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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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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.
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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
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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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Kimura A, Kosumi H, Natsuga K, Goda T, Ujiie H. Acquired perforating dermatosis induced by necitumumab. J Eur Acad Dermatol Venereol 2022; 36:e822-e823. [PMID: 35686644 DOI: 10.1111/jdv.18306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/03/2022] [Indexed: 11/28/2022]
Affiliation(s)
- A Kimura
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - H Kosumi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - K Natsuga
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - T Goda
- Department of Medical Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - H Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Tsutsui K, Namikawa K, Mori T, Kato K, Jinnai S, Nakama K, Ogata D, Takahashi A, Yamazaki N. Case of acquired reactive perforating collagenosis induced by panitumumab for colon cancer. J Dermatol 2020; 48:e114-e115. [PMID: 33264448 DOI: 10.1111/1346-8138.15718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Keita Tsutsui
- Department of Dermatological Oncology, National Cancer Center Hospital, Tokyo, Japan.,Department of Dermatology, Fukuoka University, Fukuoka, Japan
| | - Kenjiro Namikawa
- Department of Dermatological Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Taisuke Mori
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Ken Kato
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shunichi Jinnai
- Department of Dermatological Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kenta Nakama
- Department of Dermatological Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Dai Ogata
- Department of Dermatological Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Akira Takahashi
- Department of Dermatological Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Naoya Yamazaki
- Department of Dermatological Oncology, National Cancer Center Hospital, Tokyo, Japan
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Gore Karaali M, Erdil D, Erdemir VA, Gurel MS, Koku Aksu AE, Leblebici C. Evaluation of clinicopathological and treatment characteristics of 80 patients with acquired perforating dermatosis. Dermatol Ther 2020; 33:e14465. [PMID: 33112028 DOI: 10.1111/dth.14465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/13/2020] [Accepted: 10/23/2020] [Indexed: 12/22/2022]
Abstract
Acquired perforating dermatosis (APD) is a group of a rare dermatological disorder characterized by elimination of dermal connective tissue through epidermis. We aimed to evaluate the characteristics of patients diagnosed with APD and to determine the differences in comorbidities according to subtypes of APD. A retrospective, observational, cross-sectional study was designed. Patients diagnosed with APD between January 2008 and January 2019 were reviewed. Eighty patients were included in the study. 61.2% (n = 49) of the patients were female and 38.8% (n = 31) were male with a mean age of 58.4 ± 12.5 years. 82.5% (n = 66) of the patients were diagnosed with reactive perforating collagenosis (RPC) and 17.5% (n = 14) of perforating folliculitis (PF). The most common concomitant disease was diabetes mellitus (82.5%). 5.0% of the patients had malignancy. The comorbidity rate in RPC group was higher than PF (P < .05). Topical steroid was the most frequently (90.0%) used treatment. Complete response was obtained 55.0% of patients. Exitus was observed in 23.8% (n = 19) of patients in a mean 17.6 ± 25.7 months follow-up period. APD may be associated with many diseases. Comorbidities are more frequent in RPC group. This situation warns us to evaluate patients with RPC in more detail for underlying diseases. High mortality rate related to the underlying systemic diseases suggests being careful in terms of mortality in patients diagnosed with APD.
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Affiliation(s)
- Muge Gore Karaali
- Department of Dermatology, Mengücek Gazi Training and Research Hospital, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Duygu Erdil
- Department of Dermatology, University of Health Science (HSU) Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Vefa Aslı Erdemir
- Department of Dermatology, Göztepe Training and Research Hospital, Medeniyet University, Istanbul, Turkey
| | - Mehmet Salih Gurel
- Department of Dermatology, Göztepe Training and Research Hospital, Medeniyet University, Istanbul, Turkey
| | - Ayse Esra Koku Aksu
- Department of Dermatology, University of Health Science (HSU) Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Cem Leblebici
- Department of Pathology, University of Health Science (HSU) Istanbul Training and Research Hospital, Istanbul, Turkey
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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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Silva LD, S Lokuhetty MD. Giant variant of acquired perforating dermatosis, clinically masquerading as a sarcoma: A report of a rare case. INDIAN J PATHOL MICR 2020; 63:128-130. [PMID: 32031142 DOI: 10.4103/ijpm.ijpm_837_18] [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: 11/04/2022] Open
Abstract
Acquired perforating dermatosis is a group of disease characterized by transepidermal elimination of altered dermal constituents of unknown pathogenesis. The giant variant was first described in 2006, as an emerging entity with seven reported cases to date. Here is an 83-year-old male presented with a 4-year history of gradually enlarging soft tisssue mass with ulcerartions at the left knee joint. Imaging revealed an extra-articular, single, heterogeneous, multinodular mass, suspicious for a soft tissue sarcoma. Wide local excision of the mass showed fleshy, hemorrhagic nodules communicating with epidermal ulcers. Microscopy showed cystic spaces straddling dermis and subcutis, containing eosinophilic, amorphous, granular material extruding through epidermal craters, surrounded by exuberant myofibroblastic proliferation. Trichrome and van-Gieson stains confirmed that the extruded material is collagen and the histology was compatible with the giant variant of acquired perforating collagenosis. Awareness of histological appearance prevents misdiagnosis and overtreatment of this entity, masquerading as a sarcoma clinically.
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Affiliation(s)
- Lalani De Silva
- Department of Pathology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - M D S Lokuhetty
- Department of Pathology, Faculty of Medicine, University of Colombo, Sri Lanka
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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.
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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.
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Maruyama A, Katoh N. Perforating folliculitis triggered by bevacizumab administration. J Dermatol 2020; 47:e298-e299. [PMID: 32463526 DOI: 10.1111/1346-8138.15415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ayano Maruyama
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Norito Katoh
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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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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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
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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
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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.
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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: )
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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
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Tsuboi H, Mukuno A, Sato N, Katsuoka K, Yanase N. Acquired Reactive Perforating Collagenosis in a Patient with Lung Fibrosis. J Dermatol 2014; 31:916-9. [PMID: 15729865 DOI: 10.1111/j.1346-8138.2004.tb00626.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Reactive perforating collagenosis (RPC) is a rare disorder characterized by the transepidermal elimination of altered collagen. The inherited form of RPC begins in early childhood, but acquired reactive perforating collagenosis (ARPC) begins in adult life. ARPC is associated with diabetes mellitus, renal disease, and malignancy. ARPC with lung fibrosis has not previously been reported in the literature, and the relationship between ARPC and lung fibrosis has not been studied. The etiological relationship between the two disorders appears to be uncertain. Although their association in this case could be due to chance, it may be due to the transforming growth factor beta abnormalities seen in both diseases. In this report, we describe a case of ARPC with lung fibrosis and propose an etiological association between the two diseases.
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Affiliation(s)
- Hiromi Tsuboi
- Department of Dermatology, Kitasato University School of Medicine, Kanagawa, Japan
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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.
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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.
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Affiliation(s)
- Gunnar Wagner
- Department of Dermatology, Allergology, and Phlebology, Bremerhaven Reinkenheide Hospital, Germany.
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Karram S, Loya A, Hamam H, Habib RH, Khalifeh I. Transepidermal elimination in cutaneous leishmaniasis: a multiregional study. J Cutan Pathol 2012; 39:406-12. [PMID: 22443392 DOI: 10.1111/j.1600-0560.2012.01890.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transepidermal elimination has been documented in a myriad of infectious diseases; however, its occurrence in cutaneous leishmaniasis has not been evaluated. METHODS Skin biopsies (n = 212) with cutaneous leishmaniasis in Lebanon (n = 46), Syria (n = 53), Saudi Arabia (n = 45) and Pakistan (n = 68) were evaluated. Clinical data collected included age, gender, eruption type (papule, nodule, verrucous or scar), duration and anatomic location. Histopathologically, multiple parameters were recorded including Ridley's parasitic index and pattern, transepidermal elimination, interface changes, ulceration and necrosis. Transepidermal elimination was defined as the presence of amastigotes in the epidermis in all layers, limited to the basal layer or present in a perforating plug. All cases were confirmed by polymerase chain reaction (PCR) analysis followed by restriction fragment length polymorphism analysis for molecular subspeciation. RESULTS Leishmania tropica was identified in 88.2% and Leishmania major in 11.8% of all cases. Transepidermal elimination was observed in 28.3% of cases (29 perforating plug, 19 all layers and 12 basal layer) with a significant prevalence of L. major in this group (35 vs. 2%, p < 0.001). Cases with transepidermal elimination were associated with interface changes and higher parasitic index (p < 0.001) but not with an increased ulceration rate (p > 0.05). Multivariate analysis showed that transepidermal elimination was independently predicted by L. major [OR (95% confidence interval) = 80 (9-712); p < 0.001], parasitic index [OR = 3.4 (2.1-5.3); p < 0.001], interface changes [OR = 6.24 (2.2-17.8); p < 0.001] and necrosis [OR = 0.2 (0.1-0.8);p = 0.026]. CONCLUSIONS We report the largest multiregional cutaneous leishmaniasis series with a 28.3% documented transepidermal elimination incidence of which 48% were perforating plug; a significant prevalence of L. major was also identified in the transepidermal elimination group. The association of transepidermal elimination with interface changes and a higher parasitic index, without an increased ulceration rate, may reflect a unique biologic alteration in the epidermis, serving to facilitate the extrusion of the parasites through the skin.
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Affiliation(s)
- Sarah Karram
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Müller CSL, Tilgen W, Rass K. Leucocytoclastic vasculitis associated with acquired reactive perforating collagenosis: A diagnostic mimicry. DERMATO-ENDOCRINOLOGY 2011; 1:229-31. [PMID: 20592796 DOI: 10.4161/derm.1.4.9555] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 07/18/2009] [Indexed: 11/19/2022]
Affiliation(s)
- Cornelia S L Müller
- Clinic of Dermatology, Venereology and Allergology; The Saarland University Hospital; Homburg/Saar, Germany
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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.
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Affiliation(s)
- N Scola
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Deutschland.
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AMANO H, NAGAI Y, KISHI C, ISHIKAWA O. Acquired reactive perforating collagenosis in dermatomyositis. J Dermatol 2011; 38:1199-201. [DOI: 10.1111/j.1346-8138.2011.01210.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Karpouzis A, Giatromanolaki A, Sivridis E, Kouskoukis C. Acquired reactive perforating collagenosis: current status. J Dermatol 2010; 37:585-92. [PMID: 20629824 DOI: 10.1111/j.1346-8138.2010.00918.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Acquired reactive perforating collagenosis is a unique perforating dermatosis, characterized clinically by umbilicated hyperkeratotic papules or nodules and histologically by a focal hyperkeratosis in direct contact with transepidermal perforating dermal collagen. Several inflammatory or malignant systemic diseases may coexist with acquired reactive perforating collagenosis. The possible biochemical or immunological mechanisms of the systemic diseases, potentially responsible for the development and appearance of acquired reactive perforating collagenosis, are still under investigation. Several topical treatments, ultraviolet B phototherapy and allopurinol p.o. administration may be effective.
