Here we present a case of apd that developed in a patient on pd. Acquired perforating dermatosis apd is a debilitating and itchy skin disease. However, the pathological features of this condition are not uniform. Indian j dermatol venereol leprol serial online 1993 cited 2020 apr 25. Clinically the acquired perforating dermatoses are characterised by. They may resemble any of the four classic perforating dermatoses including rpc, eps, pf or kd.
The lesions used to aggravate in winters and heal with superficial scarring. 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 see also. Acquired perforating dermatosis in a patient on peritoneal dialysis. Elastosis perforans serpiginosum accessed 27 august 2018 back of neck in teenage boys. Reactive perforating collagenosis is a rare dermatosis, firstly described in 1967 and known to manifest as an inherited autosomal recessive form occurring in childhood and a sporadic, acquired form.
Acquired reactive perforating dermatosis arpd is a rare disease with characteristic clinical findings which is classified as a primary perforating dermatosis. The inherited form of the disease manifests in childhood, whereas acquired reactive perforating collagenosis occurs in adulthood faver et al. Frequently more than one pattern is observed in the same patient. Examination revealed multiple discrete, erythematous, crateriform nodules and plaques with central plugs of an escharlike black crust. Please remove adblock adverts are the main source of revenue for dovemed. Division of dermatopathology, department of pathology and laboratory medicine, david. Reactive perforating collagenosis is a rare skin disorder characterized by the transepidermal elimination of altered collagen through the epidermis. Acquired perforating dermatosis is a rather rare skin disorder which develops in individuals undergoing dialysis. 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. Reactive perforating collagenosis pathology dermnet nz. The histopathology report was collected postpartum, showed perforating folliculitis. We retrospectively analyzed the data of 8 patients with apd presenting to our center.
Pdf reactive perforating collagenosis is a rare dermatosis, firstly described in 1967 and. Histopathology study, performed in all patients using hematoxylineosin, masson trichromic. Diagnostic criteria include central hyperkeratotic or cup. Histopathological examination revealed ruptured epidermis with elimination of dermal. Reactive perforating collagenosis academic journals. Please visit the project page for details or ask questions at wikipedia talk. Acquired perforating dermatosis in patients with chronic. Acquired perforating dermatosis in a patient with chronic renal failure. Ortuno, acquired perforating dermatosis in a peritoneal dialysispatient. Acquired reactive perforating dermatosis wagner 20 jddg. Rare skin disease in which abnormal elastic tissue fibers, other connective tissue elements and cellular debris are expelled from papillary dermis through epidermis emedicine. Acquired perforating dermatosis apd is an uncommon disease.
A clinicopathologic study of thirty cases of acquired perforating dermatosis in korea. Treatment of acquired perforating dermatosis with narrowband. Pattern recognition is a vital skill for histopathological diagnosis of inflammatory dermatoses. Acquired reactive perforating dermatosis is a variant of prurigo nodularis. Garciamalinis aj, del valle sanchez e, sanchezsalas mp, et al. Apd has been reported to occur in association with various diseases, but is most commonly associated with dialysisdependent chronic renal failure crf or diabetes. Acquired perforating dermatosis is difficult to treat. 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 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. While used for both the inherited and acquired forms, the name reactive perforating dermatosis is also used for the more common acquired type. We present the clinicopathological features of apd in patients with diabetic kidney disease and discuss the recent advances in management. A transepidermal perforation of the epidermis filled with basophilic collagen bundles, dyskeratotic epidermal cells, neutrophilic debris, etc. Acquired reactive perforating dermatosis wagner 20. There was no history suggestive of systemic involvement. We describe effective therapy of acquired perforating dermatosis with narrowband uvb in 5 patients. Acquired perforating dermatosis apd, eps see separate chapter and pediatric rpc are sufficiently different to be considered independent clinical entities.
