression. In our study, we documented significant improvements in the severity of the disease as measured by the eczema area and severity index (EASI), in 32 patients with the renal disease through the use of mycophenolate mofetil (MMF), with EASI decreasing from 31 [interquartile range (IQR) = 4] to 3 (IQR = 4) by the 3rd month. Moreover, such changes persisted for up to 2 years despite a decrease in the dose of MMF to half after 1 year. In conclusion, our study showed that MMF is a safe and effective immunosuppressive drug for short- and intermediate-term therapy of severe APD and confirmed its autoimmune etiology.
Collapse
Affiliation(s)
- Shaima Al-Bader
- Asad Al-Hamad Dermatology Center, Ministry of Health, Safat, Kuwait
| | - Kamel El-Reshaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - John Madda
- Department of Pathology, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| |
Collapse
|
6
|
Huang F, Ren W, Wang M, Li X, Pan M. Acquired reactive perforating collagenosis combined with MRSA: A case report. MEDICINE INTERNATIONAL 2023; 3:9. [PMID: 36793622 PMCID: PMC9922796 DOI: 10.3892/mi.2023.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/23/2023] [Indexed: 01/27/2023]
Abstract
Acquired reactive perforating collagenosis (ARPC) is a rare chronic skin disease associated with various internal diseases, particularly diabetes and chronic renal failure. The present study describes the case of a patient with ARPC combined with methicillin-resistant Staphylococcus aureus (MRSA), in an aim to broaden the current understanding of ARPC. A 75-year-old female presented with a 5-year history of pruritus and ulcerative eruptions on the trunk of her body, which became more severe within 1 year. A cutaneous examination revealed a diffuse distribution of erythema and papules, and nodules of various sizes, some of which sagged at the center and had a dark brown crust. A histopathological analysis revealed typical perforations of the collagen fibers. The patient was initially treated with topical corticosteroids and oral antihistamines for skin lesions and pruritus. Medications for glucose control were also administered. Upon the second admission, a combination of antibiotics and acitretin was added. The keratin plug shrank, and the pruritus was relieved. To date, to the best of our knowledge, this is the first reported case of concurrent ARPC and MRSA.
Collapse
Affiliation(s)
- Fuqian Huang
- Department of Dermatology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Weiqi Ren
- Department of Dermatology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Miaomiao Wang
- Department of Dermatology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Xiufang Li
- Department of Dermatology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Min Pan
- Department of Dermatology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| |
Collapse
|
7
|
Guo L, Zeng YP, Jin HZ. Reactive perforating collagenosis treated with dupilumab: A case report and literature review. Dermatol Ther 2022; 35:e15916. [PMID: 36214259 DOI: 10.1111/dth.15916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Lan Guo
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Yue-Ping Zeng
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Hong-Zhong Jin
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| |
Collapse
|
8
|
Tai A, Prakash S, Lade S, McCormack CJ, Goh MSY. Two cases of acquired perforating dermatosis successfully treated with allopurinol. Australas J Dermatol 2021; 63:121-124. [PMID: 34490893 DOI: 10.1111/ajd.13712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Aswan Tai
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Saurabh Prakash
- Department of Anatomical Pathology, Melbourne Pathology, Melbourne, Victoria, Australia
| | - Stephen Lade
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Christopher J McCormack
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michelle S Y Goh
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
9
|
Bellinato F, Maurelli M, Gisondi P, Girolomoni G. Acquired perforating dermatoses show increased levels of cutaneous advanced glycation end-products. Clin Exp Dermatol 2021; 47:80-85. [PMID: 34260091 DOI: 10.1111/ced.14851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Acquired perforating dermatoses (APDs) are characterized by transepidermal elimination of skin materials. Altered glycation of dermal components may be involved in pathogenesis. AIM To assess whether patients affected by APDs have increased levels of cutaneous advanced glycation end-products (AGEs). METHODS A cross-sectional controlled study involving a total of 109 patients was conducted, enrolling 29 patients consecutively diagnosed with primary APDs [reactive perforating collagenosis (RPC), elastosis perforans serpiginosa (EPS), perforating folliculitis (PF) and Kyrle disease (KD)], 40 age- and sex-matched healthy controls (HCs) and 40 patients with mild atopic dermatitis (AD). The levels of cutaneous AGEs were measured using a validated fluorescence technique. RESULTS The median skin autofluorescence value in patients with APDs was significantly higher [2.7 arbitrary units (AU), interquartile range (IQR) 1.9-3.9 AU] compared with HCs (1.8 AU, IQR 1.6-2.3 AU; P < 0.001) and patients with AD (2.1 AU, IQR 1.9-2.3 AU; P = 0.01). Median values were 3.5 AU (IQR 2.7-4.6 AU) for RPC, 1.83.5 AU (1.4-2.4 AU) for EPS, 3.1 AU (2.4-4.4 AU) for PF and 2.6 AU (2.3-3.1 AU) for KD. CONCLUSIONS Our results may suggest a possible physiopathological role of AGEs in the transepidermal elimination mechanisms involved in certain APDs.
