Acquired Perforating Dermatosis: Clinical and Histopathological Analysis of 95 Patients From One Center
Keywords:
Acquired perforating dermatosis, reactive perforating collagenosis, elastosis perforans serpiginosa, perforating folliculitis, Kyrle's disease, histopatology, dermoscopyAbstract
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.
References
Rapini RP, Herbert AA, Drucker CR. Acquired perforating dermatosis. Evidence for combined transepidermal elimination of both collagen and elastic fibers. Arch Dermatol. 1989;125(8):1074-1078. doi:10.1001/archderm.125.8.1074
Patterson JW. The perforating disorders. J Am Acad Dermatol. 1984;10(4):561-581. doi:10.1016/s0190-9622(84)80259-5
Lynde CB, Pratt MD. Clinical Images: Acquired perforating dermatosis: association with diabetes and renal failure. CMAJ. 2009;181(9):615. doi:10.1503/cmaj.082013
Saray Y, Seçkin D, Bilezikçi B. Acquired perforating dermatosis: clinicopathological features in twenty-two cases. J Eur Acad Dermatol Venereol. 2006;20(6):679-688. doi:10.1111/j.1468-3083.2006.01571.x
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(2):223-227. doi:10.1111/j.1468-3083.2009.03333.x
Akoglu G, Emre S, Sungu N, Kurtoglu G, Metin A. Clinicopathological features of 25 patients with acquired perforating dermatosis. Eur J Dermatol. 2013;23(6):864-871. doi:10.1684/ejd.2013.2237
Kim SW, Kim MS, Lee JH, et al. A clinicopathologic study of thirty cases of acquired perforating dermatosis in Korea. Ann Dermatol. 2014;26(2):162-171. doi:10.5021/ad.2014.26.2.162
Akoglu G, Sungu N, Karaismailoglu E, Aktas A. Expression of the receptor for advanced glycation end products in acquired reactive perforating collagenosis. Indian J Dermatol Venereol Leprol. 2017;83(4):432-435. doi:10.4103/ijdvl.IJDVL_113_16
García-Malinis AJ, Del Valle Sánchez E, Sánchez-Salas MP, Del Prado E, Coscojuela C, Gilaberte Y. Acquired perforating dermatosis: clinicopathological study of 31 cases, emphasizing pathogenesis and treatment. J Eur Acad Dermatol Venereol. 2017;31(10):1757-1763. doi:10.1111/jdv.14220
Garrido PM, Queirós C, Borges-Costa J, Soares-Almeida L, Filipe P. Acquired perforating dermatosis: clinicopathologic study of a 10-year period at a tertiary teaching hospital. Int J Dermatol. 2020;59(4):445-450. doi:10.1111/ijd.14760
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(6):e14465. doi:10.1111/dth.14465
Wang W, Liao Y, Fu L, Kan B, Peng X, Lu Y. Dermoscopy Features of Acquired Perforating Dermatosis Among 39 Patients. Front Med (Lausanne). 2021;8:631642. doi:10.3389/fmed.2021.631642
Elmas ÖF, Kilitci A, Uyar B. Dermoscopic Patterns of Acquired Reactive Perforating Collagenosis. Dermatol Pract Concept. 2020;11(1):e2020085. Published 2020 Dec 7. doi:10.5826/dpc.1101a85
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(3):463-469. doi:10.1016/j.jaad.2008.06.006
Kawakami T, Saito R. Acquired reactive perforating collagenosis associated with diabetes mellitus: eight cases that meet Faver's criteria. Br J Dermatol. 1999;140(3):521-524. doi:10.1046/j.1365-2133.1999.02722.x
Morton CA, Henderson IS, Jones MC, Lowe JG. Acquired perforating dermatosis in a British dialysis population. Br J Dermatol. 1996;135(5):671-677.
