array:23 [
  "pii" => "S0365059623002003"
  "issn" => "03650596"
  "doi" => "10.1016/j.abd.2022.06.009"
  "estado" => "S300"
  "fechaPublicacion" => "2024-01-01"
  "aid" => "835"
  "copyright" => "Sociedade Brasileira de Dermatologia"
  "copyrightAnyo" => "2023"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "pt" => array:18 [
      "pii" => "S266627522300231X"
      "issn" => "26662752"
      "doi" => "10.1016/j.abdp.2023.09.013"
      "estado" => "S300"
      "fechaPublicacion" => "2024-01-01"
      "aid" => "835"
      "copyright" => "Sociedade Brasileira de Dermatologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "pt" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Cartas &#8208; Terapia</span>"
        "titulo" => "Dermatose perfurante reacional adquirida tratada com sucesso com alopurinol"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "148"
            "paginaFinal" => "149"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 1258
                "Ancho" => 1675
                "Tamanyo" => 572473
              ]
            ]
            "descripcion" => array:1 [
              "pt" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopatologia da biopsia de pele mostrando elimina&#231;&#227;o folicular de fibras el&#225;sticas &#40;mostradas em preto&#41; e col&#225;geno &#40;estruturas eosin&#243;filas&#59; Verhoeff&#44; 100<span class="elsevierStyleHsp" style=""></span>&#215;&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Ana Gusm&#227;o Palmeiro, Maria Jo&#227;o Gon&#231;alves, Cristina Amaro, Isabel Viana"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Ana Gusm&#227;o"
                "apellidos" => "Palmeiro"
              ]
              1 => array:2 [
                "nombre" => "Maria Jo&#227;o"
                "apellidos" => "Gon&#231;alves"
              ]
              2 => array:2 [
                "nombre" => "Cristina"
                "apellidos" => "Amaro"
              ]
              3 => array:2 [
                "nombre" => "Isabel"
                "apellidos" => "Viana"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0365059623002003"
          "doi" => "10.1016/j.abd.2022.06.009"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623002003?idApp=UINPBA00008Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S266627522300231X?idApp=UINPBA00008Z"
      "url" => "/26662752/0000009900000001/v1_202401040746/S266627522300231X/v1_202401040746/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S0365059623001988"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2022.05.011"
    "estado" => "S300"
    "fechaPublicacion" => "2024-01-01"
    "aid" => "833"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter - Therapy</span>"
      "titulo" => "Complete resolution of generalized annular elastolytic giant cell granuloma with doxycycline"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "150"
          "paginaFinal" => "153"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1753
              "Ancho" => 3175
              "Tamanyo" => 780040
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0005"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Multiple erythematous annular plaques on the back and posterior neck at the initial visit&#46; &#40;B&#41; Complete resolution of the lesions after 5 months under treatment with doxycycline 100&#8239;mg&#47;day</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "D&#237;dac Mar&#237;n-Pi&#241;ero, M&#46; &#193;ngeles Sola-Casas, Noelia Perez-Mu&#241;oz"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "D&#237;dac"
              "apellidos" => "Mar&#237;n-Pi&#241;ero"
            ]
            1 => array:2 [
              "nombre" => "M&#46; &#193;ngeles"
              "apellidos" => "Sola-Casas"
            ]
            2 => array:2 [
              "nombre" => "Noelia"
              "apellidos" => "Perez-Mu&#241;oz"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275223002291"
        "doi" => "10.1016/j.abdp.2023.09.011"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223002291?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623001988?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009900000001/v1_202401040817/S0365059623001988/v1_202401040817/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S0365059623001915"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2023.02.004"
    "estado" => "S300"
    "fechaPublicacion" => "2024-01-01"
    "aid" => "826"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter - Tropical&#47;Infectious and parasitic dermatology</span>"
      "titulo" => "<span class="elsevierStyleItalic">Mycobacterium</span> abscessus sporotrichoid infection after a dog bite"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "145"
          "paginaFinal" => "147"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 287
              "Ancho" => 955
              "Tamanyo" => 33915
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0015"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">M&#46; abscessus</span> colonies grew in Lowenstein Jensen culture after 7 days</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Patricia Guadalupe Mendoza-Del Toro &#40;Patricia&#41;, Arturo Robles-Tenorio &#40;Arturo&#41;, V&#237;ctor Manuel Tarango-Mart&#237;nez &#40;Victor&#41;"
          "autores" => array:3 [
            0 => array:3 [
              "preGrado" => "MD"
              "nombre" => "Patricia Guadalupe"
              "apellidos" => "Mendoza-Del Toro &#40;Patricia&#41;"
            ]
            1 => array:3 [
              "preGrado" => "MD"
              "nombre" => "Arturo"
              "apellidos" => "Robles-Tenorio &#40;Arturo&#41;"
            ]
            2 => array:3 [
              "preGrado" => "MD"
              "nombre" => "V&#237;ctor Manuel"
              "apellidos" => "Tarango-Mart&#237;nez &#40;Victor&#41;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275223002229"
        "doi" => "10.1016/j.abdp.2023.09.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223002229?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623001915?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009900000001/v1_202401040817/S0365059623001915/v1_202401040817/en/main.assets"