Collapse
Affiliation(s)
- F Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - M Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - P Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - G Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| |
Collapse
|
10
|
Ye B, Cao Y, Liu Y. Successful treatment of acquired reactive perforating collagenosis with itraconazole. Eur J Med Res 2021; 26:74. [PMID: 34256825 PMCID: PMC8276408 DOI: 10.1186/s40001-021-00542-6] [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: 05/01/2021] [Accepted: 06/30/2021] [Indexed: 11/22/2022] Open
Abstract
Background Acquired reactive perforating collagenosis (ARPC) is a rare form of transepithelial elimination in which altered collagen is extruded through the epidermis. Case presentation A 23-year-old male presented with cup-like ulcerated lesions on his limbs since 3 months. A series of serological and immunological tests showed no abnormalities. A diagnosis of ARPC was based on skin biopsy findings. The patient was cured using treatment with itraconazole for 8 weeks, in the absence of a fungal infection. Conclusions The anti-inflammatory and anti-angiogenic effects of itraconazole can have good therapeutic benefits for ARPC.
Collapse
Affiliation(s)
- Binrong Ye
- Zhejiang Chinese Medical University, No. 548, Binwen Road, Binjiang district, Hangzhou, 310053, Zhejiang, China.,Dermatology, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, No.18 Yang Su Road, Suzhou, 215009, Jiangsu, China
| | - Yi Cao
- Zhejiang Chinese Medical University, No. 548, Binwen Road, Binjiang district, Hangzhou, 310053, Zhejiang, China.
| | - Yeqiang Liu
- Dermatopathology, Shanghai Skin Disease Hospital, No. 1278 Baode Road, Zhabei District, Shanghai, 200443, China
| |
Collapse
|
11
|
Jiang X, Song TT, Hao F. Erlotinib-induced reactive perforating collagenosis in a case of lung adenocarcinoma. Indian J Dermatol Venereol Leprol 2021; 87:548-551. [PMID: 34219432 DOI: 10.25259/ijdvl_288_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 11/01/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Xia Jiang
- Dermatology and Plastic Surgery Center, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
| | - Ting-Ting Song
- Dermatology and Plastic Surgery Center, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
| | - Fei Hao
- Dermatology and Plastic Surgery Center, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
| |
Collapse
|
12
|
|
13
|
Khan S, Khachemoune A. Tender nodules on the foot and buttock. JAAPA 2021; 34:55-56. [PMID: 33600113 DOI: 10.1097/01.jaa.0000733280.28389.c1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Samiya Khan
- Samiya Khan is a student in the Long School of Medicine at the University of Texas Health Science Center at San Antonio. Amor Khachemoune is on the faculty at SUNY Downstate Medical Center and practices at the Veterans Affairs Medical Center, both in Brooklyn, N.Y. The authors have disclosed no potential conflicts of interest, financial or otherwise
| | | |
Collapse
|
14
|
Eljazouly M, Alj M, Chahboun F, Chahdi H, Chiheb S. Acquired Reactive Perforating Collagenosis: A Case Report. Cureus 2021; 13:e13583. [PMID: 33796426 PMCID: PMC8006497 DOI: 10.7759/cureus.13583] [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: 11/21/2022] Open
Abstract
Reactive perforating collagenosis (RPC) is a rare form of dermatosis. It forms with perforating folliculitis, Kyrle's disease, and serpiginous perforating elastosis, which is a group of perforating dermatosis. RPC can be hereditary with autosomal dominant transmission or it can be acquired, which is usually observed in diabetics with chronic renal failure. Here we report a new observation in a 72-year-old woman treated by phototherapy with a favorable outcome
Collapse
Affiliation(s)
- Madiha Eljazouly
- Dermatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Maha Alj
- Dermatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Fatimazahra Chahboun
- Dermatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Hafsa Chahdi
- Pathology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR.,Pathology, Military Hospital Mohammed V, Rabat, MAR
| | - Soumiya Chiheb
- Dermatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR.,Dermatology, Ibn Rochd University Hospital, Casablanca, MAR
| |
Collapse
|
15
|
Ramos-Cavazos CJ, Gómez-Flores M, Suárez-Sánchez KP, Ocampo-Candiani J, Herz-Ruelas ME. UVBNB phototherapy, a valuable tool for treating acquired perforating collagenosis: Case report and review of published cases. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 37:168-170. [PMID: 33217064 DOI: 10.1111/phpp.12627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Cesar Jair Ramos-Cavazos
- Dermatology Department, University Hospital "Dr. José Eleuterio González", U.A.N.L., Monterrey, México
| | - Minerva Gómez-Flores
- Dermatology Department, University Hospital "Dr. José Eleuterio González", U.A.N.L., Monterrey, México
| | | | - Jorge Ocampo-Candiani
- Dermatology Department, University Hospital "Dr. José Eleuterio González", U.A.N.L., Monterrey, México
| | | |
Collapse
|
16
|
Singhania N, Singhania G, Al-Rabadi L. Acquired Reactive Perforating Collagenosis. Clin Exp Nephrol 2020; 24:1086-1087. [DOI: 10.1007/s10157-020-01929-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
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.
Collapse
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.
| | | |
Collapse
|
19
|
Ding H, Wang X. Reflectance confocal microscopic appearance of acquired reactive perforating collagenosis. Skin Res Technol 2020; 27:111-112. [PMID: 32596869 DOI: 10.1111/srt.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/04/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Hui Ding
- Department of Cosmetic Laser Surgery, Hospital for Skin Disease and Institute of Dermatology, Peking Union Medical College & Chinese Academy of Medical Sciences, Nanjing, China
| | - Xiaopo Wang
- Department of Pathology, Hospital for Skin Disease and Institute of Dermatology, Peking Union Medical College & Chinese Academy of Medical Sciences, Nanjing, China
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Bartling SJ, Naff JL, Canevari MM, Fink CM. Pruritic Rash in an Elderly Patient with Uncontrolled Diabetes Mellitus. AACE Clin Case Rep 2019; 5:e146-e149. [DOI: 10.4158/accr-2018-0388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/08/2018] [Indexed: 11/15/2022] Open
|
24
|
Kanra AY, Ari Yaylali S, Karadag AS, Ardagil Akçakaya A, Zemheri IE. Acquired perforating collagenosis associated with ranibizumab injection and succesfully switched to aflibercept. GMS OPHTHALMOLOGY CASES 2019; 8:Doc06. [PMID: 30607312 PMCID: PMC6308902 DOI: 10.3205/oc000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: To report a case of acquired reactive perforating collagenosis (ARPC) triggered by an intravitreal ranibizumab injection that was successfully treated by switching to aflibercept (AFL). Methods: A 73-year-old Caucasian man with an occult choroidal neovascular membrane in the right eye received three-monthly intravitreal ranibizumab injections. Two weeks after the second ranibizumab injection, he complained about a generalized, excessively pruriginous eruption that was further exacerbated by the third injection. On the basis of clinical and histological findings, he was diagnosed with ARPC and treated with narrow band ultraviolet-B (NBUVB) phototherapy. Results: He was subsequently switched to intravitreal AFL injections administered according to a pro re nata regimen. Following NBUVB phototherapy, three additional AFL injections were required. Still, the reactive perforating collagenosis was in remission and the choroidal neovascular membrane was inactive. Conclusions: Our case is the first report of ARPC after ranibizumab injections. Both the skin lesions and the choroidal neovascular membrane were successfully treated after switching to AFL.