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Affiliation(s)
- Anthony Karpouzis
- Department of Dermatology, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
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Satti MB, Aref AH, Raddadi AA, Al-Ghamdi FA. Acquired reactive perforating collagenosis: a clinicopathologic study of 15 cases from Saudi Arabia. J Eur Acad Dermatol Venereol 2010; 24:223-7. [DOI: 10.1111/j.1468-3083.2009.03333.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hari Kumar KVS, Prajapati J, Pavan G, Parthasarathy A, Jha R, Modi KD. Acquired perforating dermatoses in patients with diabetic kidney disease on hemodialysis. Hemodial Int 2009; 14:73-7. [PMID: 19758294 DOI: 10.1111/j.1542-4758.2009.00405.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acquired perforating dermatoses (APD) is an uncommon skin disorder seen in patients with diabetes mellitus, chronic kidney disease, or both together. We present the clinicopathological features of APD in patients with diabetic kidney disease and discuss the recent advances in management. We retrospectively analyzed the data of 8 patients with APD presenting to our center. All patients were known cases of Type 2 diabetes and chronic kidney disease requiring maintenance dialysis. Acquired perforating dermatoses was diagnosed based on clinical presentation of itchy, keratotic papulonodular lesions, and characteristic histopathological features of transepithelial elimination on skin biopsy. The patients were subdivided into 4 types of APD based on the biopsy features. All our patients had Type 2 diabetes over 5 years duration and were on maintenance dialysis for more than 6 months before presentation. Acquired perforating dermatoses symptoms appeared 2 to 6 months before presentation. The majority of patients (6/8) had a subtype of reactive perforating collagenosis. All the patients showed significant resolution with topical glucocorticoid therapy. Acquired perforating dermatoses is a skin complication seen in Type 2 diabetes, chronic kidney disease, or when both are present together. Early identification and therapy prevents the associated morbidity.
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Affiliation(s)
- K V S Hari Kumar
- Department of Endocrinology, MEDWIN Hospitals, Nampally, Hyderabad 500001, Andhra Pradesh, India
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Gnanaraj P, Venugopal V, Sangitha C, Rajagopalan V, Pandurangan CN. A giant variant of acquired reactive perforating collagenosis associated with hydronephrosis: successful treatment with allopurinol. Int J Dermatol 2009; 48:204-6. [PMID: 19200207 DOI: 10.1111/j.1365-4632.2009.03801.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shiomi T, Yoshida Y, Horie Y, Yamamoto O. Acquired reactive perforating collagenosis with the histological features of IgG4-related sclerosing disease in a patient with Mikulicz's disease. Pathol Int 2009; 59:326-31. [DOI: 10.1111/j.1440-1827.2009.02374.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Gambichler T, Birkner L, Stücker M, Othlinghaus N, Altmeyer P, Kreuter A. Up-regulation of transforming growth factor-beta3 and extracellular matrix proteins in acquired reactive perforating collagenosis. J Am Acad Dermatol 2009; 60:463-9. [PMID: 19231643 DOI: 10.1016/j.jaad.2008.06.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 05/28/2008] [Accepted: 06/03/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Acquired reactive perforating collagenosis (ARPC) is an uncommon itchy dermatosis of unknown etiology. OBJECTIVES We aimed to study clinical features of ARPC and to characterize the expression profiles of proteins which are involved in extracellular matrix remodeling and wound repair. METHODS Seventeen patients with ARPC were included in the study. Immunohistochemical analyses were performed for CD34, factor VIIIa, vascular endothelial growth factor, matrix metalloproteinase-1 (MMP-1), tissue inhibitor of metalloproteinase-1 (TIMP-1), transforming growth factor-beta3 (TGF-beta3), Smad-3, and Smad-7. RESULTS Twelve patients (70.6%) had diabetes mellitus with disease duration of 14.6 +/- 13.1 years (mean +/- standard deviation). In all patients, chronic kidney disease was evident; two patients were receiving hemodialysis. Preexisting scabies infection was observed in 7 patients (41.2%). CD34 staining was significantly stronger in vessels of perilesional than those of lesional skin (P = .024). TGF-beta3, MMP-1, and TIMP-1 immunoreactivity was significantly stronger in lesional skin as compared with perilesional skin (P = .016, P = .0065, and P = .035, respectively). Although Smad-3 and Smad-7 immunoreactivity did not significantly differ in lesional and perilesional skin, there was a significant correlation between the protein expression of TGF-beta3 and Smad-3 (r = 0.56; P = .02), Smad-7 (r = 0.64; P = .006), and TIMP-1 (r = 0.56; P = .018) expression. LIMITATIONS We did not perform polymerase chain reaction studies on mRNA expression. CONCLUSIONS Our clinical data indicate that ARPC is etiopathogenetically linked to chronic kidney disease. Overexpression of TGF-beta3 and extracellular matrix proteins may represent antecedent tissue repair and therefore may be considered a significant event in the resolution of ARPC lesions.