  ]
  "en" => array:17 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter - Therapy</span>"
    "titulo" => "Acquired reactive perforating dermatosis successfully treated with allopurinol"
    "tieneTextoCompleto" => true
    "saludo" => "<span class="elsevierStyleItalic">Dear Editor&#44;</span>"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "148"
        "paginaFinal" => "149"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Ana Gusm&#227;o Palmeiro, Maria Jo&#227;o Gon&#231;alves, Cristina Amaro, Isabel Viana"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Ana Gusm&#227;o"
            "apellidos" => "Palmeiro"
            "email" => array:1 [
              0 => "apgpalmeiro@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Maria Jo&#227;o"
            "apellidos" => "Gon&#231;alves"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Cristina"
            "apellidos" => "Amaro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Isabel"
            "apellidos" => "Viana"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Dermatology Department&#44; Hospital de Egas Moniz&#44; Centro de Lisboa Ocidental&#44; Lisbon&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Rheumatology Department&#44; Hospital de Egas Moniz&#44; Centro de Lisboa Ocidental&#44; Lisbon&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1441
            "Ancho" => 3175
            "Tamanyo" => 242746
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Erythematous papules on the anterior surface of thighs and knees&#59; &#40;B&#41; detail of central adherent hyperkeratotic plugs</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acquired Reactive Perforating Dermatosis &#40;ARPD&#41; is a rare group of skin disorders&#44; characterized by transepidermal elimination of various materials&#44; such as collagen&#44; elastin&#44; and keratin&#46; When the elimination occurs through a follicular unit&#44; it is called perforating folliculitis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The most common systemic diseases associated with ARPD are diabetes mellitus and renal failure&#44; but associations with infectious&#44; inflammatory and autoimmune diseases have been reported&#44; with possible triggers including immunological vasculopathy in the setting of the underlying autoimmune disorder and dermal microangiopathy due to scratching&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 54-year-old woman that was referred to the Dermatology outpatient clinic with a pruritic dermatosis of unknown evolution time&#46; The dermatosis was diffusely distributed bilaterally on her thighs and elbows and was composed of erythematous-violaceus umbilicated papules with central adherent hyperkeratotic plugs &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Koebner phenomenon was present in some of the lesions&#46; The patient had Rheumatoid Arthritis &#40;RA&#41;&#44; positive for both rheumatoid factor and anti-citrullinated protein antibodies&#44; with unsatisfactory control under 12&#46;5&#8239;mg of prednisolone daily&#46; She had never been treated with biological drugs and had recently suspended sulfasalazine due to hepatotoxicity&#46; Blood work revealed a mildly elevated erythrocyte sedimentation rate of 42&#8239;mm&#47;h &#40;normal &#60;29&#8239;mm&#47;h&#41;&#44; but glycemia and kidney function were normal&#46; Considering the cutaneous manifestations associated with rheumatoid arthritis&#44; such as rheumatoid neutrophilic dermatosis and interstitial granulomatosis dermatitis&#44; a punch biopsy was carried out&#46; Histopathology revealed a dilated hair follicle with infundibular disruption&#44; containing keratinous debris and neutrophils&#46; Verhoeff stain evidenced that the eliminated materials were both elastic fibers and collagen &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Consequently&#44; a diagnosis of perforating folliculitis was made&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">After a suboptimal response to topical clobetasol propionate and antihistamines and given the impossibility of safely undergoing phototherapy &#40;the patient had a hearing and cognitive impairment&#41;&#44; initiation of allopurinol 100&#8239;mg&#47;day resulted in a considerable symptomatic relief and almost complete resolution of the dermatosis&#44; with no adverse effects&#46; The patient maintains regular follow at Dermatology and Rheumatology outpatient clinics and has since started abatacept&#44; a disease-modifying anti-rheumatic agent&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">As of today&#44; there are no specific evidence-based guidelines regarding the treatment of perforating dermatosis&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> When possible&#44; the priority should be the control of the underlying disease&#46; Other treatment options include topical or systemic retinoids&#44; antibiotics&#44; topical&#44; intralesional&#44; or systemic glucocorticoids&#44; antihistamines&#44; surgery&#44; narrow-band ultraviolet B phototherapy&#44; PUVA and allopurinol&#46; Allopurinol may be a valid and helpful treatment for ARPD&#44; with successful results reported in 14 case reports and case series&#44; with no reported adverse reactions&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> Its exact mechanism of action is unknown&#44; but it may act via its antioxidant effect due to the inhibition of xanthine oxidase&#46; A recent systematic review suggests it as a first-line systemic treatment&#44; along with antihistamines&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; due to the rarity of these diseases and the lack of guidelines&#44; the management of ARPD can be challenging&#46; We present a rare association of perforating folliculitis and rheumatoid arthritis&#44; successfully treated with allopurinol 100&#8239;mg once per day&#46; Our experience supports allopurinol as a safe and effective treatment for ARPD&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Ana Gusm&#227;o