Acquired Perforating Dermatosis

Aka: Acquired Perforating Dermatosis, Perforating Dermatosis

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II. Pathophysiology

  1. Perforating Dermatosis present with papulonodular rashes characterized by transepidermal elimination of dermal components
  2. Acquired Perforating Dermatosis (described on this page), is characterized by transepidermal elimination of connective tissue

III. Types: Perforating Dermatosis

  1. Secondary Perforating Dermatosis (due to CKD, diabetes)
    1. Acquired Perforating Dermatosis (described on this page)
  2. Primary Causes of Perforating Dermatosis
    1. Kyrle Disease (KD)
      1. Transepidermal elimination of abnormal keratin
      2. May be a variant of Prurigo Nodularis
    2. Reactive Perforating Collagenosis (RPC)
      1. Childhood onset, with an transepidermal elimination of Collagen fibers
    3. Elastosis Perforans Serpinginosum (EPS)
      1. Childhood onset, with an transepidermal elimination of elastic fibers
    4. Perforating Folliculitis (PF)
      1. Transepidermal elimination of follicular contents

IV. Causes

  1. Chronic Kidney Disease (occurs in 10% of Hemodialysis patients)
  2. Diabetes Mellitus

V. Findings

  1. Characteristics
    1. Pruritic
    2. Umbilicated round Papules and Plaques
    3. Central hyperkeratotic crust or core (core is often excoriated from lesion)
  2. Distribution
    1. Most common on lower extremities
    2. May also affect upper extremities and trunk
  3. Provocative
    1. Trauma and scratching result in additional skin lesions (Koebner Phenomenon)

VI. Differential Diagnosis

  1. Superficial Folliculitis
  2. Prurigo Nodularis
  3. Insect Bite
  4. Scabies
  5. Keratosis Pilaris

VII. Management

  1. Treat the underlying conditions
  2. Symptomatic
    1. Corticosteroids (topical, systemic)
    2. Keratolytics (e.g. salicylic Acid, Retinoids, urea)
    3. Antihistamines (e.g. Cetirizine)
    4. Skin Emollients
    5. Ultraviolet BPhototherapy

VIII. Resources

  1. Harbaoui (2024) Acquired Perforating Dermatosis, StatPearls, Treasure Island (FL)
    1. https://www.ncbi.nlm.nih.gov/books/NBK539715/

IX. References

  1. Wolff (2017) Fitzpatrick's Clinical Dermatology, 8th ed, McGraw Hill, p. 429
  2. McConnell (2024) Am Fam Physician 110(1):81-2 [PubMed]

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