ACQUIRED PERFORATING DISORDER

By Gary M. White, MD

Acquired Perforating Disorder. Kyrle disease 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:

Clinical

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.

Treatment

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.

Additional Pictures

Acquired Perforating Disorder.  Kyrle disease Acquired Perforating Disorder.  Kyrle disease Acquired Perforating Disorder.  Kyrle disease Acquired Perforating Disorder.  Kyrle disease

Acquired Perforating Disorder.  Kyrle disease Acquired Perforating Disorder.  Kyrle disease

References

Diabetes x 18 years. Virtual Grand Rounds in Dermatology

Dermatol Pract Concept. 2015 Apr; 5(2): 75–77

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