Palmeiro&#58; Critical literature review&#59; intellectual participation in propaedeutic and&#47;or therapeutic&#59; management of studied cases&#59; data collection&#44; analysis and interpretation&#59; preparation and writing of the manuscript&#59; study conception and planning&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Maria Jo&#227;o Gon&#231;alves&#58; Manuscript critical review&#59; intellectual participation in propaedeutic and&#47;or therapeutic&#59; management of studied cases&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Cristina Amaro&#58; Manuscript critical review&#59; approval of the final version of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic&#59; management of studied cases&#59; study conception and planning&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Isabel Viana&#58; Approval of the final version of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic&#59; management of studied cases&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:4 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Financial support"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Authors&#8217; contributions"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Conflicts of interest"
        ]
        3 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2022-04-11"
    "fechaAceptado" => "2022-06-01"
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#8902;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Hospital de Egas Moniz&#44; Centro de Lisboa Ocidental&#44; Lisbon&#44; Portugal&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1441
            "Ancho" => 3175
            "Tamanyo" => 242746
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Erythematous papules on the anterior surface of thighs and knees&#59; &#40;B&#41; detail of central adherent hyperkeratotic plugs</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1258
            "Ancho" => 1675
            "Tamanyo" => 572756
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology of punch biopsy showing transepidermal elimination of elastic fibers &#40;shown in black&#41; and collagen &#40;eosinophilic structures&#41; &#40;Verhoeff stain&#44; &#215;100&#41;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:4 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical practice guide for the treatment of perforating dermatosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Kawakami"
                            1 => "M&#46; Akiyama"
                            2 => "A&#46; Ishida-Yamamoto"
                            3 => "H&#46; Nakano"
                            4 => "C&#46; Mitoma"
                            5 => "K&#46; Yoneda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/1346-8138.15647"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dermatol"
                        "fecha" => "2020"
                        "volumen" => "47"
                        "paginaInicial" => "1374"
                        "paginaFinal" => "1382"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33094871"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of acquired reactive perforating dermatosis - a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Luk&#225;cs"
                            1 => "S&#46; Schliemann"
                            2 => "P&#46; Elsner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ddg.13561_g"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dtsch Dermatol Ges"
                        "fecha" => "2018"
                        "volumen" => "16"
                        "paginaInicial" => "825"
                        "paginaFinal" => "842"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29989381"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acquired reactive perforating collagenosis and pseudoporphyric bullous dermatosis in a hemodialysis patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Sabanis"
                            1 => "E&#46; Paschou"
                            2 => "E&#46; Gavriilaki"
                            3 => "A&#46; Kalaitzoglou"
                            4 => "D&#46; Papanikolaou"
                            5 => "S&#46; Vasileiou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/hdi.12427"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hemodial Int"
                        "fecha" => "2016"
                        "volumen" => "20"
                        "paginaInicial" => "E14"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27147549"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Elastosis perforans serpiginosa induced by d-penicillamine treated with cyclosporine and allopurinol"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Valenzuela-Ubi&#241;a"
                            1 => "D&#46; Jim&#233;nez-Gallo"
                            2 => "F&#46;R&#46; Torre"
                            3 => "M&#46; Linares-Barrios"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Dermatol Ther"
                        "fecha" => "2020"
                        "volumen" => "33"
                        "itemHostRev" => array:3 [
                          "pii" => "S1885585720305223"
                          "estado" => "S300"
                          "issn" => "18855857"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/03650596/0000009900000001/v1_202401040817/S0365059623002003/v1_202401040817/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "96904"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letter &#8211; Therapy"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009900000001/v1_202401040817/S0365059623002003/v1_202401040817/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623002003?idApp=UINPBA00008Z"
]
Compartilhar
Informação da revista
Vol. 99. Núm. 1.
Páginas 148-149 (1 janeiro 2024)
Compartilhar
Compartilhar
Baixar PDF
Mais opções do artigo
Visitas
3850
Vol. 99. Núm. 1.
Páginas 148-149 (1 janeiro 2024)
Letter - Therapy
Acesso de texto completo
Acquired reactive perforating dermatosis successfully treated with allopurinol
Visitas
3850
Ana Gusmão Palmeiroa,
Autor para correspondência
apgpalmeiro@gmail.com

Corresponding author.
, Maria João Gonçalvesb, Cristina Amaroa, Isabel Vianaa
a Dermatology Department, Hospital de Egas Moniz, Centro de Lisboa Ocidental, Lisbon, Portugal
b Rheumatology Department, Hospital de Egas Moniz, Centro de Lisboa Ocidental, Lisbon, Portugal
Este item recebeu
Informação do artigo
Texto Completo
Bibliografia
Baixar PDF
Estatísticas
Figuras (2)
Texto Completo
Dear Editor,

Acquired Reactive Perforating Dermatosis (ARPD) is a rare group of skin disorders, characterized by transepidermal elimination of various materials, such as collagen, elastin, and keratin. When the elimination occurs through a follicular unit, it is called perforating folliculitis.1 The most common systemic diseases associated with ARPD are diabetes mellitus and renal failure, but associations with infectious, inflammatory and autoimmune diseases have been reported, with possible triggers including immunological vasculopathy in the setting of the underlying autoimmune disorder and dermal microangiopathy due to scratching.

We present the case of a 54-year-old woman that was referred to the Dermatology outpatient clinic with a pruritic dermatosis of unknown evolution time. The dermatosis was diffusely distributed bilaterally on her thighs and elbows and was composed of erythematous-violaceus umbilicated papules with central adherent hyperkeratotic plugs (Fig. 1). Koebner phenomenon was present in some of the lesions. The patient had Rheumatoid Arthritis (RA), positive for both rheumatoid factor and anti-citrullinated protein antibodies, with unsatisfactory control under 12.5 mg of prednisolone daily. She had never been treated with biological drugs and had recently suspended sulfasalazine due to hepatotoxicity. Blood work revealed a mildly elevated erythrocyte sedimentation rate of 42 mm/h (normal <29 mm/h), but glycemia and kidney function were normal. Considering the cutaneous manifestations associated with rheumatoid arthritis, such as rheumatoid neutrophilic dermatosis and interstitial granulomatosis dermatitis, a punch biopsy was carried out. Histopathology revealed a dilated hair follicle with infundibular disruption, containing keratinous debris and neutrophils. Verhoeff stain evidenced that the eliminated materials were both elastic fibers and collagen (Fig. 2). Consequently, a diagnosis of perforating folliculitis was made.

