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Ding W, Wang Y, Song L, Zhou N. A potential new treatment with upadacitinib for acquired reactive perforating collagenosis. JAAD Case Rep 2024; 48:112-114. [PMID: 38813063 PMCID: PMC11134568 DOI: 10.1016/j.jdcr.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Affiliation(s)
- Wei Ding
- Department of Dermatology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Yuting Wang
- Department of Dermatology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Linyi Song
- Department of Dermatology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Naihui Zhou
- Department of Dermatology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
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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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Alhadlg M, Alhammad G, Madani A. Acquired perforating dermatosis associated with risankizumab. JAAD Case Rep 2024; 45:88-90. [PMID: 38434600 PMCID: PMC10907506 DOI: 10.1016/j.jdcr.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Affiliation(s)
- Munira Alhadlg
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ghadah Alhammad
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Madani
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Lungu A, Hsieh A, Kaya G, Menzinger S. Perforating Fibrous Histiocytoma Mimicking Keratoacanthoma: A Case Report. Dermatopathology (Basel) 2023; 11:8-12. [PMID: 38247724 PMCID: PMC10801575 DOI: 10.3390/dermatopathology11010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/24/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
A 31-year-old male presented with a firm, well-demarcated, erythematous, crateriform, and ulcerated nodule in the left lumbar region, which persisted for 3 months. Clinically, a keratoacanthoma was suspected. The histological analysis was consistent with perforating fibrous histiocytoma, a rare histopathologic variant of fibrous histiocytoma. To our knowledge, this is the third case reported in the literature.
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Affiliation(s)
- Alina Lungu
- Department of Clinical Pathology, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland; (G.K.); (S.M.)
| | - Aurélie Hsieh
- Department of Dermatology and Venereology, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland;
| | - Gürkan Kaya
- Department of Clinical Pathology, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland; (G.K.); (S.M.)
- Department of Dermatology and Venereology, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland;
| | - Sébastien Menzinger
- Department of Clinical Pathology, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland; (G.K.); (S.M.)
- Department of Dermatology and Venereology, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland;
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5
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Marinelli LM, Arballo OM, Guerrero G, Wohltmann WE. Perforating Calcinosis Cutis as a Complication of Intraosseous Fluid Infusion in the Setting of a Near-Drowning Event. Mil Med 2023; 188:e3703-e3706. [PMID: 36461682 DOI: 10.1093/milmed/usac385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/03/2022] [Accepted: 11/17/2022] [Indexed: 11/09/2023] Open
Abstract
Iatrogenic calcinosis cutis represents a subset of calcinosis cutis resulting secondary to treatments or procedures. We present the first report of calcinosis cutis resulting from the intraosseous infusion and one of a few cases with associated transepidermal elimination. A previously healthy 2-year-old female presented with a new-onset unilateral shin rash 1 week following hospitalization for a near-drowning event. A dermatologic exam revealed multiple small, tender, firm, chalky-white papules with surrounding erythema, in addition to two erythematous macules superior and medial to the papular lesions, corresponding to prior intraosseous access sites. The rash persisted despite trials of topical mupirocin and acyclovir cream, prompting a referral to a dermatologist. An excisional biopsy was performed, revealing circumscribed dermal deposits of acellular basophilic material connected to the overlying epidermis through an invaginated keratin plug. A von Kossa silver stain highlighted the deposits, confirming the diagnosis of perforating calcinosis cutis. The lesions did not recur following the excisional biopsy. Iatrogenic calcinosis cutis may be seen as a complication of the infusion of calcium-containing fluids via intraosseous access, in addition to the more commonly observed peripheral intravenous access. Awareness of this disorder is important in order to distinguish it from an infectious mimic and guide the selection of therapy.
