Acquired perforating dermatosis associated with endstage diabetic kidney failure in a hemodialysis patient aleksandra wieczorek,1 lukasz matusiak,2 jacek c szepietowski2 acquired perforating dermatosis apd is an uncommon skin disorder seen in majority among patients with chronic kidney disease and also in those with diabetes mellitus. The term acquired perforating dermatosis was first used by rapini et al. Giant variant of acquired perforating dermatosis in a renal. We describe effective therapy of acquired perforating dermatosis with narrowband uvb in 5 patients. Acquired perforating dermatosis apd is the most common perforating dermatosis, known to often occur in patients with chronic kidney disease or diabetes. Reactive perforating collagenosis rpc is a very rare skin disorder that can manifest during early childhood or. It is not well established as to how wide spread it is in patients on peritoneal dialysis pd and its implications in this population have not been well studied. Oct 27, 2009 acquired perforating dermatosis classically presents with severely pruritic follicular hyperkeratotic papules, sometimes umbilicated, on the hairbearing limbs of adults, as in our patient. The inherited form is a very rare condition with less than 50 cases reported in literature worldwide. Garciamalinis aj, del valle sanchez e, sanchezsalas mp, et al. The signs and symptoms of acquired perforating dermatosis include. Both conditions fall within the group of perforating dermatoses. What are the signs and symptoms of acquired perforating dermatosis.
While used for both the inherited and acquired forms, the name reactive perforating dermatosis is also used for the more common acquired type. It has been described in diabetic andor renal patients. Acquired reactive perforating collagenosis and chronic hbv infection 2 introduction reactive perforating collagenosis rpc is a rare cutaneous disorder of unknown etiology 1. Acquired perforating dermatosis may manifest with several polymorphous skin lesions, such as hyperkeratotic, often umbilicated, millimetric or larger papules or nodules. Special attention was paid, if shown in our specimens, to epidermal perforation of collagen and the composition of the covering debris. Treatment of acquired perforating dermatosis with narrowband. Reactive perforating collagenosis rpc is a very rare skin disorder that can manifest during early childhood or adulthood. We report a case of typical and aggressive apd in a 70yearold man. The purpose of this study was to clarify the clinical and histopathological features of apd, and evaluate. Perforating dermatoses are a group of skin diseases characterized by transepidermal elimination of dermal material. Acquired perforating dermatosis apd is an uncommon skin eruption of unclear etiology that most often is associated with diabetes mellitus or chronic renal insufficiency. Acquired reactive perforating dermatosis wagner 20 jddg. Acquired perforating dermatosis apd is strongly associated with pruritus, chronic renal failure, andor diabetes mellitus. Case report giant variant of acquired perforating dermatosis in a renal dialysis patient laurenmetterle,bs,cynthiam.
Acquired reactive perforating dermatosis is characterized by umbilicated erythematous papules and plaques with firmly adherent crusts. Acquired perforating dermatosis apd, which encompasses kyrle disease, acquired rpc, acquired pf, and acquired eps and is often associated with underlying chronic renal failure or diabetes mellitus picture 4ab and table 1. Acquired perforating dermatosis apd is a debilitating and itchy skin disease. Diagnostic criteria include central hyperkeratotic or cup. In patients receiving dialysis, acquired perforating dermatosis occurs in about 10% of patients. Acquired perforating dermatosis in patients with chronic renal failure.
Intensive light microscopical analysis of biopsied lesions was performed. A clinicopathologic study of thirty cases of acquired perforating dermatosis in korea article pdf available in annals of dermatology 262. Acquired perforating dermatosis may manifest with several polymorphous skin lesions, such as hyperkeratotic, often umbilicated, millimetric or larger papules or. Acquired perforating dermatosis apd is an uncommon disease characterized by lesions exhibiting transepidermal elimination of collagen or elastic fibers.
Apd affects adults and is associated with systemic diseases, mainly diabetes mellitus and renal failure. Here we present a case of apd that developed in a patient on pd. Acquired reactive perforating dermatosis arpd is a rare disease with characteristic clinical findings which is classified as a primary perforating. Acquired perforating dermatosis diabetes care american. Acquired reactive perforating dermatosis is a variant of. Disseminated acquired reactive perforating collagenosis. Statistical comparison with previous results for prurigo nodularis pn showed that up is clearly a subtype of pn. Reactive perforating collagenosis clinical presentation. It is also rarely associated with liver disease, malignant disease, hypothyroidism and hiv.
