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Acquired Perforating Dermatosis: A Disorder Treatable with Mycophenolate Mofetil
Shaima Al-Bader1, Kamel El-Reshaid2, John Madda3
1Asad Al-Hamad Dermatology Center, Ministry of Health, Safat, Kuwait.
Abstract:
Acquired perforating dermatosis (APD) is an adult skin disease characterized by an umbilicated papulonodular rash with transepidermal elimination of dermal components such as collagen and/or elastin. It is frequently associated with multiple medications and diseases such as diabetes and chronic renal failure. It is a disabling disease with severe pruritus in 83.3% of cases and generalized ulcerating lesions that are associated with infections and scarring. Nearly 10% of renal patients are affected. Supportive measurements of disease activity and previous medications failed to halt its natural progression. In our study, we documented significant improvements in the severity of the disease as measured by the eczema area and severity index (EASI), in 32 patients with the renal disease through the use of mycophenolate mofetil (MMF), with EASI decreasing from 31 [interquartile range (IQR) = 4] to 3 (IQR = 4) by the 3rd month. Moreover, such changes persisted for up to 2 years despite a decrease in the dose of MMF to half after 1 year. In conclusion, our study showed that MMF is a safe and effective immunosuppressive drug for short- and intermediate-term therapy of severe APD and confirmed its autoimmune etiology.
Insights
Mycophenolate mofetil (MMF) significantly improved acquired perforating dermatosis (APD) in renal patients. This immunosuppressive therapy reduced disease severity and symptoms for up to two years.
Area of Science:
- Dermatology
- Immunology
- Nephrology
Background:
- Acquired perforating dermatosis (APD) is a severe skin condition often linked to diabetes and chronic kidney disease.
- APD causes disabling pruritus and ulcerating lesions, frequently unresponsive to conventional treatments.
- Nearly 10% of patients with renal disease are affected by APD.
Purpose of the Study:
- To evaluate the efficacy of mycophenolate mofetil (MMF) in treating severe acquired perforating dermatosis (APD) in patients with renal disease.
- To assess the safety and long-term effectiveness of MMF for APD management.
Main Methods:
- A study involving 32 patients with renal disease and severe APD.
- Treatment with mycophenolate mofetil (MMF).
- Disease severity assessed using the Eczema Area and Severity Index (EASI).
Main Results:
- Significant reduction in EASI scores from 31 to 3 within 3 months of MMF treatment.
- Sustained improvement in disease severity for up to 2 years, even with reduced MMF dosage.
- MMF demonstrated a favorable safety profile in this patient cohort.
Conclusions:
- Mycophenolate mofetil (MMF) is a safe and effective treatment for severe acquired perforating dermatosis (APD), particularly in patients with renal disease.
- MMF offers both short- and intermediate-term therapeutic benefits for APD.
- The study supports an autoimmune etiology for APD.
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