Acquired perforating calcific collagenosis after topical calcium chloride exposure

A 24‐year‐old healthy man presented with a 6‐week history of numerous umbilicated coalescing erythematous papules with some scale and crust on his anterior medial thighs. The eruption began 1 to 2 weeks after he spilled calcium chloride rock salts on his pants while salting the sidewalk during a snow storm. The salts dissolved and remained in contact with his skin for at least 4 hours until he was able to change clothes. A skin biopsy shows thick and thin collagen fibers with partial calcification in the papillary and upper reticular dermis associated with a sparse infiltrate of neutrophils, lymphocytes and mononuclear histiocytes. There are foci of transepidermal elimination of calcified fibers with adjacent epidermal hyperplasia and ortho‐ and parakeratosis. Von Kossa stain highlights calcification of the fibers, and trichrome stain confirms the fibers are collagen. A Verhoeff‐van Gieson stain shows no abnormality of elastic fibers. The patient was treated with topical betametasone diproprionate cream twice daily for 3 weeks, as well as a short course of oral levofloxacin and topical gentamicin cream. The lesions resolved over 3 weeks with residual scarring. We report a unique case of acquired perforating calcific collagenosis secondary to topical calcium chloride exposure. Patel RR, Zirvi M, Walters RF, Kamino H. Acquired perforating calcific collagenosis after topical calcium chloride exposure.     

反应性穿通性胶原病

报告1例反应性穿通性胶原病.患者女,37岁.面部、四肢出现多发性红色丘疹8个月,无系统疾病病史.皮损组织病理柃查示表皮内有杯状角栓,角栓下方为变性的胶原,并与真皮相通,弹性纤维染色阴性.诊断:反应性穿通性胶原病.     

Coexistent lepromatous leprosy and reactive perforating collagenosis

The cases of two young men with coexistent lepromatous leprosy and reactive perforating collagenosis are reported. Although both patients' parents were consanguineous, experimental induction of Koebner's phenomenon by superficial scratching failed to produce the lesions of reactive perforating collagenosis. The lesions of reactive perforating collagenosis showed a satisfactory response to treatment with topical retinoic acid.     

Allopurinol in the treatment of acquired reactive perforating collagenosis

Acquired reactive perforating collagenosis is a perforating dermatosis usually associated with different systemic diseases, mainly diabetes mellitus and/or chronic renal insufficiency. Different therapies have been tried but treatment is not standardized yet and remains a challenge. In the last few years, allopurinol has been reported as a good therapeutic option for acquired reactive perforating collagenosis. We describe the case of a 73-year-old man affected by acquired reactive perforating collagenosis associated with diabetes type 1 and chronic renal failure with secondary hyperparathyroidism. The patient was successfully treated with allopurinol 100mg once/day p.o..     

Reactive perforating collagenosis

Five cases of reactive perforating collagenosis (RPC) are reported. Four of these cases were in a father and his three children. This is the first reported instance of RPC occurring in more than one generation. The clinical and histological features of the disease are described and compared with other disorders showing perforating skin lesions, such as Kyrle's disease, perforating folliculitis and elastosis perforans serpiginosa. Evidence is presented to show that RPC is a genetically determined disorder with an inherited predisposition to an unusual skin reaction to superficial trauma.     

Case for diagnosis. Hyperpigmented and excoriated papules and nodules in a diabetic patient

Reactive perforating collagenosis is a rare perforating dermatosis clinically characterized by intensely pruritic hyperpigmented papules, plaques, and nodules with a central keratotic plug. Histopathology reveals transepidermal elimination of collagen fibers. Its pathophysiology is still under investigation, but the acquired form has been linked to systemic conditions such as diabetes mellitus and chronic kidney disease. However, it has also been described as a paraneoplastic syndrome. The authors present the case of a 65-year-old diabetic patient in which a myeloproliferative neoplasm was suspected.     

AN ADULT CASE OF REACTIVE PERFORATING COLLAGENOSIS

A case of reactive perforating collagenosis (RPC) is reported. The patient was a 20-year-old man with suspected Wegener's granulomatosis, who had asymptomatic papular lesions on his elbows. Histologically these papules were compatible with RPC. Electron microscopic studies showed masses of fine filamentous material around well-developed histiocytes. The differentiation from collagenoma perforans verruciforme (CPV) is discussed.     