Collapse
Affiliation(s)
- Ayse Yagmur Kanra
- Istanbul Sultanbeyli World Eye Hospital, Department of Ophthalmology, Sultanbeyli/Istanbul, Turkey
| | - Sevil Ari Yaylali
- Istanbul Medeniyet University Göztepe, Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Ayse Serap Karadag
- Istanbul Medeniyet University Göztepe, Training and Research Hospital, Department of Dermatology, Istanbul, Turkey
| | - Aylin Ardagil Akçakaya
- Istanbul Medeniyet University Göztepe, Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Itir Ebru Zemheri
- Istanbul Sağlık Bilimleri University Ümraniye Training and Research Hospital, Department of Pathology, Istanbul, Turkey
| |
Collapse
|
25
|
Parodi A, Castello M, Corbetta S, Cordera R, Cristaudo A, Cucchia R, Guazzoni V, Leuzzi M, Mussini A, Patrizi A, Pigatto P, Regazzini R, Rizzo D, Stingeni L, Zichichi L. Skin and diabetes: an experts' opinion from the Italian diabetologists and dermatologists of the DiaDex group. GIORN ITAL DERMAT V 2018; 153:649-658. [DOI: 10.23736/s0392-0488.18.06080-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
26
|
Seale L, Schneider SL, Pritchett EN. Diffuse pruritic papules. JAAD Case Rep 2018; 4:749-751. [PMID: 30225332 PMCID: PMC6138850 DOI: 10.1016/j.jdcr.2018.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lauren Seale
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Ellen N. Pritchett
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
- Correspondence to: Ellen N. Pritchett, MD, MPH, Henry Ford Hospital System, Department of Dermatology, 3031 W Grand Boulevard, Suite 800, Detroit, Michigan 48202.
| |
Collapse
|
27
|
Lukács J, Schliemann S, Elsner P. Behandlung der erworbenen reaktiven perforierenden Dermatose - eine systematische Übersicht. J Dtsch Dermatol Ges 2018; 16:825-844. [DOI: 10.1111/ddg.13561_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/17/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Judit Lukács
- Klinik für Hautkrankheiten; Universitätsklinikum Jena; Erfurter Straße 35; D-07743 Jena Deutschland
| | - Sibylle Schliemann
- Klinik für Hautkrankheiten; Universitätsklinikum Jena; Erfurter Straße 35; D-07743 Jena Deutschland
| | - Peter Elsner
- Klinik für Hautkrankheiten; Universitätsklinikum Jena; Erfurter Straße 35; D-07743 Jena Deutschland
| |
Collapse
|
28
|
Lukács J, Schliemann S, Elsner P. Treatment of acquired reactive perforating dermatosis - a systematic review. J Dtsch Dermatol Ges 2018; 16:825-842. [DOI: 10.1111/ddg.13561] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/17/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Judit Lukács
- Department of Dermatology; University Hospital Jena; Erfurter Strasse 35 D-07743 Jena Germany
| | - Sibylle Schliemann
- Department of Dermatology; University Hospital Jena; Erfurter Strasse 35 D-07743 Jena Germany
| | - Peter Elsner
- Department of Dermatology; University Hospital Jena; Erfurter Strasse 35 D-07743 Jena Germany
| |
Collapse
|
29
|
Kosumi H, Iwata H, Tsujiwaki M, Shimizu H. Diagnosis at a Glance: Acquired Perforating Dermatosis. Diabetes Care 2018; 41:911-912. [PMID: 29559455 DOI: 10.2337/dc17-2572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/05/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Hideyuki Kosumi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroaki Iwata
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masumi Tsujiwaki
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Shimizu
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| |
Collapse
|
30
|
Reid J, Almond L, Matthewman N, Stringer H, Francis N, Al Abadie M. A case of acquired reactive perforating collagenosis. Australas J Dermatol 2017. [PMID: 28636209 DOI: 10.1111/ajd.12618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jeremy Reid
- School of Medicine, University of Birmingham, Birmingham, UK
| | - Lorna Almond
- School of Medicine, University of Birmingham, Birmingham, UK
| | | | - Howard Stringer
- School of Medicine, University of Birmingham, Birmingham, UK
| | | | | |
Collapse
|
31
|