Acquired perforating dermatosis can histologically resemble kyrle disease, reactive perforating collagenosis, perforating folliculitis, and occasionally elastosis perforans serpiginosa. Acquired occurs in adulthood, usually in patients with diabetes or chronic renal. Diagnosis of acquired perforating dermatosis relies on the patients history, clinical presentation of the lesions, and especially histopathology with recognition of classic histological features. This dermatopathology histopathology reference contains information about over. Treatment of acquired perforating dermatosis with cantharidin. Pdf leucocytoclasic vascuitis associated with acquired reactive. Acquired perforating dermatosis in a patient on peritoneal.
Acquired reactive perforating dermatosis is a variant of. Histopathology of acquired perforating dermatosis at the. Evidence for combined transepidermal elimination of both collagen and elastic fibers. Coexistence of acquired perforating dermatosis and bullous. Acquired perforating dermatosis classically presents with severely pruritic follicular hyperkeratotic papules, sometimes umbilicated, on the hairbearing limbs of adults, as in our patient. Intensive light microscopical analysis of biopsied lesions was performed. Acquired perforating dermatoses apd is an uncommon skin disorder seen in patients with diabetes mellitus, chronic kidney disease, or both together.
The 2 distinct forms of are an inherited form that manifests in childhood and an acquired sporadic form that occurs in adulthood. Criteria included all parameters previously described by weigelt et al. Reactive perforating collagenosis is a rare skin disorder in which abnormal collagen fibres extrude through the epidermis outer layer of skin. Acquired perforating dermatosis apd is strongly associated with pruritus, chronic renal failure, andor diabetes mellitus. Acquired perforating dermatosis wiley online library. Skin biopsy is diagnostic for apd, and histopathology reveals findings of any of the four perforating dermatoses, and often more than one pattern is observed in a single patient 1,2.
Soepronos textbook is available on and includes detailed information on over 600 entities and includes four dvd diskettes with highresolution images that provide a virtual dermatopathology reference and guide. The low power view of perforating collagenosis shows an invaginating epidermal process figure 1. Mar 25, 2018 learn indepth information on acquired perforating dermatosis, its causes, symptoms, diagnosis, complications, treatment, prevention, and prognosis. In some literature, acquired perforating dermatosis is a third major group and is a catchall term for cases of perforating disease arising in adults, usually associated with a systemic disease. Acquired perforating dermatosis in a patient with chronic renal failure 11 figure 3. Here, we present two cases of inherited form of rpc in a family. Acquired perforating dermatosis apd is histopathologically characterized by transepidermal elimination of various dermal substances. Giant variant of acquired perforating dermatosis in a. His elder sister 7yearsold also had a history of similar lesions since the age of 3 years. Acquired reactive perforating dermatosis vashishtha r. Jul 01, 2011 rare skin disease in which abnormal elastic tissue fibers, other connective tissue elements and cellular debris are expelled from papillary dermis through epidermis emedicine. Dermatoscopic findings during apd show bright white clouds and structureless grey areas which may be useful to distinguish apd from prurigo. 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. Perforating dermatoses primary care dermatology society uk.
Acquired perforating dermatosis in renal and diabetic patients. Acquired perforating dermatosis apd is an uncommon disease characterized by lesions exhibiting transepidermal elimination of collagen or elastic fibers. Skin biopsy is mandatory for the diagnosis of acquired perforating dermatosis. 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. Histopathological examination shows a typical cupshaped ulceration in the epidermis containing cellular debris and collagen. All lesions disappeared completely after 10 to 15 exposures without.
Two distinct forms of the disease have been identified. Soeprono teaches and practices dermatopathology at loma linda university, school of medicine, department of dermatology. The dose was started at 400 mjcm 2 and increased to a maximum of 1500 mjcm 2. Kyrle disease is characterised by the formation of large papules with central keratin plugs and is often associated with hepatic, renal or diabetic. The classical morphology and histopathology of the lesion and demonstration of collagen fibres in the crater. Learn indepth information on acquired perforating dermatosis, its causes, symptoms, diagnosis, complications, treatment, prevention, and prognosis. This approach was well illustrated in the textbook. Mar 07, 2017 reactive perforating collagenosis is a rare skin disorder characterized by the transepidermal elimination of altered collagen through the epidermis. Acquired perforating disorders fitzpatricks dermatology. 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. Giant variant of acquired perforating dermatosis in a renal. Statistical comparison with previous results for prurigo nodularis pn showed that up is clearly a subtype of pn. A 5yearold male child presented with multiple, asymptomatic, raised lesions over dorsum of bilateral hands, feet and face since the age of 1 year.