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Affiliation(s)
- Lisa M Marinelli
- Department of Pathology and Area Laboratory Service, Brooke Army Medical Center, Ft Sam Houston, TX 78234, USA
| | - Olivia M Arballo
- Department of Dermatology, Blanchfield Army Community Hospital, Fort Campbell, KY 42223, USA
| | - Giselle Guerrero
- Department of Internal Medicine, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Wendi E Wohltmann
- Departments of Dermatology and Pathology, Brooke Army Medical Center, Ft Sam Houston, TX 78234, USA
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6
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Gao Z, Lu S, Shan S. Acquired perforating dermatosis: A clinicopathologic study, and the features of dermoscopy and reflective confocal microscopy of 37 cases. Skin Res Technol 2023; 29:e13416. [PMID: 37522501 PMCID: PMC10351033 DOI: 10.1111/srt.13416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Acquired perforating dermatosis (APD) is a rare skin condition characterized by degenerated materials eliminated from the dermis. Several retrospective studies on APD have been reported; however, few data are available on Chinese APD and their features on dermoscopy and reflective confocal microscope (RCM) assays. OBJECTIVE The aim of this study was to retrospectively evaluate the clinical and histopathologic data of 37 acquired perforating dermatosis cases, and assess their features on dermoscopy and RCM. METHODS Thirty-seven APD patients were retrospectively enrolled in our study. We characterized the clinical histopathological features, concomitant diseases, treatment responses, and the dermoscopy and RCM findings. RESULTS Pruritus was the most common symptom, with the lower extremities as the most predilection sites (86.5%, n = 32; 91.9%, n = 34, respectively). Concomitant diseases were found in 34 patients (92.6%), among which diabetes mellitus was the most common, followed by thyroid nodules, allergic dermatosis, and chronic renal insufficiency. Dermoscopy and RCM assays were performed in 11 patients. The typical RCM images were hyperreflective cord-like structures from the epidermis to dermis. Dermoscopy features of fully developed lesions showed central ulceration with peripheral hairpin-like or loop-like capillaries with characteristic garland arrangements. CONCLUSION APD is an uncommon skin disorder associated with various systemic conditions in Chinese individuals. Thyroid disorders are an overlooked complication and may play an important role in the development of APD. The results of this study indicate that noninvasive dermoscopy and RCM examination are helpful in the rapid diagnosis and early intervention of APD.
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Affiliation(s)
- Zhe Gao
- Department of DermatologyHangzhou Third People's HospitalHangzhouChina
| | - Si‐Jia Lu
- Department of PathologyHangzhou Third People's HospitalHangzhouChina
| | - Shi‐Jun Shan
- Department of DermatologyHangzhou Third People's HospitalHangzhouChina
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7
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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.
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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
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8
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Schremser V, Tittes J, Tanew A, Radakovic S. Sustained clearance of acquired perforating dermatosis after narrowband UVB phototherapy: A retrospective cohort study on seven patients. J Eur Acad Dermatol Venereol 2023; 37:e747-e748. [PMID: 36683565 DOI: 10.1111/jdv.18904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023]
Affiliation(s)
- Verena Schremser
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Julia Tittes
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Sonja Radakovic
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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9
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Oka M. Localized Bullous Pemphigoid in a Patient with Acquired Reactive Perforating Collagenosis. Case Rep Dermatol 2023; 15:1-4. [PMID: 36619702 PMCID: PMC9818675 DOI: 10.1159/000528140] [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: 09/13/2022] [Accepted: 11/09/2022] [Indexed: 01/07/2023] Open
Abstract
A 61-year-old man presented with 6-month and 5-day histories of multiple, pruritic nodular eruptions on the trunk and extremities and bullous eruptions on the left foot, respectively. The nodular eruptions had been treated with topical corticosteroids without improvement. He had been diagnosed with diabetes mellitus at the age of 42 years and had been suffering from end-stage renal disease for 1 year. Physical examination revealed scattered violet-brown papules and nodules on the trunk and extremities, many of which had central umbilicated necrosis or keratin plugs. Additionally, two tense bullae and five erosions were noted on the dorsal aspect of the left foot. Laboratory tests showed elevated levels of serum anti-bullous pemphigoid (BP)180 antibody. Histopathological findings of a nodule and a bulla were compatible with those of acquired reactive perforating collagenosis (ARPC) and BP, respectively. The papular and nodular lesions were diagnosed as ARPC, while bullous and erosive lesions were diagnosed as localized BP. The present case, together with previously reported cases of coexisting generalized BP and ARPC, suggests that coexistence of BP, regardless of whether generalized or localized, is significantly associated with ARPC.
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Affiliation(s)
- Masahiro Oka
- Department of Dermatology, Kita-Harima Medical Center, Ono City, Japan
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10
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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.
