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Acquired perforating dermatosis in patients with chronic renal failure and diabetes mellitus.

Hong SB, Park JH, Ihm CG, Kim NI - J. Korean Med. Sci. (2004)

Bottom Line: Twelve patients with APD associated with CRF and DM were enrolled in the study.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).

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea. nikim@khmc.or.kr

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. Twelve 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.

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

Mentions: The histologic features of our ten cases showed a vertically oriented, shallow, cup-shaped invagination of the epidermis, forming a short channel. The channel was lined by acanthotic epithelium along the sides. At the base of the invagination there was an attenuated layer of keratinocytes that in some foci appear eroded. Within the channel there was densely packed degenerated basophilic staining material, neutrophils, and basophilically altered collagen bundles. Vertically oriented perforating bundles of collagen were present interposed between the keratinocytes of the attenuated bases of the invagination. Masson trichrome staining showed transepidermal elimination of the collagen (Fig. 2). Verhoeff-van Gieson staining for elastic fibers was negative in the epidermis and in the crater. The overall histologic appearances were consistent with a reactive perforating collagenosis. And the histologic features of two cases showed central epidermal invagination filled with heavy keratotic, partly parakeratotic plug and basophilic debries. Many vacuolated cells and a few dyskeratotic cells were seen below the keratotic plug (Fig. 3). Masson's trichrome and Verhoeff-van Gieson stains was negative in the epidermis and in the crater. The overall histologic appearances were consistent with a Kyrle's disease. In eight cases, the dermis below the crater contained numerous vessels, many of which had a thickened and PAS-positive wall and a mixed infiltrate of mononuclear cells and neutrophils with occasional eosinophils (Fig. 4).


Acquired perforating dermatosis in patients with chronic renal failure and diabetes mellitus.

Hong SB, Park JH, Ihm CG, Kim NI - J. Korean Med. Sci. (2004)

Kyrle's disease showing a heavy keratotic, partly parakeratotic plug containing basophilic debris lies in an invagination of the epidermis (H&E, ×40).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2822312&req=5

Figure 3: Kyrle's disease showing a heavy keratotic, partly parakeratotic plug containing basophilic debris lies in an invagination of the epidermis (H&E, ×40).
Mentions: The histologic features of our ten cases showed a vertically oriented, shallow, cup-shaped invagination of the epidermis, forming a short channel. The channel was lined by acanthotic epithelium along the sides. At the base of the invagination there was an attenuated layer of keratinocytes that in some foci appear eroded. Within the channel there was densely packed degenerated basophilic staining material, neutrophils, and basophilically altered collagen bundles. Vertically oriented perforating bundles of collagen were present interposed between the keratinocytes of the attenuated bases of the invagination. Masson trichrome staining showed transepidermal elimination of the collagen (Fig. 2). Verhoeff-van Gieson staining for elastic fibers was negative in the epidermis and in the crater. The overall histologic appearances were consistent with a reactive perforating collagenosis. And the histologic features of two cases showed central epidermal invagination filled with heavy keratotic, partly parakeratotic plug and basophilic debries. Many vacuolated cells and a few dyskeratotic cells were seen below the keratotic plug (Fig. 3). Masson's trichrome and Verhoeff-van Gieson stains was negative in the epidermis and in the crater. The overall histologic appearances were consistent with a Kyrle's disease. In eight cases, the dermis below the crater contained numerous vessels, many of which had a thickened and PAS-positive wall and a mixed infiltrate of mononuclear cells and neutrophils with occasional eosinophils (Fig. 4).

Bottom Line: Twelve patients with APD associated with CRF and DM were enrolled in the study.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).

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea. nikim@khmc.or.kr

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. Twelve 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.

Show MeSH
Related in: MedlinePlus