Cleveland Clinic Journal of MedicineAcquired Reactive Perforating Collagenosis in a Patient with Diabetes

Exploring the Pathogenesis and Systemic Associations of Acquired Reactive Perforating Collagenosis

In the investigation of a 47-year-old patient presenting with pruritic eruptions and systemic symptoms, a diagnosis of acquired reactive perforating collagenosis (ARPC) coexistent with type 2 diabetes was established. This article elucidates the clinical and histological characteristics of ARPC, highlighting its possible links with systemic diseases such as diabetes and chronic kidney disease. The findings underscore the importance of considering underlying systemic conditions in patients presenting with dermatological manifestations.

Key Points:

• Patient Presentation: A 47-year-old woman exhibited pruritic, umbilicated hyperkeratotic papules and nodules on her left ankle, coupled with systemic symptoms like thirst and polyuria indicative of underlying metabolic issues.
• Diagnostic Findings: Histologic analysis revealed transepidermal elimination of dermal collagen, characteristic of ARPC, along with elevated blood glucose and lipid levels, confirming coexistent type 2 diabetes.
• Treatment and Outcome: The patient responded positively to treatment with loratadine and halometasone cream, showing significant improvement within 4 weeks.
• Disease Classification: ARPC falls under acquired perforating dermatosis, typically presenting as chronic pruritic cutaneous disorders with transepidermal elimination of dermal components.
• Epidemiology: ARPC primarily affects middle-aged adults and is often associated with systemic diseases such as diabetes and chronic kidney disease.
• Pathogenesis Theories: Theories suggest microtrauma from scratching and microangiopathy may play roles in the disease’s development, especially under conditions of systemic disease-induced pruritus.
• Symptomatology and Incidence: Pruritus is the most commonly reported symptom, with the Koebner phenomenon observed in a significant portion of cases.
• Underlying Conditions: Besides diabetes, other comorbidities associated with ARPC include chronic kidney disease, cardiovascular diseases, and various infections.
• Treatment Options: Management strategies for ARPC include treating the underlying disease and utilizing topical treatments such as corticosteroids and keratolytics, with systemic treatments reserved for severe cases.

“The presence of the Koebner phenomenon suggests that trauma plays a role in the pathogenesis of acquired perforating dermatosis (APD).”

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