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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
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11
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Sutedja EK, Widjaya MRH, Dharmadji HP, Achdiat PA, Tsaqilah L. Coexistent Lichen Amyloidosis and Acquired Reactive Perforating Collagenosis in Type 2 Diabetes Mellitus and Post-Thyroidectomy Hypothyroidism Due to Papillary Thyroid Carcinoma: A Rare Case. Int Med Case Rep J 2022; 15:745-752. [PMID: 36573223 PMCID: PMC9789704 DOI: 10.2147/imcrj.s391199] [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: 09/29/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
An abundance of endocrine receptors is expressed on the skin and becomes the target of many hormones. This was associated with various skin diseases that might occur in some endocrine diseases eg, lichen amyloidosis (LA) and acquired reactive perforating collagenosis (ARPC). Here, we report a coexistent LA and ARPC in a 55-year-old woman, characterized with multiple pruritic hyperkeratotic papules and plaques on both arms accompanied by pruritic hyperkeratotic papules and nodules on both legs. She had a history of type 2 diabetes mellitus (DM) and post-thyroidectomy hypothyroidism due to papillary thyroid carcinoma. Histopathological examination revealed amyloid deposition in the papillary dermis corresponding with LA and cup-shaped epidermal depression filled with collagen corresponding with ARPC. The hyperkeratotic papules and nodules flattened in one month after application of 0.05% clobetasol propionate ointment with occlusion on both arms and 0.05% retinoic acid gel on both legs. Hyperkeratotic papules, nodules, and plaques in a patient with a history of endocrine diseases, such as type 2 DM and thyroid disorders should undergo histopathological examination to confirm the diagnosis of skin diseases eg, LA or ARPC.
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Affiliation(s)
- Eva Krishna Sutedja
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia,Correspondence: Eva Krishna Sutedja, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel/Fax +62222032426 ext. 3449, Email
| | - Muhamad Radyn Haryadi Widjaya
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Hartati Purbo Dharmadji
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Pati Aji Achdiat
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Laila Tsaqilah
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
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12
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Ghosh SK, Datta M, Das S, Mondal S. Pruritic papules in a boy. Pediatr Dermatol 2022; 39:470-472. [PMID: 35797213 DOI: 10.1111/pde.15024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/23/2022] [Accepted: 04/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Sudip Kumar Ghosh
- Department of Dermatology, Venereology, and Leprosy, R. G. Kar Medical College, Kolkata, West Bengal, India
| | - Madhab Datta
- Department of Dermatology, Venereology, and Leprosy, R. G. Kar Medical College, Kolkata, West Bengal, India
| | - Sisir Das
- Department of Dermatology, Venereology, and Leprosy, R. G. Kar Medical College, Kolkata, West Bengal, India
| | - Satarupa Mondal
- Department of Dermatology, Venereology, and Leprosy, R. G. Kar Medical College, Kolkata, West Bengal, India
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13
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Filho RT, da Costa Pereira Cestari S, Dehó IZ, Tovo RF, Marques GF, Lírio ID, Petaccia de Macedo M. Acquired perforating dermatosis in the setting of hepatocellular carcinoma. JAAD Case Rep 2021; 18:89-93. [PMID: 34877394 PMCID: PMC8627901 DOI: 10.1016/j.jdcr.2021.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Reinaldo Tovo Filho
- Instituto de Ensino e Pesquisa do Hospital Sírio Libanês, São Paulo, Brazil.,Department of Dermatology, Medical School, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Reinaldo Falavigna Tovo
- Faculdade de Medicina da Pontificia Universidade Católica Campus Sorocaba, São Paulo, Brazil
| | | | - Ivana Diniz Lírio
- Instituto de Ensino e Pesquisa do Hospital Sírio Libanês, São Paulo, Brazil
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14
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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.
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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
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16
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Wang W, Liao Y, Fu L, Kan B, Peng X, Lu Y. Dermoscopy Features of Acquired Perforating Dermatosis Among 39 Patients. Front Med (Lausanne) 2021; 8:631642. [PMID: 33898479 PMCID: PMC8060433 DOI: 10.3389/fmed.2021.631642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/10/2021] [Indexed: 11/13/2022] Open
Abstract
In this report, we concluded there are four dermoscopic features of APD including a yellow-brown homogeneous structureless area in the center of the lesion, dotted and linear vessels distribution radially and a dam shape uplift at the periphery, as well as a white irregular ring surrounding the lesion. There are three features, including the yellow-brown homogeneous structureless area in the center of the lesion, the dotted and linear vessels distribution radially and the white irregular ring surrounding the lesion were correspond to the report of Emma Ormerod et al.These features are also similar to those previously discribed in three separated reports of seven cases with APD. In our report, we found a new dermoscopic features: the dam shape uplift at the periphery. These finding may be contributed to improve the rate of clinical diagnosis of APD.
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Affiliation(s)
- Wenju Wang
- Department of Dermatovenereology, Chengdu Second People's Hospital, Chengdu, China
| | - Yansen Liao
- Department of Oncology, Chengdu Second People's Hospital, Chengdu, China
| | - Lixin Fu
- Department of Dermatovenereology, Chengdu Second People's Hospital, Chengdu, China
| | - Bei Kan
- Department of Dermatovenereology, Chengdu Second People's Hospital, Chengdu, China
| | - Xiaodong Peng
- Department of Oncology, Chengdu Second People's Hospital, Chengdu, China
| | - Yonghong Lu
- Department of Dermatovenereology, Chengdu Second People's Hospital, Chengdu, China
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17
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Gontijo JRV, Júnior FF, Pereira LB, Pedrosa MS. Trauma-induced acquired reactive perforating collagenosis. An Bras Dermatol 2021; 96:392-393. [PMID: 33840572 PMCID: PMC8178551 DOI: 10.1016/j.abd.2020.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- João Renato Vianna Gontijo
- Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Dermatology Service, Hospital Mater Dei, Belo Horizonte, MG, Brazil.
| | | | - Luciana Baptista Pereira
- Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Faculty of Medicine, Universidade Federal de Minas, Belo Horizonte, MG, Brazil
| | - Moisés Salgado Pedrosa
- Patology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Uzuncakmak TK, Cebeci Kahraman F, Arslan Z, Gürel MS, Cobanoglu Simsek B. Koebnerization of acquired reactive perforating collagenosis after wet cupping successfully treated with UVA1 phototherapy. Dermatol Ther 2020; 33:e14540. [PMID: 33188578 DOI: 10.1111/dth.14540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/29/2020] [Accepted: 11/11/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Tugba Kevser Uzuncakmak
- Department of Dermatology, Istanbul Medeniyet University Medical Faculty, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Filiz Cebeci Kahraman
- Department of Dermatology, Istanbul Medeniyet University Medical Faculty, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Arslan
- Department of Dermatology, Istanbul Medeniyet University Medical Faculty, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Salih Gürel
- Department of Dermatology, Istanbul Medeniyet University Medical Faculty, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Bengu Cobanoglu Simsek
- Department of Dermatology, Istanbul Medeniyet University Medical Faculty, Goztepe Training and Research Hospital, Istanbul, Turkey
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Kawakami T, Akiyama M, Ishida‐Yamamoto A, Nakano H, Mitoma C, Yoneda K, Suga Y. Clinical practice guide for the treatment of perforating dermatosis. J Dermatol 2020; 47:1374-1382. [DOI: 10.1111/1346-8138.15647] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Tamihiro Kawakami
- Division of Dermatology Tohoku Medical and Pharmaceutical University SendaiJapan
| | - Masashi Akiyama
- Department of Dermatology Nagoya University Graduate School of Medicine HagoyaJapan
| | | | - Hajime Nakano
- Department of Dermatology Hirosaki University Graduate School of Medicine HirosakiJapan
| | | | - Kozo Yoneda
- Department of Clinical Pharmacology Faculty of Pharmaceutical Sciences Osaka Ohtani University OsakaJapan
| | - Yasushi Suga
- Department of Dermatology Juntendo University Urayasu Hospital Urayasu Japan
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20
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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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21
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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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22
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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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23
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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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24
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Villela-Segura U, Miranda-Aguirre AI, Estrada-Aguilar L. Crateriform plaques in a patient with end-stage renal disease. The case of an acquired reactive perforating collagenosis. Nefrologia 2019; 40:358-360. [PMID: 31351699 DOI: 10.1016/j.nefro.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Uriel Villela-Segura
- Servicio de Dermatología, Hospital Regional Licenciado Adolfo López Mateos, ISSSTE, Ciudad de México, México.