Figure 1.

(A) Erythematous papules on the anterior surface of thighs and knees; (B) detail of central adherent hyperkeratotic plugs

(0.23MB).
Figure 2.

Histopathology of punch biopsy showing transepidermal elimination of elastic fibers (shown in black) and collagen (eosinophilic structures) (Verhoeff stain, ×100)

(0.55MB).

After a suboptimal response to topical clobetasol propionate and antihistamines and given the impossibility of safely undergoing phototherapy (the patient had a hearing and cognitive impairment), initiation of allopurinol 100 mg/day resulted in a considerable symptomatic relief and almost complete resolution of the dermatosis, with no adverse effects. The patient maintains regular follow at Dermatology and Rheumatology outpatient clinics and has since started abatacept, a disease-modifying anti-rheumatic agent.

As of today, there are no specific evidence-based guidelines regarding the treatment of perforating dermatosis.2 When possible, the priority should be the control of the underlying disease. Other treatment options include topical or systemic retinoids, antibiotics, topical, intralesional, or systemic glucocorticoids, antihistamines, surgery, narrow-band ultraviolet B phototherapy, PUVA and allopurinol. Allopurinol may be a valid and helpful treatment for ARPD, with successful results reported in 14 case reports and case series, with no reported adverse reactions.2–4 Its exact mechanism of action is unknown, but it may act via its antioxidant effect due to the inhibition of xanthine oxidase. A recent systematic review suggests it as a first-line systemic treatment, along with antihistamines.2

In conclusion, due to the rarity of these diseases and the lack of guidelines, the management of ARPD can be challenging. We present a rare association of perforating folliculitis and rheumatoid arthritis, successfully treated with allopurinol 100 mg once per day. Our experience supports allopurinol as a safe and effective treatment for ARPD.

Financial support

None declared.

Authors’ contributions

Ana Gusmão Palmeiro: Critical literature review; intellectual participation in propaedeutic and/or therapeutic; management of studied cases; data collection, analysis and interpretation; preparation and writing of the manuscript; study conception and planning.

Maria João Gonçalves: Manuscript critical review; intellectual participation in propaedeutic and/or therapeutic; management of studied cases.

Cristina Amaro: Manuscript critical review; approval of the final version of the manuscript; intellectual participation in propaedeutic and/or therapeutic; management of studied cases; study conception and planning.

Isabel Viana: Approval of the final version of the manuscript; intellectual participation in propaedeutic and/or therapeutic; management of studied cases.

Conflicts of interest

None declared.

References
[1]
T. Kawakami, M. Akiyama, A. Ishida-Yamamoto, H. Nakano, C. Mitoma, K. Yoneda, et al.
Clinical practice guide for the treatment of perforating dermatosis.
J Dermatol, 47 (2020), pp. 1374-1382
[2]
J. Lukács, S. Schliemann, P. Elsner.
Treatment of acquired reactive perforating dermatosis - a systematic review.
J Dtsch Dermatol Ges, 16 (2018), pp. 825-842
[3]
N. Sabanis, E. Paschou, E. Gavriilaki, A. Kalaitzoglou, D. Papanikolaou, S. Vasileiou, et al.
Acquired reactive perforating collagenosis and pseudoporphyric bullous dermatosis in a hemodialysis patient.
Hemodial Int, 20 (2016), pp. E14-8
[4]
S. Valenzuela-Ubiña, D. Jiménez-Gallo, F.R. Torre, M. Linares-Barrios.
Elastosis perforans serpiginosa induced by d-penicillamine treated with cyclosporine and allopurinol.
Dermatol Ther, 33 (2020),

Study conducted at the Hospital de Egas Moniz, Centro de Lisboa Ocidental, Lisbon, Portugal.

Copyright © 2023. Sociedade Brasileira de Dermatologia
Baixar PDF
Idiomas
Anais Brasileiros de Dermatologia (Portuguese)
Opções de artigo
Ferramentas
en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.