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Hiraiwa T, Yamamoto T. Successful treatment with phototherapy for acquired reactive perforating collagenosis subsequently exacerbated following improvement of diffuse erythema induced by immune checkpoint inhibitors. J Dermatol 2022; 50:e164-e165. [PMID: 36585743 DOI: 10.1111/1346-8138.16694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Tomoko Hiraiwa
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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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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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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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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Bartling SJ, Naff JL, Canevari MM, Fink CM. Pruritic Rash in an Elderly Patient with Uncontrolled Diabetes Mellitus. AACE Clin Case Rep 2019; 5:e146-e149. [DOI: 10.4158/accr-2018-0388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/08/2018] [Indexed: 11/15/2022] Open
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6
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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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7
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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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8
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Kim SW, Kim MS, Lee JH, Son SJ, Park KY, Li K, Seo SJ, Han TY. A clinicopathologic study of thirty cases of acquired perforating dermatosis in Korea. Ann Dermatol 2014; 26:162-71. [PMID: 24882969 PMCID: PMC4037667 DOI: 10.5021/ad.2014.26.2.162] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 03/15/2013] [Accepted: 03/15/2013] [Indexed: 11/22/2022] Open
Abstract
Background Acquired perforating dermatosis (APD) is histopathologically characterized by transepidermal elimination of materials from the upper dermis. APD can be divided into four diseases: Kyrle's disease, perforating folliculitis, elastosis perforans serpiginosa, and reactive perforating collagenosis. APD is usually associated with systemic diseases, especially diabetes mellitus or chronic renal failure. So far, there have only been a few Korean studies of APD, which have a limited number of patients. Objective The aim of this study is to evaluate the clinical and histopathologic characteristics of 30 cases of APD and to examine the association with systemic diseases. Methods We retrospectively reviewed the medical records and biopsy specimens of 30 patients who were diagnosed with APD. Results The mean age was 55.5 years, and the average duration of the lesion was 7.8 months. The lower extremities (73.3%) were the most frequently occurring sites of the lesion. Twenty-five patients (83.3%) had pruritus, and Koebner's phenomenon was present in 11 patients. Patients of 63.3% had at least one systemic disease. Diabetes mellitus (n=17, 56.7%) and chronic renal failure (n=10, 33.3%) were the most commonly associated conditions. Most patients received topical steroids (93.3%) and antihistamines (80.0%). The most common histopathologic type was reactive perforating collagenosis (n=23, 73.3%). Conclusion In this study, most patients had a systemic association to the diseases. Therefore, we suggest that further evaluation is necessary for patients who present with APD. This includes reviewing patient's comprehensive past medical history, clinical exam, and additional diagnostic testing to check for the possibility of associated systemic diseases.
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Affiliation(s)
- Seo Wan Kim
- Department of Dermatology, Eulji General Hospital, Eulji University, Seoul, Korea
| | - Mi Sun Kim
- Department of Dermatology, Eulji General Hospital, Eulji University, Seoul, Korea
| | - June Hyunkyung Lee
- Department of Dermatology, Eulji General Hospital, Eulji University, Seoul, Korea
| | - Sook-Ja Son
- Department of Dermatology, Eulji General Hospital, Eulji University, Seoul, Korea
| | - Kui Young Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kapsok Li
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Tae Young Han
- Department of Dermatology, Eulji General Hospital, Eulji University, Seoul, Korea
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Escribano-Stablé JC, Doménech C, Matarredona J, Pascual JC, Jaen A, Vicente J. Tacalcitol in the treatment of acquired perforating collagenosis. Case Rep Dermatol 2014; 6:69-73. [PMID: 24707254 PMCID: PMC3975195 DOI: 10.1159/000360390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Acquired perforating collagenosis (APC) is a rare perforating dermatosis characterized by transepidermal collagen elimination. We describe a 65-year-old patient, with long-standing type 2 diabetes mellitus and a 2-year history of itchy hyperkeratotic nodules situated on the back, who was subsequently diagnosed with APC. Treatment included topical corticosteroids and antihistamines, without improvement of the lesions. However, therapy with topical tacalcitol administered for 2 months produced a significant response leading to complete remission of APC.
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Affiliation(s)
| | - C Doménech
- Dermatology Department, Elx/Elche General University Hospital, Elx/Elche, Spain
| | - J Matarredona
- Dermatology Department, Elx/Elche General University Hospital, Elx/Elche, Spain
| | - J C Pascual
- Dermatology Department, Elx/Elche General University Hospital, Elx/Elche, Spain
| | - A Jaen
- Dermatology Department, Elx/Elche General University Hospital, Elx/Elche, Spain
| | - J Vicente
- Dermatology Department, Elx/Elche General University Hospital, Elx/Elche, Spain
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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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Beco L, Heimann M, Olivry T. Is feline acquired reactive perforating collagenosis a wound healing defect? Treatment with topical betamethasone and halofuginone appears beneficial. Vet Dermatol 2010; 21:434-6. [PMID: 20492626 DOI: 10.1111/j.1365-3164.2010.00878.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Healy R, Cerio R, Hollingsworth A, Bewley A. Acquired perforating dermatosis associated with pregnancy. Clin Exp Dermatol 2009; 35:621-3. [DOI: 10.1111/j.1365-2230.2009.03763.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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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15
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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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Abe R, Murase S, Nomura Y, Natsuga K, Tateishi Y, Tomita Y, Tsuji-Abe Y, Matsumura T, Shimizu H. Acquired perforating dermatosis appearing as elastosis perforans serpiginosa and perforating folliculitis. Clin Exp Dermatol 2008; 33:653-4. [PMID: 18616731 DOI: 10.1111/j.1365-2230.2008.02770.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Gönül M, Cakmak SK, Gül U, Kiliç A, Ergül G. Two cases of acquired perforating dermatosis treated with doxycycline therapy. Int J Dermatol 2007; 45:1461-3. [PMID: 17184266 DOI: 10.1111/j.1365-4632.2006.02947.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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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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Martín-Ezquerra G, Bassas-Vila J, Salleras-Redonnet M, Sánchez-Regaña M, Umbert-Millet P. Verrucous and crusty lesions since childhood. Clin Exp Dermatol 2006; 31:493-4. [PMID: 16681628 DOI: 10.1111/j.1365-2230.2006.02116.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G Martín-Ezquerra
- Department of Dermatology. Hospital Universitari Sagrat Cor, Barcelona, Spain.
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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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Brinkmeier T, Herbst RA, Frosch PJ. Reactive perforating collagenosis associated with scabies in a diabetic. J Eur Acad Dermatol Venereol 2004; 18:588-90. [PMID: 15324402 DOI: 10.1111/j.1468-3083.2004.00978.x] [Citation(s) in RCA: 15] [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) in adults commonly manifests in patients with diabetes mellitus. Pruritus and consequent induced scratching have been identified as the bases for the evolution of this skin disease. We present the unusual case of a 55-year-old female diabetic with characteristic umbilicated skin lesions and a long history of scabies. Histology from a crusty nodule revealed transepidermal elimination of collagen. Following antiscabietic treatment, two courses of oral doxycycline demonstrated beneficial effects in controlling the perforating skin disorder.
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Affiliation(s)
- T Brinkmeier
- Department of Dermatology, Klinikum Dortmund gGmbH, and University of Witten/Herdecke, Beurhausstrasse 40, D-44137 Dortmund, Germany.
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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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