García-Malinis AJ, Del Valle Sánchez E, Sánchez-Salas MP, Del Prado E, Coscojuela C, Gilaberte Y. Acquired perforating dermatosis: clinicopathological study of 31 cases, emphasizing pathogenesis and treatment. J Eur Acad Dermatol Venereol 2017; 31:1757-1763. [PMID: 28300323 DOI: 10.1111/jdv.14220] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 02/21/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Acquired perforating dermatosis (APD) is a rare group of skin disorders of unknown aetiology and pathogenesis and is associated with several systemic diseases. OBJECTIVE We review the clinicopathological features, associated systemic diseases and treatment response in a series of APD patients. METHODS We conducted a retrospective observational study of all patients histologically diagnosed with APD in Hospital San Jorge (Huesca, Spain) between 2002 and 2014. Demographic and clinical features were collected from medical records. Statistical analyses were carried out using SPSS software (version 20.0; IBM Corp, Armonk, NY, USA). RESULTS The study population consisted of 31 patients (19 women and 12 men), with a mean age of 54 years. Reactive perforating collagenosis (n = 15, 45%) was the most common histopathologic type. The most frequently affected area was the lower limbs (66.6%, n = 22), and pruritus was present in 19 patients (61.3%, P = 0.005). Arterial hypertension (30.3%) was the most common associated condition. Five patients were receiving treatment with infliximab when diagnosed with APD. Most patients responded to topical steroids and oral antihistamines (n = 15). LIMITATIONS This study is retrospective, and the sample size is limited. CONCLUSION Acquired perforating dermatosis is an underdiagnosed dermatosis frequently associated with systemic disorders. Its pathogenesis may involve vascular damage, not only in patients with diabetes, but also in those with arterial hypertension and chronic venous insufficiency. Control of pruritus and underlying extracutaneous disorders, as well as discontinuation of the treatment with biologics, are important aspects of the management of this dermatosis.
Collapse
Affiliation(s)
| | | | | | - E Del Prado
- Unit of Dermatology, Hospital San Jorge, Huesca, Spain
| | - C Coscojuela
- Unit of Dermatology, Hospital San Jorge, Huesca, Spain
| | - Y Gilaberte
- Unit of Dermatology, Hospital San Jorge, Huesca, Spain
| |
Collapse
|
32
|
Ikeda T, Mikita N, Furukawa F, Iwahashi Y. A case of rheumatoid vasculitis with acquired reactive perforating collagenosis. Mod Rheumatol 2016; 29:547-550. [DOI: 10.1080/14397595.2016.1245175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Takaharu Ikeda
- Department of Dermatology, Wakayama Medical University Graduate School of Medicine, Wakayama, Japan and
| | - Naoya Mikita
- Department of Dermatology, Wakayama Medical University Graduate School of Medicine, Wakayama, Japan and
| | - Fukumi Furukawa
- Department of Dermatology, Wakayama Medical University Graduate School of Medicine, Wakayama, Japan and
| | - Yoshifumi Iwahashi
- Department of Human Pathology, Wakayama Medical University Graduate School of Medicine, Wakayama, Japan
| |
Collapse
|
33
|
Matsuzaki Y, Yokoyama S, Rokunohe A, Minakawa S, Nakano H, Sawamura D. Successful treatment of Kyrle disease with narrowband ultraviolet B. J Dermatol 2016; 44:721-722. [PMID: 27451031 DOI: 10.1111/1346-8138.13525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Yasushi Matsuzaki
- Department of Dermatology, Hirosaki University School of Medicine, Aomori, Japan
| | - Shohei Yokoyama
- Department of Dermatology, Aomori National Hospital, Aomori, Japan
| | - Akiko Rokunohe
- Department of Dermatology, Hirosaki University School of Medicine, Aomori, Japan
| | - Satoko Minakawa
- Department of Dermatology, Hirosaki University School of Medicine, Aomori, Japan
| | - Hajime Nakano
- Department of Dermatology, Hirosaki University School of Medicine, Aomori, Japan
| | - Daisuke Sawamura
- Department of Dermatology, Hirosaki University School of Medicine, Aomori, Japan
| |
Collapse
|
34
|
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.