Objective the aim of this study was to delineate the clinical and histopathological features of acquired perforating dermatosis and to investigate the potential. B in the lumbar region, erythematous papules, some following a linear path, suggesting koebner phenomenon arrows. Apd affects adults and is associated with systemic diseases, mainly diabetes mellitus and renal failure. This reflects that there is overlap with the other acquired perforating disorders of perforating folliculitis and kyrle disease. The purpose of this study was to clarify the clinical and histopathological features of apd, and evaluate.
In addition, clinical and microscopic features of epidermal perforation identical to those in acquired reactive perforating dermatosis ardp were observed. Summary acquired reactive perforating dermatosis is characterized by umbilicated. 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. A clinicopathologic study of thirty cases of acquired. Skin biopsy confirmed the clinical impression of acquired perforating dermatosis, a perforating disorder strongly associated with diabetes mellitus and chronic renal disease. Reactive perforating collagenosis in two siblings bmj. Acquired reactive perforating collagenosis associated with. Its diagnosis is based on biopsy and the treatment is not very clear.
Jul 01, 2011 uncommon autoimmune blistering disorder associated with glutensensitive enteropathy. Elastosis perforans serpiginosum accessed 27 august 2018. Pathology outlines elastosis perforans serpiginosum. Acquired perforating dermatosis statpearls ncbi bookshelf. This has resulted in some authors advocating for a combined designation of acquired perforating dermatosis apd. Casereport acquired perforating dermatosis in a patient on peritoneal dialysis. Acquired perforating dermatosis associated with metastatic.
Modi, acquired perforating dermatoses in patients with diabetic kidney disease on hemodialysis. A clinicopathologic study of thirty cases of acquired perforating dermatosis in korea article pdf available in annals of dermatology 262. The secondary form is known as acquired perforating dermatosis. Acquired perforating dermatosis has been reported to occur in association with various diseases, but is most commonly associated with dialysisdependent chronic renal failure or diabetes mellitus. Acquired reactive perforating dermatosis vashishtha r, agrawal u s. Both conditions fall within the group of perforating dermatoses. Pdf a clinicopathologic study of thirty cases of acquired. Perforating article about perforating by the free dictionary. Uncommon autoimmune blistering disorder associated with glutensensitive enteropathy. Acquired perforating dermatosis, elastosis perforans serpiginosa, kyrles disease, perforating folliculitis, reactive perforating collagenosis introduction acquired perforating dermatosis apd is histopathologically characterized by transepidermal elimination of various dermal substances.
In 1989, rapini et al coined the term acquired perforating dermatosis apd as a distinct entity. There have been an increasing number of reports of perforating dermatoses in association with systemic. Acquired perforating dermatosis apd is a skin disorder occurring in the patients with chronic renal failure crf, diabetes mellitus dm or both. Jan 01, 2010 acquired perforating dermatoses apd is an uncommon skin disorder seen in patients with diabetes mellitus, chronic kidney disease, or both together. Acquired perforating dermatosis associated with pregnancy. 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. Reactive perforating collagenosis rpc is a rare form of transepithelial elimination, in which genetically altered collagen is extruded through the epidermis. The code is valid for the year 2020 for the submission of hipaacovered transactions. Of the acquired and inherited form, inherited form is extremely rare. Acquired reactive perforating dermatosis summary acquired reactive perforating dermatosis is characterized by umbilicated erythematous papules and plaques with firmly adherent crusts. 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. Oct 26, 2017 examination revealed multiple discrete, erythematous, crateriform nodules and plaques with central plugs of an escharlike black crust. Apd can be divided into four diseases, according to the types of epidermal disruption and the natures of the eliminated materials.
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