J Korean Med Sci.  2004 Apr;19(2):283-288. 10.3346/jkms.2004.19.2.283.

Acquired Perforating Dermatosis in Patients with Chronic Renal Failure and Diabetes Mellitus

• Hong SB
• Park JH
• Ihm CG
• Kim NI

• KMID: 1733490
• DOI: http://doi.org/10.3346/jkms.2004.19.2.283

Abstract

Acquired perforating dermatosis (APD) is a skin disorder occurring in the patients with chronic renal failure (CRF), diabetes mellitus (DM) or both. 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. Twelves patients with APD associated with CRF and DM were enrolled in the study. In six patients who required hemodialysis, the lesions appeared 2-5 yr (mean 3 yr) after the initiation of dialysis, 18-22 yr (mean 19.3 yr) after the occurrence of DM. The other patients who did not receive hemodialysis noted the lesions 4-17 yr (mean 9.5 yr) after the onset of DM. All patients had an eruption of generally pruritic keratotic papules and nodules, primarily on the extensor surface of the extremities and the trunk. The histologic features of our cases showed a crateriform invagination of the epidermis filled by a parakeratotic plug and basophilic cellular debris. The period of treatment for patients who suffered from severe (7 cases) or very severe (3 cases) on the pruritus intensity was longer than that of patients who had mild pruritus (2 cases). These data showed that scratching appear to play a critical part in the pathogenesis of APD.

Keyword

Skin Diseases; Acquired Perforating Dermatosis; Kidney Failure, Chronic; Diabetes Mellitus

MeSH Terms

Adult
Aged
Diabetes Mellitus, Type I/*complications
Diabetes Mellitus, Type II/*complications
Female
Histamine H1 Antagonists/therapeutic use
Human
Kidney Failure, Chronic/*complications
Male
Middle Aged
Phototherapy
Pruritus/drug therapy/etiology
Skin Diseases/drug therapy/*etiology/pathology
Tranquilizing Agents/therapeutic use

Figure

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  Fig. 1 Linear hyperkeratotic umbilicated papules on the extensor surface of the extremities and the trunk (A, B, C, D). Note Koebner phenomenon from scratching.

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  Fig. 2 Collagen fibers with near-vertical extrusion into keratinous epidermal depression (Masson trichrome stain, ×200).

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  Fig. 3 Kyrle's disease showing a heavy keratotic, partly parakeratotic plug containing basophilic debris lies in an invagination of the epidermis (H&E, ×40).

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  Fig. 4 Vessle wall thickening and inflammatory cell infiltrates in the upper dermis (H&E, ×100).

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