A NEW TREATMENT FOR ACQUIRED REACTIVE PERFORATING COLLAGENOSIS

Acquired reactive perforating collagenosis is reported in an insulin dependent diabetic patient with renal impairment, managed successfully with surgical debridement and split skin grafting. The literature on treatment of reactive perforating collagenosis is reviewed.     

Reactive perforating collagenosis in Hodgkin's disease

Two patients with Hodgkin's disease developed a condition that has been termed "reactive perforating collagenosis." In both cases, pruritus was severe and seemed to be responsible for the vigorous rubbing and scratching that caused the skin lesions. In one patient, the lesions disappeared upon remission of Hodgkin's disease. Perforating collagenosis has been described in children as a hereditary disease, and has also been described in adults with diabetes and on hemodialysis. On the basis of the changes seen in our two patients with Hodgkin's disease, we suggest that perforating collagenosis is simply a consequence of intense scratching.     

Acquired perforating dermatosis: comparison of an acquired perforating dermatosis and perforation as an incidental histologic finding

A 66-year-old Japanese woman with a rare acquired perforating disorder, usually called adult-type reactive perforating collagenosis, is reported. The patient had poorly controlled diabetes mellitus with retinopathy under oral diabetic medication. She was found to have multiple papules and umbilicated nodules on the trunk and four extremities when she was admitted and examined for the origin of jaundice and severe pruritus of sudden onset. In the biopsy specimen, collagen fibers were observed to be eliminated from the dermis through epidermal tunnel-like perforations. No elastic fibers were eliminated, and serial sectioning of the specimen could not prove follicular perforation. Adenocarcinoma of the biliary duct was found to be the cause of the jaundice with pruritus. Although such cases are usually classified as acquired reactive perforating collagenosis of adult onset, proposed reclassification for acquired perforating disorders is discussed. Another case which also showed perforation and transepithelial elimination of both collagen and elastic fibers as an incidental histologic finding is described. Such elimination seems to be a not uncommon step in the formation of pruriginous eruptions. Therefore, these cases should be differentiated from acquired-type characteristic perforating disorders.     

Treatment of perforating collagenosis of diabetes and renal failure with allopurinol

We present a case of widespread reactive perforating collagenosis in a 63-year-old woman undergoing haemodialysis after diabetic nephropathy, who was treated successfully with allopurinol. The patient responded well and rapidly to a dose of 100 mg allopurinol daily. It is suggested that more patients with reactive perforating collagenosis may benefit from allopurinol therapy.     

Acquired perforating dermatosis associated with pregnancy

Acquired perforating collagenosis (APC) is a rare condition in which altered collagen and elastin fibres undergo transepidermal elimination. The pathogenesis is unknown but it is usually associated with underlying systemic disease, most commonly diabetes mellitus and renal impairment. We describe a case of an acquired perforating disorder occurring in pregnancy. APC is a diagnosis that can easily be missed, especially in atypical cases such as ours, and clinicians and histopathologists need to be aware of this condition to avoid unnecessary patient morbidity.     

Reactive perforating collagenosis: a condition that may be underdiagnosed

Reactive perforating collagenosis is a perforating disorder developing in adults, usually in association with diabetes mellitus or renal failure. We present three cases diagnosed at the Royal Prince Alfred Hospital in a 5 month period. All three patients had long-standing diabetes mellitus, hypertension, hypercholesterolaemia and ischaemic heart disease. Each patient presented with generalized pruritus and a papular eruption across the trunk and limbs. More than one biopsy or multiple levels were needed before the diagnostic histological features were seen. The first patient responded to 0.5% phenol with 10% glycerine in sorbolene cream. The second patient did not respond to topical betamethasone diproprionate 0.5 mg/g cream and antihistamines (hydroxyzine 25 mg nocte) and required narrow-band ultraviolet (UV) B. The third patient, having failed to respond to topical betamethasone diproprionate 0.5 mg/g cream and wet dressings, antihistamines (hydroxyzine 25 mg tds and doxepin 50 mg nocte) and UVB required acitretin 25 mg orally per day. Because reactive perforating collagenosis responds to treatment, we believe this condition should be considered in patients with diabetes mellitus or renal failure presenting with pruritus and that biopsy of intact lesions may need multiple levels to help establish the diagnosis.     

