Dermoscopy features of acquired reactive perforating collagenosis: a case series

A case report on acquired reactive perforating collagenosis

INTRODUCTION

Acquired reactive perforating collagenosis (ARPC) is a rare perforating skin disease with unclear pathogenesis, often leading to misdiagnosis. Utilizing noninvasive skin microscopy improves diagnostic accuracy while reducing misdiagnosis rates.

PATIENT CONCERNS

Given its association with systemic diseases, comprehensive examinations are crucial for early detection of related diseases such as tumors. Clinically, it still lacks standardized guidelines for the treatment. Clinical treatment is mostly based on symptomatic treatment. Oral administration of pregabalin capsules can significantly relieve itching symptoms, and narrow-wave ultraviolet irradiation can accelerate the recovery of skin lesions.

DIAGNOSIS

Dermoscopy and skin biopsy was used to confirm this case was ARPC.

INTERVENTIONS

Treatment was based on oral administration of 20 mg prednisone, 1 tablet of loratadine, 1 tablet of pregabalin in the morning and evening, and external application of halomethasone ointment.

OUTCOMES

Itching symptoms were significantly relieved.

CONCLUSION

This case report demonstrates that clinical dermoscopy can improve the diagnosis rate of ARPC, and pregabalin capsules can significantly relieve itching symptoms.

Unraveling the Enigma of Perforating Itches: A Comprehensive Report of Reactive Perforating Collagenosis in Three Patients

Reactive perforating collagenosis (RPC) is a rare dermatosis where dermal connective tissue erupts through the epidermis, resulting in diverse clinical manifestations such as umbilicated papules with crusting and excoriated nodules with central puncta. Associated with systemic disorders like diabetes mellitus, chronic kidney diseases, and autoimmune conditions, RPC's pathogenesis involves abnormal collagen metabolism, immune dysfunction, genetic predisposition, and environmental triggers. Histopathological examination reveals vertically oriented shallow cup-shaped invaginations containing degenerated collagen fibers, aiding diagnosis. Treatment includes managing underlying causes and utilizing options like topical corticoids, retinoids, and phototherapy, with a possibility of spontaneous regression and recurrence. This case report highlights the significance of considering RPC in patients with characteristic skin lesions and severe itching, emphasizing early recognition and accurate diagnosis to optimize patient care. Continued research and collaboration are crucial for improving outcomes in individuals affected by RPC.

Acquired reactive perforating collagenosis combined with MRSA: A case report

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.

Dermoscopy Features of Acquired Perforating Dermatosis Among 39 Patients

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.

Acquired Reactive Perforating Collagenosis: A Case Report

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

Necrotic plaques in an elderly male

Reactive perforating collagenosis is commonly recognised as an unusual form of transepithelial elimination of collagen and elastin fibres which are extruded through the epidermis in patients with a genetic predisposition or underlying diseases, such as diabetes mellitus or renal diseases. We present the unusual case of an 87-year-old diabetic male with a giant form of reactive perforating collagenosis and review the available literature.

Case for diagnosis. Hyperpigmented and excoriated papules and nodules in a diabetic patient

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.

Acquired reactive perforating collagenosis: A case report and review of the literature

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.

Dermoscopic pattern of Kyrle's disease

The clinical diagnosis of Kyrle's disease may sometimes be challenging, due to the clinical similarity of lesions to other pruritic dermatosis. Although the dermoscopy is being increasingly used in daily practice, there is insufficient data in literature describing the dermoscopic patterns of Kyrle's disease, since only one report has been published to date. Herein we report our dermoscopic observation with additional diagnostic tips in a case who was diagnosed with Kyrle's disease histopathologically.