Acquired perforating dermatosis

Classification according to ICD-10
L87	Disorders of transepidermal elimination
ICD-10 online (WHO version 2019)

The acquired perforating dermatosis is a nodule-forming, itchy skin disorder affecting approximately 10% of dialysis patients , in patients with advanced chronic renal disease in renal transplant patients and diabetics occurs.

Pathogenesis

Acquired perforating dermatosis is similar to idiopathic perforating dermatosis (Kyrle's disease) , but occurs in connection with chronic kidney failure or other systemic diseases . The risk of the disease is particularly high in people with diabetes or black skin.

There may be a disturbance in the transdermal elimination of skin components. The cause of this disorder is unknown. Are suspected among others

• a disruption of the growth of the epidermis or connective tissue of the skin,
• Scratching, which leads to necrosis and inflammation of the skin,
• a foreign body reaction to a change in the composition of the skin and
• Deposits of uric acid crystals in the skin that lead to an inflammatory reaction.

clinic

Arched nodules (papules) with a diameter of 2 to 8 mm are formed, which contain a keratinized plug in their center. The papules can merge into linear structures. They often occur on the trunk of the body, upper arms and thighs, on hairy areas of the body, face and scalp. The papules can appear along scratch marks ( isomorphic irritant effect ). On light skin the lesions appear pink, on dark skin the papules are hyperpigmented. There is often a central withdrawal. There is intense itching.

histology

The tissue (histological) examination shows invaginations of the epidermis with a cornified plug containing basophilic cell debris . In the lesions, hair follicles or their fragments can contain uric acid or hydroxyapatite crystals. Over time, a chronic inflammatory reaction with the formation of granulomas occurs in the papules .

therapy

The disease is persistent and difficult to treat. Among other things, the following are used:

• Skin creams with high moisture content,
• Corticoids for external use ,
• horn-releasing substances (keratolytics) ,
• Retinoids for external use,
• Isotretinoin for ingestion or
• Vitamin A .

swell

• UC Brewster et al .: Dermatological Disease in Patients With CKD . In: American Journal of Kidney Diseases . February 2008, p. 331-344 (on- line ).

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !