Dermoscopy of Acquired Perforating Dermatoses: A Case Series and Review of the Literature

Acquired perforating dermatoses (APD) represent a group of papulonodular skin disorders characterized by transepidermal elimination of dermal components, most frequently arising in patients with poorly controlled chronic systemic conditions such as diabetes mellitus (DM) and chronic renal failure (CRF). The four classical subtypes include acquired reactive perforating collagenosis (RPC), Kyrle's disease (KD), elastosis perforans serpiginosa (EPS), and perforating folliculitis (PF). Owing to their rarity and the often-complex comorbidities of affected individuals, accurate diagnosis of APD may be challenging. In this context, dermoscopy has emerged as a valuable noninvasive tool that enhances diagnostic accuracy and supports clinical decision-making. This study aimed to characterize the dermoscopic features of APD through a case series and subsequent literature review. We present clinical and dermoscopic findings from a case series of 10 patients with APD followed by a literature review of 17 published case reports and 2 case series. The predominant dermoscopic pattern comprised a central yellow-to-brown structureless area, a surrounding white rim or a broader white structureless area with or without scaling, and an outer erythematous area containing dotted or hairpin vessels. Variations in these features appeared to reflect different stages of lesion evolution. The findings reinforce dermoscopy as a useful adjunct for the recognition, characterization, and monitoring of APD, providing additional insights into disease progression and contributing to improved diagnostic accuracy and clinical management.