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Affiliation(s)
- Thilo Gambichler
- Department of Dermatology, Ruhr-University of Bochum, Bochum, Germany.
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Vano-Galvan S, Moreno C, Medina J, Pérez-García B, García-López JL, Jaén P. Perforating dermatosis in a patient receiving bevacizumab. J Eur Acad Dermatol Venereol 2009; 23:972-4. [PMID: 19470057 DOI: 10.1111/j.1468-3083.2008.03078.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ikezaki E, Sugita K, Kabashima K, Tokura Y. Scabies-induced acquired reactive perforating collagenosis. J Eur Acad Dermatol Venereol 2008; 22:120-1. [PMID: 18181992 DOI: 10.1111/j.1468-3083.2007.02285.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- F Masson
- Service d'Immunologie et d'Allergologie, Département de Médecine Interne, Hôpitaux Universitaires de Genève, 24 rue Micheli du Crest, CH 1211 Genève 14, Suisse.
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Saray Y, Seçkin D, Bilezikçi B. Acquired perforating dermatosis: clinicopathological features in twenty-two cases. J Eur Acad Dermatol Venereol 2006; 20:679-88. [PMID: 16836495 DOI: 10.1111/j.1468-3083.2006.01571.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The term of acquired perforating dermatosis (APD) comprises the perforating dermatoses occurring in adult patients. Clinical and histological features of the disease are not uniform, and may resemble any of the four classic perforating disorders: elastosis perforans serpiginosa, reactive perforating collagenosis, perforating folliculitis or Kyrle's disease. Chronic renal failure and/or diabetes mellitus usually accompany this skin disease. OBJECTIVE The aim of this study was to delineate the clinical and histopathological features of acquired perforating dermatosis and to investigate the potential relationship between this disease and associated conditions. METHODS Twenty-two patients with acquired perforating dermatosis were enrolled in this study. Clinical findings of acquired perforating dermatosis and the spectrum of associated diseases were investigated. Haematoxylin and eosin sections were re-examined, and immunohistochemical stainings (elastic van Gieson and Masson trichrome stains) and periodic acid-Schiff stain were also used for histopathological evaluation. RESULTS Different clinical types of lesions resembling reactive perforating collagenosis, perforating folliculitis or Kyrle's disease were observed. Histopathological features were consistent with any of the four types of perforating dermatoses. Most of the patients (86.4%) had at least one systemic disease. Chronic renal failure (72.7%) and diabetes mellitus (50%) were the most commonly associated conditions. Most of the patients with diabetes mellitus (90.9%) had chronic renal failure due to diabetic nephropathy. All of the patients with chronic renal failure were on dialysis treatment. The other associated conditions were hepatitis (27.3%), anti-HCV Ab-positivity (13.6%), hypothyroidism (9.1%) and tuberculosis lymphadenitis (4.5%). Of the 22 patients, 13.6% were otherwise healthy, and 9.1% were renal transplant recipients. CONCLUSION Clinicopathological findings of our study indicate that the cases with APD represent the broad spectrum of perforating disorders rather than the variants of the same disease. Although APD is frequently associated with diabetes mellitus and chronic renal failure, this skin disorder may also develop in patients with other systemic disorders, and in those without any medical problems. This skin disease is probably linked to dialysis treatment in patients with chronic renal failure due to diabetes mellitus or other causes.
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Affiliation(s)
- Y Saray
- Başkent University Faculty of Medicine, Department of Dermatology, Ankara, Turkey.
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Freise J, Lehnen M, Grabbe S, Hillen U. [Ulcerated plaques and papules limited to one leg]. Hautarzt 2006; 57:923-6. [PMID: 16670928 DOI: 10.1007/s00105-006-1127-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- J Freise
- Universitätshautklinik, Hufelandstrasse 55, 45147, Essen, Deutschland.