| | | | - Lorena Estrada-Aguilar
- Servicio de Dermatología, Hospital Regional Licenciado Adolfo López Mateos, ISSSTE, Ciudad de México, México
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25
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Blaha T, Nigwekar S, Combs S, Kaw U, Krishnappa V, Raina R. Dermatologic manifestations in end stage renal disease. Hemodial Int 2018; 23:3-18. [PMID: 30520561 DOI: 10.1111/hdi.12689] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/29/2018] [Indexed: 01/16/2023]
Abstract
Skin manifestations are commonly seen in end stage renal disease (ESRD). Skin involvement in this population can be extensive and dramatically worsen quality of life. Close observation of the skin and nails of ESRD patients by clinicians allows for timely diagnosis and treatment, which ultimately improves quality of life and reduces mortality. In this article we focus on the cutaneous changes most commonly seen in ESRD patients. PubMed/Medline database search was done for published literature on skin manifestations in ESRD patients. All the available literature was reviewed and relevant articles were used to discuss about clinical features, pathogenesis, histology and treatment of each skin disorder in ESRD patients. Most commonly encountered skin manifestations in patients with ESRD are pruritus, xerosis, pigmentation changes, nail changes, perforating disorders, calcifying disorders, bullous dermatoses and nephrogenic systemic fibrosis. Skin manifestations in ESRD can be difficult to treat and multiple comorbidities in this patient population can exacerbate these disorders. Many of the treatment options are experimental with evidence largely derived from the case reports and small clinical trials. More large-scale trials are needed to firmly establish evidence based treatment guidelines. Prompt evaluation and management of these disorders improve morbidity and quality of life in ESRD patients.
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Affiliation(s)
- Taryn Blaha
- Department of Medicine, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Sagar Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sara Combs
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Urvashi Kaw
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vinod Krishnappa
- Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, Ohio, USA.,Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Rupesh Raina
- Department of Nephrology, Cleveland Clinic Akron General, Akron, Ohio, USA
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26
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Ormerod E, Atwan A, Intzedy L, Stone N. Dermoscopy features of acquired reactive perforating collagenosis: a case series. Dermatol Pract Concept 2018; 8:303-305. [PMID: 30479861 PMCID: PMC6246055 DOI: 10.5826/dpc.0804a11] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/20/2018] [Indexed: 11/02/2022] Open
Affiliation(s)
- Emma Ormerod
- Dermatology Department, Bristol Royal Infirmary, Bristol, UK
| | - Ausama Atwan
- Dermatology Department, Royal Gwent Hospital, Newport, Wales, UK
| | - Laszlo Intzedy
- Pathology Department, Royal Gwent Hospital, Newport, Wales, UK
| | - Natalie Stone
- Dermatology Department, Royal Gwent Hospital, Newport, Wales, UK
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27
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Omerod E, Atwan A, Intzedy L, Stone N. Dermoscopy features of acquired reactive perforating collagenosis: a case series. Dermatol Pract Concept 2018. [DOI: 10.5826/10.5826/dpc.0804a11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Emma Omerod
- Dermatology Department, Bristol Royal Infirmary, Bristol, UK
| | - Ausama Atwan
- Dermatology Department, Royal Gwent Hospital, Newport, Wales, UK
| | - Laszlo Intzedy
- Pathology Department, Royal Gwent Hospital, Newport, Wales, UK
| | - Natalie Stone
- Dermatology Department, Royal Gwent Hospital, Newport, Wales, UK
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28
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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.
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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
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29
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Cloutier-Bosworth A, Naert K, Kirshen C. Non-Healing Perianal Ulcers in a Healthy Elderly Male: An Unusual Case of Perforating Dermatosis. J Cutan Med Surg 2017; 21:356-358. [PMID: 28346010 DOI: 10.1177/1203475417702145] [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: 11/15/2022]
Abstract
BACKGROUND Perforating dermatoses are a rare group of dermatologic conditions characterized by transepidermal elimination of dermal material that can be primary or acquired secondary to systemic disease. OBJECTIVE We present an atypical case of perforating dermatosis resembling elastosis perforans serpiginosa (EPS) presenting with perianal ulcers in an elderly male with no systemic disease or medications and outline his successful treatment course. CONCLUSIONS Perianal ulcers in an otherwise healthy individual is an unusual presentation for perforating disorders but should be considered in cases not responding to traditional treatment options.
