Ann Dermatol.  2014 Apr;26(2):162-171. 10.5021/ad.2014.26.2.162.

A Clinicopathologic Study of Thirty Cases of Acquired Perforating Dermatosis in Korea

• Kim SW
• Kim MS
• Lee JH
• Son SJ
• Park KY
• Li K
• Seo SJ
• Han TY

• KMID: 2171650
• DOI: http://doi.org/10.5021/ad.2014.26.2.162

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.

Keyword

Acquired perforating dermatosis; Elastosis perforans serpiginosa; Kyrle's disease; Perforating folliculitis; Reactive perforating collagenosis

MeSH Terms

Biopsy
Dermis
Diabetes Mellitus
Diagnostic Tests, Routine
Folliculitis
Histamine Antagonists
Humans
Kidney Failure, Chronic
Korea
Lower Extremity
Medical Records
Pruritus
Retrospective Studies
Skin Diseases*
Steroids
Histamine Antagonists
Steroids

Figure

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  Fig. 1 Multiple erythematous linear arranged hyperkeratotic umbilicated papules on the trunk of patient 19. Note Koebner phenomenon from scratching.

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  Fig. 2 (A) Reactive perforating collagenosis-like keratotic plugged, umbilicated papules on the lower extremities of patient 14. (B) Cup-shaped invagination of the epidermis plugged with necrotic inflammatory debris (H&E, ×40). (C) There were vertically oriented collagen bundles at the base of the lesions (H&E, ×100). (D) Transepidermal elimination of the collagen bundles (Masson-trichrome stain, ×200).

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  Fig. 3 (A) Kyrle's disease-like hyperkeratotic papules on the lower extremities of patient 3. (B) Central epidermal invagination containing parakeratotic debris (H&E, ×40). (C) Parakeratotic plug containing basophilic debris (H&E, ×200).

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  Fig. 4 (A) Elastosis perforans serpiginosa-like serpiginous hyperkeratotic plaques on the abdomen of patient 8. (B) Narrow transepidermal channels containing coarse elastic fibers and basophilic debris (H&E, ×40). (C, D) Transepidermal elimination of elastic fibers (Verhoeff-van Gieson stain; C: ×100, D: ×200).

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  Fig. 5 (A) Perforating folliculitis-like follicular infiltrating papules on the thigh of patient 25. (B) Dilated follicular infundibulum filled with mixture of keratin, basophilic debris, inflammatory cells and degenerated collagen fibers (H&E, ×100).

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