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Acquired perforating dermatosis: clinicopathological study of 31 cases, emphasizing pathogenesis and treatment
A J García-Malinis1, E Del Valle Sánchez2, M P Sánchez-Salas3
1Unit of Dermatology, Hospital San Jorge, Huesca, Spain.
Background:
Acquired perforating dermatosis (APD) is a rare group of skin disorders of unknown aetiology and pathogenesis and is associated with several systemic diseases.
Objective:
We review the clinicopathological features, associated systemic diseases and treatment response in a series of APD patients.
Methods:
We conducted a retrospective observational study of all patients histologically diagnosed with APD in Hospital San Jorge (Huesca, Spain) between 2002 and 2014. Demographic and clinical features were collected from medical records. Statistical analyses were carried out using SPSS software (version 20.0; IBM Corp, Armonk, NY, USA).
Results:
The study population consisted of 31 patients (19 women and 12 men), with a mean age of 54 years. Reactive perforating collagenosis (n = 15, 45%) was the most common histopathologic type. The most frequently affected area was the lower limbs (66.6%, n = 22), and pruritus was present in 19 patients (61.3%, P = 0.005). Arterial hypertension (30.3%) was the most common associated condition. Five patients were receiving treatment with infliximab when diagnosed with APD. Most patients responded to topical steroids and oral antihistamines (n = 15).
Limitations:
This study is retrospective, and the sample size is limited.
Conclusion:
Acquired perforating dermatosis is an underdiagnosed dermatosis frequently associated with systemic disorders. Its pathogenesis may involve vascular damage, not only in patients with diabetes, but also in those with arterial hypertension and chronic venous insufficiency. Control of pruritus and underlying extracutaneous disorders, as well as discontinuation of the treatment with biologics, are important aspects of the management of this dermatosis.
Insights
Acquired perforating dermatosis (APD) is an underdiagnosed skin condition linked to systemic diseases. Management focuses on controlling itch, treating underlying conditions, and potentially stopping biologic treatments.
Area of Science:
- Dermatology
- Pathology
Background:
- Acquired perforating dermatosis (APD) is a rare skin disorder with unknown causes.
- It is often associated with various systemic diseases.
Purpose of the Study:
- To review clinicopathological features of APD.
- To identify associated systemic diseases in APD patients.
- To evaluate treatment responses in APD cases.
Main Methods:
- Retrospective observational study of histologically diagnosed APD patients.
- Data collected from 2002-2014 at Hospital San Jorge, Spain.
- Demographic, clinical features, and treatment data were analyzed.
Main Results:
- 31 patients (mean age 54) diagnosed with APD.
- Reactive perforating collagenosis was the most common type (45%).
- Lower limbs were most affected (66.6%); pruritus was common (61.3%).
- Arterial hypertension (30.3%) was the most frequent comorbidity.
- Most patients responded to topical steroids and antihistamines.
Conclusions:
- APD is underdiagnosed and linked to systemic disorders.
- Pathogenesis may involve vascular damage, especially in patients with hypertension or venous insufficiency.
- Management requires controlling pruritus, addressing systemic issues, and considering biologic therapy cessation.