Acquired perforating dermatosis in a peritoneal dialysis patient j martins 1, m rivera 1, r carrillogijon 2, jl teruel 1 and j ortuno 1 1department of nephrology, hospital ramon y cajal, madrid, spain. Wikiproject medicine dermatology rated stubclass, midimportance this article is within the scope of wikiproject medicine, which recommends that medicinerelated articles follow the manual of style. Acquired perforating dermatosis associated with metastatic colon cancer hana jeon ab 1, g peter sarantopoulos md 2, nima m gharavi md phd 3, emma taylor md 3, melvin w chiu md mph 3 dermatology online journal 17 11. Acquired reactive perforating dermatosis arpd is a rare disease with characteristic clinical findings which is classified as a primary perforating dermatosis. In addition, clinical and microscopic features of epidermal perforation identical to those in acquired reactive perforating dermatosis ardp were observed. The follicular epithelium is disrupted with dermal collagen entering the perforation.
There are rare reports of apd in association with liver disease or thyroid disease. Acquired perforating dermatosis apd is a perforating disease characterized by transepidermal elimination of dermal material 1,2. Perforating dermatoses are a heterogeneous group that is characterized by a papulonodular rash with transepidermal elimination of dermal. Acquired perforating dermatosis apd, eps see separate chapter and pediatric rpc are sufficiently different to be considered independent clinical entities.
Acquired perforating dermatosis is clinically and histopathologically similar to perforating folliculitis, also associated with chronic kidney failure, with or without hemodialysis or peritoneal dialysis, andor diabetes mellitus, but not identical to kyrle disease 1462. Its diagnosis is based on biopsy and the treatment is not very clear. The topic acquired reactive perforating dermatosis you are seeking is a synonym, or alternative name, or is closely related to the medical condition reactive perforating collagenosis. This article is within the scope of wikiproject medicine, which recommends that medicinerelated articles follow the manual of style for medicinerelated articles and that biomedical information in any article use highquality medical sources. Acquired reactive perforating dermatosis is a variant of prurigo nodularis article in acta dermatovenereologica 972 june 2016 with 18 reads how we measure reads. Acquired perforating dermatosis classically presents with severely pruritic follicular hyperkeratotic papules, sometimes umbilicated, on the hairbearing limbs of adults, as in our patient. Acquired reactive perforating dermatosis wagner 20. The differential diagnosis includes prurigo nodularis, folliculitis, arthropod bites, multiple keratoacanthomas, psoriasis and lichen planus. Acquired reactive perforating dermatosis vashishtha r. Acquired perforating dermatosis in patients with chronic renal failure and diabetes mellitus acquired perforating dermatosis apd is a skin disorder occurring in the patients with chronic renal failure crf, diabetes mellitus dm or both.
Acquired perforating dermatosis in renal and diabetic patients. Several acquired types of perforating dermatoses have been identified, eg kyrles disease, elastosis perforans serpiginosa and reactive perforating collagenosis, the clinical boundary between these can be blurred and as such the term acquired perforating dermatosis is sometimes used to encompass this group of conditions. B in the lumbar region, erythematous papules, some following a linear path, suggesting koebner phenomenon arrows. Printed with permission from martins j, rivera m, carrillogijon r, teruel jl, ortuno j. A clinicopathologic study of thirty cases of acquired perforating dermatosis in korea seo wan kim, mi sun kim, june hyunkyung lee, sookja son, kui young park1, kapsok li1, seong jun seo1, tae young han department of dermatology, eulji general hospital, eulji university. Examination revealed multiple discrete, erythematous, crateriform nodules and plaques with central plugs of an escharlike black crust. Acquired perforating dermatosis statpearls ncbi bookshelf. Acquired perforating dermatosis is difficult to treat. Acquired perforating dermatosis in a patient on peritoneal. The exact prevalence and incidence of acquired perforating dermatosis are unknown. It is characterised by the presence of hyperkeratotic papules and. Acquired perforating dermatosis apd is the most common. Oct 26, 2017 examination revealed multiple discrete, erythematous, crateriform nodules and plaques with central plugs of an escharlike black crust. Indian j dermatol venereol leprol serial online 1993 cited 2020 mar 18.
Treatment of acquired reactive perforating dermatosis a. Some experts believe that it is due to the formation of abnormal mineral deposits resulting from a metabolic imbalance. Pdf acquired perforating dermatosis apd is a perforating disease characterized by transepidermal elimination of dermal material 1,2. Acquired perforating dermatosis is a chronic disease, usually associated with diabetes mellitus or renal failure or both. Acquired perforating dermatosis in a patient on peritoneal dialysis. The principal diagnosis feature is the presence of a central keratotic core which is overlying a focus of epidermal perforation. Acquired reactive perforating collagenosis is more common and occurs in approximately 10% of patients receiving maintenance haemodialysis. Acquired perforating dermatosis perforating dermatoses. Mar 25, 2018 the exact cause of acquired perforating dermatosis development is unknown. Reactive perforating collagenosis is a rare skin disorder characterized by the transepidermal elimination of altered collagen through the epidermis. Acquired perforating dermatosis usually occurs during the fifth decade of life. Perforating dermatoses primary care dermatology society uk.
The exact cause of acquired perforating dermatosis development is unknown. Acquired perforating dermatosis in a peritoneal dialysis. Figure 2 skin biopsy specimen of acquired perforating dermatosis shows a dilated follicle with keratinous and necrotic debris. Epidemiology the prevalence and incidence of this rare dermatosis are unknown 1, 7. In the acquired form in adults, it is frequently associated with diseases such as diabetes and chronic renal failure. Reactive perforating collagenosis pathology dermnet nz.
Apd has been reported to occur in association with various diseases, but is most commonly associated with dialysisdependent chronic renal failure crf or diabetes. Mar 07, 2017 reactive perforating collagenosis is a rare skin disorder characterized by the transepidermal elimination of altered collagen through the epidermis. Division of dermatopathology, department of pathology and laboratory medicine, david. Pdf a clinicopathologic study of thirty cases of acquired. Acquired reactive perforating dermatosis is a variant of prurigo nodularis. Treatment of acquired perforating dermatosis with cantharidin. Acquired perforating dermatosis in a patient with chronic renal failure 11 figure 3. Coexistent acquired perforating collagenosis and lepromatous leprosy with erythema nodosum leprosum. Acquired perforating dermatosis in a patient with chronic renal failure. Acquired perforating dermatosis associated with metastatic. Response to treatment lipy gupta 1, archana singal 1, deepika pandhi 1, sonal sharma 2 1 department of dermatology, university college of medical sciences and gtb hospital, university of delhi, delhi110 092, india 2 department of pathology, university college of medical sciences and gtb. A case of arpd in association with chronic renal failure and dialysis is reported here. Erythematous or nonerythematous lesions can also be found on follicular or nonfollicular regions depending on the apd type.
It is typified by presence of numerous papules on the body, especially, on the head, neck and trunk region. Acquired perforating dermatosis includes perforating dermatoses arising in adults previously named. The 2 distinct forms of are an inherited form that manifests in childhood and an acquired sporadic form that occurs in adulthood. The code is valid for the year 2020 for the submission of hipaacovered transactions. The classical morphology and histopathology of the lesion and demonstration of collagen fibres in the crater contributed to the diagnosis of rpc in the present case. Acquired perforating dermatosis in a peritoneal dialysis patient. All lesions disappeared completely after 10 to 15 exposures without. Many treatments have been proposed for acquired perforating dermatosis apd, with varying success. Skin biopsy confirmed the clinical impression of acquired perforating dermatosis, a perforating disorder strongly associated with diabetes mellitus and chronic renal disease. Acquired perforating dermatosis is a rare skin disorder which develops in individuals undergoing dialysis. Acquired perforating dermatosis apd is an uncommon cutaneous perforating disorder. The dose was started at 400 mjcm 2 and increased to a maximum of 1500 mjcm 2. Acquired perforating dermatosis in patients with chronic. This reflects that there is overlap with the other acquired perforating disorders of perforating folliculitis and kyrle disease.
Criteria included all parameters previously described by weigelt et al. Acquired perforating dermatosis consists of papulonodular skin lesions characterized by transepidermal elimination of some components of the dermis. Clinically the acquired perforating dermatoses are characterised by. The prevalence, incidence and the exact pathogenesis of this rare dermatosis are unknown 1. Acquired perforating dermatosis is clinically and histopathologically similar to perforating folliculitis, also associated with chronic kidney failure, with or without hemodialysis or peritoneal dialysis, andor diabetes mellitus, but not identical to kyrle disease. Patients with renal disease or diabetes mellitus often have an acquired perforating disease of the skin develop that is characterized by hyperkeratotic papule. In a retrospective study of patients diagnosed with apd between 2002 and 2014, included 33 patients. Apr 02, 2007 acquired perforating dermatosis consists of papulonodular skin lesions characterized by transepidermal elimination of some components of the dermis. Acquired perforating dermatosis associated with endstage. Acquired perforating dermatosis associated with primary.
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