Collapse
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: )
| |
Collapse
|
35
|
Ohashi T, Yamamoto T. Acquired reactive perforating collagenosis associated with systemic lupus erythematosus. J Dermatol 2016; 43:1097-9. [PMID: 27028318 DOI: 10.1111/1346-8138.13357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Takenobu Ohashi
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| |
Collapse
|
36
|
Pascoe VL, Fenves AZ, Wofford J, Jackson JM, Menter A, Kimball AB. The spectrum of nephrocutaneous diseases and associations. J Am Acad Dermatol 2016; 74:247-70; quiz 271-2. [DOI: 10.1016/j.jaad.2015.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/26/2015] [Accepted: 05/26/2015] [Indexed: 12/31/2022]
|
37
|
Giant acquired reactive perforating collagenosis in a patient with diabetes mellitus and metastatic breast carcinoma. JAAD Case Rep 2016; 2:22-4. [PMID: 27051818 PMCID: PMC4809472 DOI: 10.1016/j.jdcr.2015.11.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
38
|
Kittisak P, Tanaka M. Dermoscopic findings in a case of reactive perforating collagenosis. Dermatol Pract Concept 2015; 5:75-7. [PMID: 26114057 PMCID: PMC4462904 DOI: 10.5826/dpc.0502a13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/04/2015] [Indexed: 10/31/2022] Open
Affiliation(s)
- Payapvipapong Kittisak
- Division of Dermatology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Masaru Tanaka
- Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| |
Collapse
|
39
|
Ataseven A, Kayacetin S. Acquired reactive perforating collagenosis. Eurasian J Med 2015; 44:51-3. [PMID: 25610206 DOI: 10.5152/eajm.2012.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 11/24/2011] [Indexed: 11/22/2022] Open
Abstract
Acquired reactive perforating collagenosis (ARPC) is commonly recognized as an unusual skin reaction to superficial trauma that is observed in patients with a certain genetic predisposition or underlying diseases, such as diabetes mellitus or renal diseases. We present the unusual case of a 55-year-old female diabetic patient with numerous characteristic dome-shaped nodules, which consisted of central umbilication containing firm keratotic plugs.
Collapse
Affiliation(s)
- Arzu Ataseven
- Department of Dermatology, Konya Education and Research Hospital, Konya, Turkey
| | - Serra Kayacetin
- Department of Pathology, Konya Education and Research Hospital, Konya, Turkey
| |
Collapse
|
40
|
Haseer Koya H, Ananthan D, Varghese D, Njeru M, Curtiss C, Khanna A. Acquired reactive perforating dermatosis: a rare skin manifestation in end stage renal disease. Nephrology (Carlton) 2014; 19:515-6. [PMID: 25066144 DOI: 10.1111/nep.12289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2014] [Indexed: 11/28/2022]
|
41
|
El-Khalawany M, Saudi W, Kamel A, Fawzy S, Hassan H. Pseudoperforation: an uncommon histologic phenomenon in prurigo misleading for the diagnosis of reactive perforating collagenosis. Pathol Res Pract 2014; 210:1043-8. [PMID: 25042386 DOI: 10.1016/j.prp.2014.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 05/19/2014] [Accepted: 06/19/2014] [Indexed: 11/17/2022]
Abstract
Prurigo is a common skin condition characterized by vigorous scratching. Although ulceration is not uncommon in prurigo, a perforating-like lesion was not previously reported. In this study we described series of cases of prurigo with perforating-like lesions and discussed its relation to acquired perforating dermatoses. The study included 32 cases, during the period from 2008 to 2013. Clinical data and histological features were recorded and analyzed. The study included 78.1% males and 21.9% females with a mean age of 39.3 ± 5.61 years. History of insect bite was evident in 28.1%, hepatitis C virus infection in 46.9%, and diabetes mellitus in 9.4% of patients. Histologically, well developed lesions showed full thickness epidermal degeneration overlay by a cup-shaped crater. The contents of the crater included collagen and elastic fibers, bacterial colonies, inflammatory cells and necrotic keratin. The dermis showed non-altered collagen, increased vascularity and mixed inflammatory infiltrate. We believe that this pseudoperforation process is a secondary response to vigorous scratching in prurigo patients and not a primary mechanism as occurred in perforating dermatoses. The absence of altered collagen, the presence of full thickness epidermal necrosis and concomitant elimination of elastic fibers are significant histologic clues for differentiation between both conditions.