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Koukourakis MI, Maltezos E. Amifostine administration during radiotherapy for cancer patients with genetic, autoimmune, metabolic and other diseases. Anticancer Drugs 2006; 17:133-8. [PMID: 16428930 DOI: 10.1097/00001813-200602000-00003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Amifostine is a broad-spectrum cytoprotective agent approved for protection against cisplatin toxicities and radiation-induced xerostomia; strong clinical evidence exists that amifostine protects normal mucosa and lung from radiation damage. Hypotension, nausea/vomiting, fatigue and fever/rash are the main side-effects associated with amifostine administration. The present study summarizes our experience on daily amifostine administration to cancer patients with various coexisting medical conditions and diseases. The tolerance and the eventual interference of amifostine with the course of the coexisting diseases is reported, providing a core list of medical conditions met in radiotherapy practice, their compatibility with amifostine administration and recommendations on how to deal with these patients. This list comprises genetic diseases (xeroderma pigmentosum, glucose-6-phosphate dehydrogenase deficiency), autoimmune disorders (vitiligo, scleroderma, thyroiditis, perforating collagenosis), metabolic diseases (diabetes mellitus), cardiovascular diseases, neuro/psychiatric diseases and other medical conditions (hypoglycemia, hepatic cirrhosis, alcoholism). A high incidence of fever/rash was noted in patients with autoimmune diseases, while all other conditions did not alter the patterns of side-effects expected following amifostine administration.
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Affiliation(s)
- Michael I Koukourakis
- Department of Radiotherapy/Oncology, Democritus University of Thrace, Alexandroupolis, Greece.
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Ngo BT, Hayes KD, DiMiao DJ, Srinivasan SK, Huerter CJ, Rendell MS. Manifestations of cutaneous diabetic microangiopathy. Am J Clin Dermatol 2006; 6:225-37. [PMID: 16060710 DOI: 10.2165/00128071-200506040-00003] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The etiologies of a variety of skin conditions associated with diabetes have not been fully explained. One possible etiological factor is diabetic microangiopathy, which is known to affect the eyes and kidneys in patients with diabetes. There are many mechanisms by which diabetes may cause microangiopathy. These include excess sorbitol formation, increased glycation end products, oxidative damage, and protein kinase C overactivity. All of these processes occur in the skin, and the existence of a cutaneous diabetic microangiopathy has been well demonstrated. These microangiopathic changes are associated with abnormalities of skin perfusion. Because the skin plays a thermoregulatory role, there is significant capillary redundancy in normal skin. In diabetic patients, loss of capillaries is associated with a decrease in perfusion reserve. This lost reserve is demonstrable under stressed conditions, such as thermal stimulation. The associated failure of microvascular perfusion to meet the requirements of skin metabolism may result in diverse skin lesions in patients with diabetes. Many skin conditions peculiar to diabetes are fairly rare. Necrobiosis lipoidica diabeticorum (NLD) and diabetic bullae occur very infrequently as compared with diabetic retinopathy and nephropathy. Conversely, there is a correlation between diabetic microvascular disease and NLD. This correlation also exists with more common skin conditions, such as diabetic dermopathy. This relationship suggests that diabetic microangiopathy may contribute to these conditions even if it is not primarily causal. Clinically, the major significance of diabetic cutaneous microangiopathy is seen in skin ulceration which is very common and has a major impact on diabetic patients. Many factors contribute to the development of diabetic foot ulcers. Neuropathy, decreased large vessel perfusion, increased susceptibility to infection, and altered biomechanics all play a role, but there is no doubt that inadequate small blood vessel perfusion is a major cause of the inability to heal small wounds that eventually results in ulcer formation. The accessibility of skin capillaries makes cutaneous diabetic microangiopathy an attractive model for research on the evolution of microvascular disease in diabetic patients.
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Affiliation(s)
- Binh T Ngo
- Division of Dermatology, Department of Medicine, The University of Nebraska School of Medicine, Omaha, Nebraska 68131, USA
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Büchau AS, Lewerenz V, Kruse R, Neumann NJ, Ruzicka T, Reifenberger J. [Reactive perforating collagenosis disease]. Hautarzt 2005; 56:963-5. [PMID: 16143875 DOI: 10.1007/s00105-005-1023-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A S Büchau
- Hautklinik der Heinrich-Heine-Universität, Düsseldorf
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Abstract
Acquired perforating dermatosis (APD) is a skin disorder occurring in the patients with chronic renal failure (CRF), diabetes mellitus (DM) or both. The purpose of this study was to clarify the clinical and histopathological features of APD, and evaluate role of scratching in the pathogenesis of APD. Twelve patients with APD associated with CRF and DM were enrolled in the study. In six patients who required hemodialysis, the lesions appeared 2-5 yr (mean 3 yr) after the initiation of dialysis, 18-22 yr (mean 19.3 yr) after the occurrence of DM. The other patients who did not receive hemodialysis noted the lesions 4-17 yr (mean 9.5 yr) after the onset of DM. All patients had an eruption of generally pruritic keratotic papules and nodules, primarily on the extensor surface of the extremities and the trunk. The histologic features of our cases showed a crateriform invagination of the epidermis filled by a parakeratotic plug and basophilic cellular debris. The period of treatment for patients who suffered from severe (7 cases) or very severe (3 cases) on the pruritus intensity was longer than that of patients who had mild pruritus (2 cases). These data showed that scratching appear to play a critical part in the pathogenesis of APD.
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Affiliation(s)
- Seok-Beom Hong
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea.
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Fistarol SK, Itin PH. Acquired Perforating Dermatosis in a Patient with Poland Syndrome. Dermatology 2004; 207:390-4. [PMID: 14657633 DOI: 10.1159/000074121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2003] [Accepted: 05/21/2003] [Indexed: 11/19/2022] Open
Abstract
Acquired perforating dermatosis (APD) is characterized by umbilicated 1- to 10-mm-measuring papulonodules with a central adherent oystershell-like keratotic plug, typically on the dorsa of the hands, forearms and over the knees. APD is associated with systemic diseases, especially diabetes mellitus and/or renal failure. Histologically the lesions show transepidermal elimination of altered dermal components into a cup-shaped epidermal depression. We present a 69-year-old man with coexisting APD and Poland syndrome (PS), an association not yet described. PS (OMIM 173800) is a rare congenital anomaly consisting of unilateral partial or total absence of the greater pectoralis muscle and ipsilateral symbrachydactyly. Most cases of PS are sporadic as it was in our case. Our patient had, in addition, an untreated diabetic condition, hyperuricaemia, dilated cardiomyopathy and a very recent pulmonary embolism. He responded to therapy with allopurinol.
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Iyoda M, Hayashi F, Kuroki A, Shibata T, Kitazawa K, Sugisaki T, Sakai O. Acquired reactive perforating collagenosis in a nondiabetic hemodialysis patient: successful treatment with allopurinol. Am J Kidney Dis 2003; 42:E11-3. [PMID: 12955705 DOI: 10.1016/s0272-6386(03)00796-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The authors present a case of acquired reactive perforating collagenosis developed in a nondiabetic hemodialysis patient, who was treated successfully with allopurinol. Treatment of acquired reactive perforating collagenosis is difficult and often ineffective. The patient had been unresponsive to conventional treatments, but the pruritus was controlled, and skin lesions subsequently resolved after the treatment with allopurinol. Possible mechanisms of allopurinol treatment for acquired reactive perforating collagenosis are discussed.
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Affiliation(s)
- Masayuki Iyoda
- Department of Internal Medicine, Tokyu Hospital, Tokyo, Japan.
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Martín-Serradilla JI, Bajo del Pozo C, Oñate Cuchet JM, Escudero Bueno G, Cuadrado de Valles C, Sousa Pérez F. [Papular keratotic lesions in a diabetic female patient with a chronic renal failure]. Rev Clin Esp 2002; 202:567-8. [PMID: 12361560 DOI: 10.1016/s0014-2565(02)71146-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- J I Martín-Serradilla
- Servicios de Medicina Interna. Hospital General de Palencia Río Carrión. Palencia. Spain
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Abstract
Diabetes is a common disease with many cutaneous manifestations encountered by dermatologists. Diabetes and the skin may be linked by association (e.g., necrobiosis lipoidica); infection; diabetic complication (e.g., neuropathic ulcer); or treatment reaction. Review of recent studies and reports focuses on pathogenesis and treatment of these many diabetic cutaneous changes.
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Affiliation(s)
- Tammie Ferringer
- Department of Dermatology, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA 17822, USA
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42
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Ruiz Villaverde R, Martín Sánchez MC, Blasco Melguizo J, Naranjo Sintes R. [Reactive perforating collagenosis and colon carcinoma]. Rev Clin Esp 2002; 202:298-9. [PMID: 12060550 DOI: 10.1016/s0014-2565(02)71058-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Satchell AC, Crotty K, Lee S. Reactive perforating collagenosis: a condition that may be underdiagnosed. Australas J Dermatol 2001; 42:284-7. [PMID: 11903164 DOI: 10.1046/j.1440-0960.2001.00537.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Reactive perforating collagenosis is a perforating disorder developing in adults, usually in association with diabetes mellitus or renal failure. We present three cases diagnosed at the Royal Prince Alfred Hospital in a 5 month period. All three patients had long-standing diabetes mellitus, hypertension, hypercholesterolaemia and ischaemic heart disease. Each patient presented with generalized pruritus and a papular eruption across the trunk and limbs. More than one biopsy or multiple levels were needed before the diagnostic histological features were seen. The first patient responded to 0.5% phenol with 10% glycerine in sorbolene cream. The second patient did not respond to topical betamethasone diproprionate 0.5 mg/g cream and antihistamines (hydroxyzine 25 mg nocte) and required narrow-band ultraviolet (UV) B. The third patient, having failed to respond to topical betamethasone diproprionate 0.5 mg/g cream and wet dressings, antihistamines (hydroxyzine 25 mg tds and doxepin 50 mg nocte) and UVB required acitretin 25 mg orally per day. Because reactive perforating collagenosis responds to treatment, we believe this condition should be considered in patients with diabetes mellitus or renal failure presenting with pruritus and that biopsy of intact lesions may need multiple levels to help establish the diagnosis.
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Affiliation(s)
- A C Satchell
- Department of Dermatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Thiele-Ochel S, Schneider LA, Reinhold K, Hunzelmann N, Krieg T, Scharffetter-Kochanek K. Acquired perforating collagenosis: is it due to damage by scratching? Br J Dermatol 2001; 145:173-4. [PMID: 11453934 DOI: 10.1046/j.1365-2133.2001.04309.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kawakami T, Soma Y, Mizoguchi M, Saito R. Immunohistochemical analysis of transforming growth factor-beta3 expression in acquired reactive perforating collagenosis. Br J Dermatol 2001; 144:197-9. [PMID: 11167714 DOI: 10.1046/j.1365-2133.2001.03982.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Munch M, Balslev E, Jemec GB. Treatment of perforating collagenosis of diabetes and renal failure with allopurinol. Clin Exp Dermatol 2000; 25:615-6. [PMID: 11167974 DOI: 10.1046/j.1365-2230.2000.00720.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present a case of widespread reactive perforating collagenosis in a 63-year-old woman undergoing haemodialysis after diabetic nephropathy, who was treated successfully with allopurinol. The patient responded well and rapidly to a dose of 100 mg allopurinol daily. It is suggested that more patients with reactive perforating collagenosis may benefit from allopurinol therapy.
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Affiliation(s)
- M Munch
- Division of Nephrology, Department of Internal Medicine, Roskilde Hospital, DK-4000 Roskilde, Denmark.
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