RESUMEN
Acquired reactive perforating collagenosis is a unique perforating dermatosis, characterized clinically by umbilicated hyperkeratotic papules or nodules and histologically by a focal hyperkeratosis in direct contact with transepidermal perforating dermal collagen. Several inflammatory or malignant systemic diseases may coexist with acquired reactive perforating collagenosis. The possible biochemical or immunological mechanisms of the systemic diseases, potentially responsible for the development and appearance of acquired reactive perforating collagenosis, are still under investigation. Several topical treatments, ultraviolet B phototherapy and allopurinol p.o. administration may be effective.
Asunto(s)
Enfermedades del Colágeno , Enfermedades de la Piel , Alopurinol/uso terapéutico , Colágeno/metabolismo , Enfermedades del Colágeno/diagnóstico , Enfermedades del Colágeno/epidemiología , Enfermedades del Colágeno/etiología , Enfermedades del Colágeno/terapia , Comorbilidad , Diabetes Mellitus/epidemiología , Femenino , Humanos , Masculino , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/epidemiología , Enfermedades de la Piel/etiología , Enfermedades de la Piel/terapia , Terapia UltravioletaRESUMEN
HISTORY: A 60-year-old man with diabetes mellitus and chronic renal insufficiency needing hemodialysis was admitted with a 3 months history of multiple hyperkeratotic papules on the trunk and extremities partly ulcerated with a keratotic central plug. INVESTIGATIONS: Laboratory tests revealed elevated levels of blood urea nitrogen, creatinine, and HbA (1c). Histopathology showed vertical strands of collagen perforating from the ulcerated lesions. COURSE, DIAGNOSIS AND TREATMENT: The biopsy specimen was consistent with acquired reactive perforating collagenosis. The progression was stopped and secondary wound healing was initiated after two weeks of therapy with allopurinol and PUVA. CONCLUSION: Acquired reactive perforating collagenosis should be considered when ulcera with oystershell-like keratotic plugs are found especially in patients with predisposing diseases like diabetes and renal insufficiency. A good interdisciplinary cooperation between internist and dermatologist is crucial for the early recognition by histopathology and the immediate treatment.
Asunto(s)
Enfermedades del Colágeno/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Fallo Renal Crónico/epidemiología , Enfermedades de la Piel/epidemiología , Alopurinol/uso terapéutico , Antimetabolitos/uso terapéutico , Nitrógeno de la Urea Sanguínea , Enfermedades del Colágeno/tratamiento farmacológico , Enfermedades del Colágeno/patología , Creatinina/sangre , Diabetes Mellitus Tipo 2/complicaciones , Hemoglobina Glucada/análisis , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Terapia PUVA , Piel/patología , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/patología , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/epidemiología , Úlcera Cutánea/patología , Resultado del TratamientoRESUMEN
Collagenous colitis should be added to the differential diagnosis of chronic, watery, nonbloody diarrhea with normal endoscopic findings. Patients with collagenous colitis are often middle-aged women previously diagnosed as having irritable bowel syndrome. The diagnosis of collagenous colitis is based on histologic evaluation of a rectal biopsy specimen. Biopsy shows a thickened, subepithelial, acellular, eosinophilic collagen band. Symptoms often resolve after treatment with oral sulfasalazine.