Collapse
Affiliation(s)
| | - Wael Saudi
- Department of Dermatology, Misr University for Science & Technology (MUST), Cairo, Egypt
| | - Abeer Kamel
- Department of Dermatology, Al-Azhar University, Cairo, Egypt
| | - Sameh Fawzy
- Department of Dermatology, Al-Azhar University, Cairo, Egypt
| | - Hatem Hassan
- Department of Dermatology, Al-Azhar University, Dumyat, Egypt
| |
Collapse
|
42
|
Tilz H, Becker JC, Legat F, Schettini APM, Inzinger M, Massone C. Allopurinol in the treatment of acquired reactive perforating collagenosis. An Bras Dermatol 2013; 88:94-7. [PMID: 23539010 PMCID: PMC3699945 DOI: 10.1590/s0365-05962013000100012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Accepted: 04/08/2012] [Indexed: 11/22/2022] Open
Abstract
Acquired reactive perforating collagenosis is a perforating dermatosis usually associated with different systemic diseases, mainly diabetes mellitus and/or chronic renal insufficiency. Different therapies have been tried but treatment is not standardized yet and remains a challenge. In the last few years, allopurinol has been reported as a good therapeutic option for acquired reactive perforating collagenosis. We describe the case of a 73-year-old man affected by acquired reactive perforating collagenosis associated with diabetes type 1 and chronic renal failure with secondary hyperparathyroidism. The patient was successfully treated with allopurinol 100mg once/day p.o..
Collapse
Affiliation(s)
- Hemma Tilz
- Department of Dermatology, Division of General Dermatology, Medical University of Graz, Graz, Austria
| | | | | | | | | | | |
Collapse
|
43
|
Murphy-Chutorian B, Han G, Cohen SR. Dermatologic manifestations of diabetes mellitus: a review. Endocrinol Metab Clin North Am 2013; 42:869-98. [PMID: 24286954 DOI: 10.1016/j.ecl.2013.07.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Diabetes mellitus affects every organ of the body including the skin. Certain skin manifestations of diabetes are considered cutaneous markers of the disease, whereas others are nonspecific conditions that occur more frequently among individuals with diabetes compared with the general population. Diabetic patients have an increased susceptibility to some bacterial and fungal skin infections, which account, in part, for poor healing. Skin complications of diabetes provide clues to current and past metabolic status. Recognition of cutaneous markers may slow disease progression and ultimately improve the overall prognosis by enabling earlier diagnosis and treatment.
Collapse
|
44
|
Abstract
A broad range of skin diseases occurs in patients with ESRD: from the benign and asymptomatic to the physically disabling and life-threatening. Many of them negatively impact on quality of life. Their early recognition and treatment are essential in reducing morbidity and mortality. The cutaneous manifestations can be divided into two main categories: nonspecific and specific. The nonspecific manifestations are commonly seen and include skin color changes, xerosis, half-and-half nails, and pruritus. The specific disorders include acquired perforating dermatosis, bullous dermatoses, metastatic calcification, and nephrogenic systemic fibrosis. This review article describes these conditions and considers the underlying pathophysiology, clinical presentations, diagnosis, and treatment options.
Collapse
Affiliation(s)
- Timur A Galperin
- Department of Dermatology, St. Louis University, St. Louis, Missouri;, †Medical Research Council Centre for Transplantation and National Institute for Health Research Biomedical Research Centre, King's College, London, United Kingdom, ‡Department of Dermatology, University of California, San Francisco, California
| | | | | |
Collapse
|
45
|
Wagner G, Sachse MM. Acquired reactive perforating dermatosis. J Dtsch Dermatol Ges 2013; 11:723-9, 723-30. [PMID: 23718268 DOI: 10.1111/ddg.12131] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 04/16/2013] [Indexed: 11/27/2022]
Abstract
Acquired reactive perforating dermatosis is characterized by umbilicated erythematous papules and plaques with firmly adherent crusts. Histopathological examination shows a typical cup-shaped ulceration in the epidermis containing cellular debris and collagen. There is transepidermal elimination of degenerated material with basophilic collagen bundles. The etiology and pathogenesis of acquired reactive perforating dermatosis are unclear. Metabolic disorders and malignancies are associated with this dermatosis. Associated pruritus is regarded as a key pathogenic factor. Constant scratching may cause a repetitive trauma to the skin. This pathogenesis may involve a genetic predisposition. The trauma may lead to degeneration of the collagen bundles. Treatment of acquired reactive perforating dermatosis follows a multimodal approach. Apart from the treating any underlying disease, treatment of pruritus is a major goal. Systemic steroids and retinoids, as well as UVB phototherapy are well-established treatment options. Some patients may also benefit from oral allopurinol.
