Case Letter
Trauma-induced acquired reactive perforating collagenosis
João Renato Vianna Gontijoa,b,
, Florentino Fernandes Júniorc, Luciana Baptista Pereiraa,d, Moisés Salgado Pedrosae
Autor para correspondência
a Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
b Dermatology Service, Hospital Mater Dei, Belo Horizonte, MG, Brazil
c Private clinic, Belo Horizonte, MG, Brazil
d Faculty of Medicine, Universidade Federal de Minas, Belo Horizonte, MG, Brazil
e Patology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Physical exam revealed erythematous papules, either intact or with central umbilication, that evolved into crater-like ulcerations surrounded by an erythematous halo and with a dark, central keratotic plug. Intense xerosis of the skin was associated (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). Histopathology showed cup-shaped epidermal ulcerations filled with crusts and keratotic material, and the transepidermal elimination of collagen and elastic fibers (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Perforating dermatoses are a rare and heterogenous group of diseases characterized by transepidermal elimination of dermal compounds, mainly collagen and elastic fibers. The four classical or primary forms are represented by Kyrle’s disease, elastosis perforans serpiginosa, perforating folliculitis, and reactive perforating collagenosis. The word “primary” implies that the transepidermal elimination is the main pathological process. On the other hand, in perforating dermatoses termed “secondary” (granuloma annulare, necrobiosis lipoidica, rheumathoid nodule, lichen nitidus, chondrodermatitis nodularis helicis, etc.), perforation of the epidermis is regarded as an epiphenomenon.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> With the exception of elastosis perforans serpiginosa and the extremely rare familial reactive perforating collagenosis (OMIM nº 216700), that may start in childhood or adolescence, the primary forms are classically diseases of adulthood.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In 1989, Rapini et al. proposed the umbrella term “Acquired Perforating Dermatosis” (APD) to encompass cases with onset in adult life and associated with diabetes mellitus and chronic renal failure, especially in patients on dialysis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Later on, it became evident that other comorbidities such as cardiac, rheumatological, pulmonary, and malignant disorders, among others, can also be associated with APD.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Based on clinical and histopathological features, the diagnosis of Acquired Reactive Perforating Collagenosis (ARPC), triggered by excoriation of pruriginous lesions, was made. In the two largest case series published thus far, ARPC was the most prevalent type of APD.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> The clinical presentation of erythematous or brownish papules, plaques or nodules that soon become umbilicated and evolve into a crater-like ulceration with a central keratotic plug is characteristic of this condition. Lesions favor the extensor surfaces of the limbs, gluteal area, and trunk. Mucosal involvement is only observed in familial reactive perforating collagenosis.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The etiopathogenesis of all APD variants remains uncertain. The ample spectrum of associated disorders (diabetes mellitus and other endocrinological diseases, chronic renal failure, malignancies, medications, etc.) renders it difficult to develop a unicist concept to explain the etiopathogenesis. It is speculated that the impairment of metabolic products elimination in chronic renal failure and the microangiopathy in diabetes mellitus may play a role. The relationship of pruritus, excoriation and the onset of the lesions is supported by the common finding of linear lesions (Köebner phenomenon), as well as the exclusive location of the lesions within ones hand reach.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Our patient, with no comorbidity or medication usage, was diagnosed as ARPC triggered both by the excoriation of the pruriginous lesions and the xerosis of the lower limbs.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors' contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall">João Renato Vianna Gontijo: Conception and design of the study; acquisition of data; drafting the article or revising it critically for important intellectual content; final approval of the version to be submitted.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Florentino Fernandes Júnior: Drafting the article and revising it critically for important intellectual content; final approval of the version to be submitted.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Luciana Baptista Pereira: Drafting the article and revising it critically for important intellectual content; final approval of the version to be submitted.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Moisés Salgado Pedrosa: Drafting the article and revising it critically for important intellectual content; final approval of the version to be submitted.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-05-15" "fechaAceptado" => "2020-06-24" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Gontijo JRV, Júnior FF, Pereira LB, Pedrosa MS. Trauma-induced acquired reactive perforating collagenosis. An Bras Dermatol. 2021;96:392–3.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Dermatology Service, Faculty of Medicine, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 850 "Ancho" => 750 "Tamanyo" => 109448 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple erythematous papules and crater-like ulcerations on lower limbs with associated xerosis.</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" => 999 "Ancho" => 750 "Tamanyo" => 137868 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Crater-like ulcerations with a central keratotic plug.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 556 "Ancho" => 1500 "Tamanyo" => 241673 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A), Histopathological exam showing a cup-shaped lesion containing keratin, cellular debris, neutrophils and collagen and elastic fibers (Hematoxylin & eosin, ×50). (B), Presence of intraepidermal collagen fibers perpendicular to the skin surface. (Masson’s trichome, ×40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reactive perforating collagenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 23 | 6 | 29 |
| 2024 Outubro | 137 | 73 | 210 |
| 2024 Setembro | 219 | 79 | 298 |
| 2024 Agosto | 246 | 114 | 360 |
| 2024 Julho | 187 | 112 | 299 |
| 2024 Junho | 156 | 97 | 253 |
| 2024 Maio | 126 | 80 | 206 |
| 2024 Abril | 148 | 93 | 241 |
| 2024 Março | 272 | 83 | 355 |
| 2024 Fevereiro | 247 | 85 | 332 |
| 2024 Janeiro | 188 | 63 | 251 |
| 2023 Dezembro | 182 | 57 | 239 |
| 2023 Novembro | 180 | 96 | 276 |
| 2023 Outubro | 234 | 79 | 313 |
| 2023 Setembro | 161 | 87 | 248 |
| 2023 Agosto | 137 | 44 | 181 |
| 2023 Julho | 139 | 31 | 170 |
| 2023 Junho | 100 | 43 | 143 |
| 2023 Maio | 114 | 23 | 137 |
| 2023 Abril | 162 | 16 | 178 |
| 2023 Março | 146 | 56 | 202 |
| 2023 Fevereiro | 104 | 30 | 134 |
| 2023 Janeiro | 116 | 40 | 156 |
| 2022 Dezembro | 129 | 30 | 159 |
| 2022 Novembro | 166 | 54 | 220 |
| 2022 Outubro | 200 | 71 | 271 |
| 2022 Setembro | 115 | 65 | 180 |
| 2022 Agosto | 112 | 50 | 162 |
| 2022 Julho | 140 | 58 | 198 |
| 2022 Junho | 136 | 61 | 197 |
| 2022 Maio | 128 | 62 | 190 |
| 2022 Abril | 143 | 52 | 195 |
| 2022 Março | 134 | 67 | 201 |
| 2022 Fevereiro | 105 | 44 | 149 |
| 2022 Janeiro | 152 | 89 | 241 |
| 2021 Dezembro | 96 | 66 | 162 |
| 2021 Novembro | 110 | 61 | 171 |
| 2021 Outubro | 109 | 85 | 194 |
| 2021 Setembro | 107 | 54 | 161 |
| 2021 Agosto | 116 | 76 | 192 |
| 2021 Julho | 114 | 64 | 178 |
| 2021 Junho | 148 | 95 | 243 |
| 2021 Maio | 111 | 88 | 199 |
| 2021 Abril | 188 | 299 | 487 |
| 2021 Março | 17 | 22 | 39 |
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