Reactive perforating collagenosis--a case report

A case of reactive perforating collagenosis (RPC) is presented. The lesions appeared in a female at the age of 4 years. So far, the patient has had only two episodes of RPC and both were precipitated by cold weather. The lesions showed the Koebner phenomenon. Histological sections showed the changes of “transepidermal elimination of necrobiotic connective tissue”.     

反应性穿通性胶原病1例

患者女,21岁。下肢红斑、丘疹伴瘙痒1个月,无系统疾病。皮肤科检查：双下肢红斑、丘疹．中心有脐凹,内含角质栓。皮损组织病理示：表皮缺如,下方为坏死胶原纤维穿通表皮。诊断：反应性穿通性胶原病。     

Dipeptidyl peptidase‐4 inhibitor‐associated bullous pemphigoid in a patient with acquired reactive perforating collagenosis

Bullous pemphigoid (BP) is a common autoimmune blistering disorder with unknown etiology. Recently, increasing numbers of BP cases which developed under the medication with dipeptidyl peptidase‐4 inhibitors (DPP4i), widely used antihyperglycemic drugs, have been reported in published works. Here, we report a case of DPP4i (teneligliptin)‐associated BP that developed in a 70‐year‐old Japanese man. Interestingly, the patient had acquired reactive perforating collagenosis (ARPC), which is also known to be associated with the onset of BP. In the present case, clinical, histopathological and immunological findings suggested that DPP4i rather than ARPC was associated with the onset of BP.     

Acquired reactive perforating collagenosis associated with papillary thyroid carcinoma: a paraneoplastic phenomenon?

Acquired reactive perforating collagenosis (ARPC) is an uncommon dermatosis characterized by transepidermal elimination of altered collagen. It is commonly seen in patients with diabetes mellitus and/or chronic renal insufficiency. Rarely, it has been reported in association with malignancy and other conditions. We report a 30‐year‐old woman with insulin‐dependent diabetes mellitus who presented with multiple, discrete, violaceous, hyperkeratotic papules on the extensor aspects of both legs, characteristic of ARPC. Four months later, metastatic papillary thyroid cancer was diagnosed. This case further supports the possibility that ARPC may represent a paraneoplastic phenomenon.     

Acquired reactive perforating collagenosis in association with prostate adenocarcinoma,chronic lymphocytic leukemia,and Graves’ disease

Acquired reactive perforating collagenosis is a rare skin disorder characterized by the presence of umbilicated pruritic papules and nodules. Transepidermal elimination of altered and perforating bundles of basophilic collagen from the epidermis is a characteristic histologic feature of acquired reactive perforating collagenosis. Along with its well-known association with systemic diseases such as diabetes mellitus, chronic renal failure, and dermatomyositis, there are reports of acquired reactive perforating collagenosis being associated with malignancies. Herein, we present a case of acquired reactive perforating collagenosis associated with chronic lymphocytic leukemia, prostate adenocarcinoma, and Graves's disease. Clinicians are required to be more vigilant in evaluating patients with acquired reactive perforating collagenosis due to its unique association with malignancies and other systemic diseases.     

Familial Reactive Perforating Collagenosis: A Case Report

Reactive perforating collagenosis is characterised by trans-epidermal elimination of collagen and is hypothesized to be both autosomally dominant and recessive. We report a family in which two brothers and a sister had lesions of reactive perforating collagenosis.     

Erworbene reaktive perforierende Kollagenose nach Herpes zoster als isotopische Antwort?

Reactive perforating collagenosis is a disease whose pathogenesis is still not fully understood. Histological findings are degenerated collagen bundles which are arranged in vertical direction penetrating the epidermis into a dome-shaped crater. Usually diabetes mellitus and renal failure can be found among patients with reactive perforating collagenosis. To date, there have been five cases described where the eruption of reactive perforating collagenosis followed herpes zoster infection. This could be a form of Wolf's isotopic response, a term that is used for dermatoses which arise after the healing of a preexisting dermatosis. We report the sixth case of a herpes zoster-associated reactive perforating collagenosis and discuss the current literature.