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Affiliation(s)
| | - Karen Naert
- 2 University of Calgary, Calgary, Alberta, Canada
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30
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Tani S, Ishii N, Hashimoto T, Tsujioka K. Bullous pemphigoid arising in a patient with acquired perforating dermatosis. Clin Exp Dermatol 2017; 42:406-409. [PMID: 28218466 DOI: 10.1111/ced.13080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2016] [Indexed: 01/06/2023]
Abstract
A middle-aged Japanese man who had been on haemodialysis treatment for diabetic nephropathy developed multiple itchy papules and nodules, which were histopathologically diagnosed as acquired perforating dermatosis. Two years later he developed oral lesions and subsequently numerous erosive plaques with necrotic crusts on the trunk and extremities. Histopathology of a papule showed a parakeratotic plug intermingled with basophilic, necrotic debris and collagen bundles, along with penetration of collagen bundles across the epidermis and subepidermal blister. Immunoblotting studies revealed IgG autoantibodies in the patient's serum, which reacted with the C-terminal and the NC16a domains of bullous pemphigoid (BP)180, indicating presence of BP. We searched the literature and found no other cases of an autoimmune blistering disease occurring in association with a perforating disorder. Possible injury to the basement membrane zone induced during the process of transepidermal elimination might be involved in the pathogenesis of the pemphigoid disease.
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Affiliation(s)
- S Tani
- Department of Dermatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - N Ishii
- Department of Dermatology, Kurume University School of Medicine, Fukuoka, Japan
| | - T Hashimoto
- Kurume University Institute of Cutaneous Cell Biology, Fukuoka, Japan
| | - K Tsujioka
- Department of Dermatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
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31
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32
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Terziroli Beretta-Piccoli B, Guillod C, Marsteller I, Blum R, Mazzucchelli L, Mondino C, Invernizzi P, Gershwin ME, Mainetti C. Primary Biliary Cholangitis Associated with Skin Disorders: A Case Report and Review of the Literature. Arch Immunol Ther Exp (Warsz) 2017; 65:299-309. [DOI: 10.1007/s00005-016-0448-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 12/07/2016] [Indexed: 01/12/2023]
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33
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O Sullivan ED, Wardrope K. Quiz Page August 2016: Skin Lesions in a Dialysis Patient. Am J Kidney Dis 2016; 68:A18-A21. [PMID: 27477361 DOI: 10.1053/j.ajkd.2016.03.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/31/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Eoin D O Sullivan
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
| | - Katrina Wardrope
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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34
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Affiliation(s)
- Sandeep Arora
- Department of Dermatology, Army College of Medical Sciences and Base Hospital, Delhi, India
| | - Ajay Malik
- Department of Pathology, Army College of Medical Sciences and Base Hospital, Delhi, India
| | - Anil Balki
- Department of Dermatology, Army College of Medical Sciences and Base Hospital, Delhi, India
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35
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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
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36
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Kim EJ, Park HS, Yoon HS, Cho S. A case of perforating dermatofibroma with floret-like giant cells. Clin Exp Dermatol 2014; 40:305-8. [PMID: 25534666 DOI: 10.1111/ced.12539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2014] [Indexed: 11/29/2022]
Abstract
Dermatofibromas are slow-growing solitary nodules, composed mostly of a dermal proliferation of spindle cells and epithelioid cells. Some dermatofibromas present with multinucleated giant cells, such as Touton, foreign body, and osteoclast-like cells. We report a case of dermatofibroma containing both Touton giant cells and floret-type cells. A 12-year-old boy presented with a 6-mm, firm, nontender, dusky-red to greyish dermal nodule on his left popliteal fossa. As suggested clinically by the central opening, perforation of the epidermis with partial extrusion of the dermal components, including macrophages and vertically oriented collagen bundles, via transepidermal elimination, were detected. In the upper dermis, collagen trapping and mostly epithelioid cells with many giant cells were seen, while the lower part contained mainly spindle cells in a storiform pattern. Multinucleated giant cells scattered in the upper dermis were mainly floret-type multinucleated giant cells with star-shaped cytoplasmic projections, associated with some Touton giant cells. To our knowledge, this is the first report of a perforating dermatofibroma with floret-type multinucleated giant cells.
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Affiliation(s)
- E J Kim
- Department of Dermatology, Seoul National University Boramae Hospital, Seoul, Korea
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