Letter - Therapy
Acquired reactive perforating dermatosis successfully treated with allopurinol
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Therapy</span>" "titulo" => "Acquired reactive perforating dermatosis successfully treated with allopurinol" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor,</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "148" "paginaFinal" => "149" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ana Gusmão Palmeiro, Maria João Gonçalves, Cristina Amaro, Isabel Viana" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Ana Gusmão" "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">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Maria João" "apellidos" => "Gonçalves" "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, Hospital de Egas Moniz, Centro de Lisboa Ocidental, Lisbon, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Rheumatology Department, Hospital de Egas Moniz, Centro de Lisboa Ocidental, Lisbon, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "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">(A) Erythematous papules on the anterior surface of thighs and knees; (B) detail of central adherent hyperkeratotic plugs</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">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.<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, 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.</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. The dermatosis was diffusely distributed bilaterally on her thighs and elbows and was composed of erythematous-violaceus umbilicated papules with central adherent hyperkeratotic plugs (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). 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 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Consequently, a diagnosis of perforating folliculitis was made.</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 (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.</p><p id="par0020" class="elsevierStylePara elsevierViewall">As of today, there are no specific evidence-based guidelines regarding the treatment of perforating dermatosis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> 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.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> 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.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">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.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">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.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Maria João Gonçalves: Manuscript critical review; intellectual participation in propaedeutic and/or therapeutic; management of studied cases.</p><p id="par0045" class="elsevierStylePara elsevierViewall">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.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Isabel Viana: Approval of the final version of the manuscript; intellectual participation in propaedeutic and/or therapeutic; management of studied cases.</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.</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" => "2022-04-11" "fechaAceptado" => "2022-06-01" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Hospital de Egas Moniz, Centro de Lisboa Ocidental, Lisbon, Portugal.</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">(A) Erythematous papules on the anterior surface of thighs and knees; (B) 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 (shown in black) and collagen (eosinophilic structures) (Verhoeff stain, ×100)</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. 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| 2024 Setembro | 219 | 102 | 321 |
| 2024 Agosto | 223 | 131 | 354 |
| 2024 Julho | 190 | 111 | 301 |
| 2024 Junho | 170 | 69 | 239 |
| 2024 Maio | 179 | 69 | 248 |
| 2024 Abril | 188 | 86 | 274 |
| 2024 Março | 233 | 65 | 298 |
| 2024 Fevereiro | 413 | 118 | 531 |
| 2024 Janeiro | 364 | 75 | 439 |
| 2023 Dezembro | 108 | 64 | 172 |
| 2023 Novembro | 128 | 87 | 215 |
| 2023 Outubro | 65 | 83 | 148 |
| 2023 Setembro | 30 | 38 | 68 |
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