Perforating dermatoses

LAST UPDATED: Jul 27, 2021

Introduction

The perforating dermatoses are a group of uncommon conditions characterised by the presence of keratotic papules. Some cases are associated with systemic disease, especially diabetes mellitus and renal failure.

This chapter is set out as below:

Aetiology
Clinical findings
Images
Management

Aetiology

Most of the perforating dermatoses are acquired
The clinical appearance results from the transepidermal elimination of altered collagen and elastic fibres through the epidermis

Clinical findings

Several acquired types of perforating dermatoses have been identified, eg Kyrle's disease, elastosis perforans serpiginosa and reactive perforating collagenosis, the clinical boundary between these can be blurred and as such the term acquired perforating dermatosis is sometimes used to encompass this group of conditions

Clinically the acquired perforating dermatoses are characterised by multiple, hyperpigmented, scaly papules and nodules. Lesions are typically found on hair-bearing areas of the arms, thighs and buttocks, although other sites can be affected. The pattern of lesions in elastosis perforans serpiginosa is different, with grouped arcuate or serpiginous keratotic papules

Clinical Images

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Acquired perforating dermatosis

Central…

Acquired perforating dermatosis

A larger…

Management

The perforating dermatoses often persist for months or years. Spontaneous remission can occur, and has been seen following kidney transplantation in patients with renal failure

There is no reliably effective treatment, although some patients benefit from potent topical steroids, intralesional steroids or phototherapy

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Image Rights - The PCDS would like to thank Dermatoweb, DermQuest (Galderma), and others who have contributed images. All named individuals and organisations maintain copyright for the relevant images.