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Acquired Perforating Dermatosis — SCE Dermatology MCQ

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HardInflammatory DermatosesAcquired Perforating DermatosisSCE Dermatology

A 60-year-old man presents with acquired perforating dermatosis. He has chronic kidney disease on haemodialysis and type 2 diabetes. He develops intensely pruritic hyperkeratotic papules with central keratotic plugs on his trunk and limbs. Biopsy shows transepidermal elimination of collagen and elastic fibres. What is the most appropriate treatment?

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Correct answer: B — Topical retinoids (Tretinoin cream) or NB-UVB phototherapy

Acquired perforating dermatosis (Kyrle disease/acquired reactive perforating collagenosis) occurs in the context of CKD (particularly on dialysis), diabetes mellitus, and other systemic diseases. The pathogenesis involves transepidermal elimination of dermal material (collagen, elastic fibres) through the epidermis, driven by pruritus-related scratching (Koebner phenomenon). Treatment includes: topical retinoids (Tretinoin 0.025-0.1% — promotes epidermal turnover and reduces keratotic plugs), NB-UVB phototherapy (effective for both pruritus and lesions), oral Allopurinol (effective in some CKD patients), and optimisation of underlying disease (improving dialysis adequacy, glycaemic control). Addressing uraemic pruritus is important.

Reference: BAD 2019; Perforating Dermatosis Review