Collapse
Affiliation(s)
- Gunnar Wagner
- Department of Dermatology, Allergology, and Phlebology, Bremerhaven Reinkenheide Hospital, Germany.
| | | |
Collapse
|
46
|
Yong A, Chong WS, Tey HL. Effective treatment of uremic pruritus and acquired perforating dermatosis with amitriptyline. Australas J Dermatol 2013; 55:e54-7. [DOI: 10.1111/ajd.12026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 12/11/2012] [Indexed: 11/29/2022]
|
47
|
Markova A, Lester J, Wang J, Robinson-Bostom L. Diagnosis of common dermopathies in dialysis patients: a review and update. Semin Dial 2013; 25:408-18. [PMID: 22809004 DOI: 10.1111/j.1525-139x.2012.01109.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cutaneous abnormalities in patients with end-stage renal disease (ESRD) receiving hemodialysis or peritoneal dialysis may demonstrate signs of their underlying condition or reveal associated disease entities. While a thorough examination of the scalp, skin, mucosa, and nails is integral to establishing a diagnosis, certain conditions will resolve only with dialysis or improvement of their renal disease and others may not require or respond to treatment. Half and half nails, pruritus, xerosis, and cutaneous hyperpigmentation are common manifestations in ESRD. With hemodialysis, uremic frost is no longer prevalent in ESRD patients and ecchymoses have decreased in incidence. Acquired perforating dermatoses are seen in over one-tenth of hemodialysis patients. Metastatic calcinosis cutis and calciphylaxis are both rarely reported, although the latter is seen almost exclusively in the setting of hemodialysis. Diagnosis of nephrogenic systemic fibrosis has historically been challenging; as such, new diagnostic criteria have been proposed. Blood porphyrin profiles are needed to differentiate between porphyria cutanea tarda and pseudoporphyria. We will review and provide an update on the aforementioned common cutaneous manifestations of ESRD in patients receiving dialysis.
Collapse
Affiliation(s)
- Alina Markova
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA
| | | | | | | |
Collapse
|
48
|
Abstract
With the rising incidence of diabetes mellitus (DM) in the US, it is of paramount importance that practitioners understand the complications of DM and how best to manage them. Diabetes affects every organ system and the skin is no exception. There are numerous cutaneous manifestations of DM that have similar etiologies and result from the same pathologic mechanisms as the internal complications of this disease state. In addition, skin manifestations may precede the diagnosis of diabetes. The present article reviews both the common and less common cutaneous manifestations of DM, including presenting lesions, pathogenesis, and management.
Collapse
Affiliation(s)
- Lauren Levy
- Mt Sinai Medical Center, New York, New York 10029, USA
| | | |
Collapse
|
49
|
Abstract
Diabetes mellitus is the most common endocrine disorder with continuously increasing prevalence. Blood vessels, nerves, eyes, kidneys and skin are affected, which causes both an enormous financial burden and a reduced quality of life of the affected patients. Long-standing diabetes may impair skin homeostasis resulting in skin manifestations in at least one third of all diabetics. The skin involvement may be the first presenting sign of diabetes, thus the respective skin signs should lead to diabetes focused diagnostic. Besides, the skin signs may be considered as a marker for the course of the disease or for the success of therapeutic interventions.
Collapse
Affiliation(s)
- B Behm
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | | | | | | |
Collapse
|
50
|
Scola N, Gambichler T, Altmeyer P, Stücker M, Kreuter A. [Acquired reactive perforating collagenosis following herpes zoster as isotopic response?]. Hautarzt 2011; 62:683-7. [PMID: 21732160 DOI: 10.1007/s00105-011-2202-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Reactive perforating collagenosis is a disease whose pathogenesis is still not fully understood. Histological findings are degenerated collagen bundles which are arranged in vertical direction penetrating the epidermis into a dome-shaped crater. Usually diabetes mellitus and renal failure can be found among patients with reactive perforating collagenosis. To date, there have been five cases described where the eruption of reactive perforating collagenosis followed herpes zoster infection. This could be a form of Wolf's isotopic response, a term that is used for dermatoses which arise after the healing of a preexisting dermatosis. We report the sixth case of a herpes zoster-associated reactive perforating collagenosis and discuss the current literature.
Collapse
Affiliation(s)
- N Scola
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Deutschland.
| | | | | | | | | |
Collapse
|