ACQUIRED PERFORATING DISORDER
By Gary M. White, MD
Multiple nodules with a central keratotic core on the legs of a dialysis patient.
Acquired perforating disorder (APD), AKA Kyrle disease, is the primary variant of a group of perforating disorders. The underlying process is transepidermal elimination of dermal collagen. Triggers of lesions seem to involve local trauma, e.g., scratching.
APD has been associated with:
- Diabetes mellitus
- Chronic renal failure
- Drugs: biologics (e.g., natalizumab, gefitinib, infliximab, etanercept, bevacizumab, erlotinib and sorafenib) and protease inhibitors (e.g., indinavir and telaprevir).
Hyperkeratotic papules and nodules develop. A central keratotic plug is characteristic. Lesions may be very pruritic and a component of prurigo nodularis may be present.
No treatment is consistently effective. The patient should be encouraged to not scratch although s/he may not be successful. Topical steroids and emollients to reduce xerosis, itch, and inflammation may be very helpful in some cases [JAMA Derm 2014;150;1371]. UVB may be tried.
Diabetes x 18 years. Virtual Grand Rounds in Dermatology
Dermatol Pract Concept. 2015 Apr; 5(2): 75–77
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