Tsuboi H, Mukuno A, Sato N, Katsuoka K, Yanase N. Acquired reactive perforating collagenosis in a patient with lung fibrosis. J Dermatol. 2004;31(11):916-919. doi:10.1111/j.1346-8138.2004.tb00626.x
Tsutsui K, Namikawa K, Mori T, et al. Case of acquired reactive perforating collagenosis induced by panitumumab for colon cancer. J Dermatol. 2021;48(2):e114-e115. doi:10.1111/1346-8138.15718
Healy R, Cerio R, Hollingsworth A, Bewley A. Acquired perforating dermatosis associated with pregnancy. Clin Exp Dermatol. 2010;35(6):621-623. doi:10.1111/j.1365-2230.2009.03763.x
Eriyagama S, Wee JS, Ho B, Natkunarajah J. Acquired reactive perforating collagenosis associated with urticarial vasculitis in pregnancy. Clin Exp Dermatol. 2014;39(1):81-83. doi:10.1111/ced.12169
Gontijo JRV, Júnior FF, Pereira LB, Pedrosa MS. Trauma-induced acquired reactive perforating collagenosis. An Bras Dermatol. 2021;96(3):392-393. doi:10.1016/j.abd.2020.06.022
Brinkmeier T, Herbst RA, Frosch PJ. Reactive perforating collagenosis associated with scabies in a diabetic. J Eur Acad Dermatol Venereol. 2004;18(5):588-590. doi:10.1111/j.1468-3083.2004.00978.x
Hinrichs W, Breuckmann F, Altmeyer P, Kreuter A. Acquired perforating dermatosis: a report on 4 cases associated with scabies infection. J Am Acad Dermatol. 2004;51(4):665-667. doi:10.1016/j.jaad.2004.02.025
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(8):972-974. doi:10.1111/j.1468-3083.2008.03078.x
Gilaberte Y, Coscojuela C, Vázquez C, Roselló R, Vera J. Perforating folliculitis associated with tumour necrosis factor-alpha inhibitors administered for rheumatoid arthritis. Br J Dermatol. 2007;156(2):368-371. doi:10.1111/j.1365-2133.2006.07598.x
Severino-Freire M, Sibaud V, Tournier E, et al. Acquired perforating dermatosis associated with sorafenib therapy. J Eur Acad Dermatol Venereol. 2016;30(2):328-330. doi:10.1111/jdv.12720
Edek YC, Tamer F, Öğüt B. Lichen planus pigmentosus inversus with nail involvement following COVID-19 vaccination: A case report. Dermatol Ther. 2022;35(11):e15809. doi:10.1111/dth.15809
Afacan E, Edek YC, İlter N, Gülekon A. Can Covid-19 vaccines cause or exacerbate bullous pemphigoid? A report of seven cases from one center. Int J Dermatol. 2022;61(5):626-627. doi:10.1111/ijd.16086
Krajewski PK, Matusiak Ł, Szepietowski JC. Psoriasis flare-up associated with second dose of Pfizer-BioNTech BNT16B2b2 COVID-19 mRNA vaccine. J Eur Acad Dermatol Venereol. 2021;35(10):e632-e634. doi:10.1111/jdv.17449
Bostan E, Gulseren D, Gokoz O. New-onset leukocytoclastic vasculitis after COVID-19 vaccine. Int J Dermatol. 2021;60(10):1305-1306. doi:10.1111/ijd.15777
Chae KS, Park YM, Cho SH, Cho BK. Reactive perforating collagenosis associated with periampullary carcinoma. Br J Dermatol. 1998;139(3):548-550. doi:10.1046/j.1365-2133.1998.02435.x
Singh EN, Kumar S, Agarwal US, Meena R, Purohit S. Acquired reactive perforating collagenosis associated with mediastinal synovial sarcoma. Clin Exp Dermatol. 2019;44(3):325-327. doi:10.1111/ced.13684
Huseynova L, Akdogan N, Gököz Ö, Evans SE. Acquired reactive perforating collagenosis in association with prostate adenocarcinoma, chronic lymphocytic leukemia, and Graves' disease. An Bras Dermatol. 2020;95(3):336-339. doi:10.1016/j.abd.2019.09.029
Fernandes KA, Lima LA, Guedes JC, Lima RB, D'Acri AM, Martins CJ. Acquired perforating dermatosis in a patient with chronic renal failure. An Bras Dermatol. 2016;91(5 suppl 1):10-13. doi:10.1590/abd1806-4841.20164619
Harbaoui S, Litaiem N. Acquired Perforating Dermatosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; February 17, 2022.
Lukács J, Schliemann S, Elsner P. Treatment of acquired reactive perforating dermatosis - a systematic review. J Dtsch Dermatol Ges. 2018;16(7):825-842. doi:10.1111/ddg.13561
Sezer E, Erkek E. Acquired perforating dermatosis successfully treated with photodynamic therapy. Photodermatol Photoimmunol Photomed. 2012;28(1):50-52. doi:10.1111/j.1600-0781.2011.00634.x
Matsui A, Nakano H, Aizu T, Sawamura D. Treatment of acquired reactive perforating collagenosis with 308-nm excimer laser. Clin Exp Dermatol. 2016;41(7):820-821. doi:10.1111/ced.12891
Hoque SR, Ameen M, Holden CA. Acquired reactive perforating collagenosis: four patients with a giant variant treated with allopurinol. Br J Dermatol. 2006;154(4):759-762. doi:10.1111/j.1365-2133.2005.07111.x
Krüger K, Tebbe B, Krengel S, Goerdt S, Orfanos CE. Erworbene reaktiv perforierende Dermatose. Erfolgreiche Behandlung mit Allopurinol in 2 Fällen [Acquired reactive perforating dermatosis. Successful treatment with allopurinol in 2 cases]. Hautarzt. 1999;50(2):115-120. doi:10.1007/s001050050874
Doehner W, Schoene N, Rauchhaus M, et al: Effects of xanthine oxidase inhibition with allopurinol on endothelial function and peripheral blood flow in hyperuremic patients with chronic heart failure: Results from 2 placebo-controlled studies. Circulation 105:2619-2624, 2002
Rees R, Smith D, Li TD, et al. The role of xanthine oxidase and xanthine dehydrogenase in skin ischemia. J Surg Res. 1994;56(2):162-167. doi:10.1006/jsre.1994.1027
Hawkes JS, Young CM, Cleland LG: Ischemia reperfusion injury in pedicle skin flaps in the pig: Lack of protective effect of SOD and allopurinol. Br J Plast Surg 42:668-674, 1989
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