Clinicopathologic and dermoscopic features of acquired perforating dermatosis: case report

Authors: Jay-V James G. Barit, Felix Paolo J. Lizarondo, Eileen Liesl A. Cubillan

Abstract

Introduction: Acquired perforating dermatosis (APD) belongs to the class of perforating dermatoses, disorders that represent transepidermal elimination of dermal connective tissue. It is common among patients with underlying diabetes mellitus or chronic kidney disease.

Case Summary: We report a case of a 47 year old male who presented with a four-year history of initially few sporadic erythematous papules that spontaneously ulcerate and heal with hyperpigmentation, with associated occasional tenderness and pruritus. He is a known Type 2 diabetic for nine years and hypertensive for three years. On physical examination, there were multiple round, brown, firm scaly papules some with a central keratotic plug in the abdomen and extremities. Dermoscopy of the lesions showed three zones: a central keratotic plug in the center, a surrounding whitish-gray structureless area, and a peripheral brown pigmentation. Routine histology showed epidermal hyperplasia, transepidermal elimination of degenerated collagen fibers with a central basophilic plug consisting of keratin, collagen and a mixed inflammatory infiltrate. The patient was given tretinoin 0.05% cream applied once daily for his lesions.

Conclusion: Acquired perforating dermatosis is a distinct dermatologic disorder common in patients with diabetes mellitus and chronic disease presenting as hyperkeratotic papules with associated pruritus. As a highly variable histopathologic entity, its proper recognition clinically allows for management. The most common histopathologic pattern of APD is transepidermal elimination of collagen fibers seen in reactive perforating collagenosis. Distinct dermoscopic findings of a three-zone central hyperkeratosis, structureless area and reticulate hyperpigmenation may aide in clinical diagnosis as well as biopsy site selection.

 

Citation

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Keywords

acquired perforating dermatosis, diabetes mellitus, chronic kidney disease, dermoscopy

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