ARPC FORM 59 PDF

Language: English Turkish. Acquired reactive perforating collagenosis ARPC is commonly recognized as an unusual skin reaction to superficial trauma that is observed in patients with a certain genetic predisposition or underlying diseases, such as diabetes mellitus or renal diseases. We present the unusual case of a year-old female diabetic patient with numerous characteristic dome-shaped nodules, which consisted of central umbilication containing firm keratotic plugs. Acquired reactive perforating collagenosis ARPC is a skin disorder that is characterized by the transepidermal elimination of altered collagen through the epidermis [ 1 ]. An inherited form was first described by Mehregan et al. We hereby describe a case of acquired reactive perforating collagenosis in a patient with diabetes mellitus.

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Language: English Turkish. Acquired reactive perforating collagenosis ARPC is commonly recognized as an unusual skin reaction to superficial trauma that is observed in patients with a certain genetic predisposition or underlying diseases, such as diabetes mellitus or renal diseases.

We present the unusual case of a year-old female diabetic patient with numerous characteristic dome-shaped nodules, which consisted of central umbilication containing firm keratotic plugs. Acquired reactive perforating collagenosis ARPC is a skin disorder that is characterized by the transepidermal elimination of altered collagen through the epidermis [ 1 ].

An inherited form was first described by Mehregan et al. We hereby describe a case of acquired reactive perforating collagenosis in a patient with diabetes mellitus. A year-old woman presented with a 4 month history of skin eruption and pruritus on her lower extremities.

She had an 18 year history of type 2 diabetes mellitus that was treated with subcutaneous insulin injections. The skin eruptions developed on both legs. At the time of presentation, there were numerous dome-shaped nodules, which were characterized by central umbilications containing firm keratotic plugs, and erythema was observed around the nodules Figure 1. The patient did not have a renal disorder due to the diabetes mellitus. Histopathological evaluation of a representative skin lesion showed transepidermal elimination of necrotic collagen bundles into a cup-shaped epidermal depression.

Numerous neutrophil polymorphonuclears were observed. Marked neutrophilia, in addition to mononuclear cell infiltration particularly of macrophages and giant cells, was observed under the dome-shaped lesions and debris Figure 2. Van Gieson simple staining showed degenerated collagen fibers that had perforated through the epidermis Figure 3. Therefore, an ARPC diagnosis was verified, and the patient was referred to an endocrinologist for the management of her diabetes mellitus and underwent narrow UVB treatment, without significant amelioration.

Umblicated and erythematous papules with adherent central keratotic plug on lower extremities. Transepidermal elimination of necrotic collagen bundles into a cup-shaped epidermal depression.

This classification was made according to the type of epidermal damage and the characteristics of the eliminated material [ 5 ]. The pathogenesis of ARPC is unknown. As originally postulated by Mehregan et al. In ARPC, the defect occurs in the papillary dermis where histochemically altered but ultrastructurally intact-type IV collagen is present; the collagen is surrounded and engulfed by focal epidermal proliferation.

A central crater containing inflammatory cells, keratinous material and altered collagen then develops and the altered collagen is subsequently expelled by transepithelial migration [ 6 ]. ARPC has been observed in association with multiple disorders, including diabetes mellitus, renal failure, hyperparathyroidism, liver disease, neurodermatitis, IgA nephropathy, periampullary carcinoma with jaundice, adenocarcinoma and liver neoplasms [ 7 ]. The disease presents clinically as umbilicated papules with a central adherent keratotic plug [ 8 ].

The hands and legs are frequently involved. Thus, it is thought that traumatic stimulation, such as scratching, induces the transepidermal elimination of the degenerated collagen fibers [ 9 ]. The possible biochemical or immunological mechanisms of the systemic diseases that are potentially responsible for the development and appearance of ARPC are still under investigation [ 10 ].

There is no specific treatment for ARPC. Topical and oral retinoids and topical and intralesional glucocorticoids have been reported to be effective in some patients in a case series [ 11 ]. In addition, individual lesions can be excised. Tretinoin 0. ARPC is usually refractory to treatment; however, there have been reports of ARPC that has been successfully treated with phototherapy.

The course of this disease is chronic, and if the associated diseases are treated, patients may have a better prognosis [ 12 ]. In conclusion ARPC is a rare disease in terms of the clinical and histological findings. In the presence of diabetes mellitus and severe pruritus, ARPC must be considered in the differential diagnosis.

Conflict of interest statement: The authors declare that they have no conflict of interest to the publication of this article. National Center for Biotechnology Information , U. Journal List Eurasian J Med v. Eurasian J Med. Arzu Ataseven 1 and Serra Kayacetin 2. Author information Article notes Copyright and License information Disclaimer. Received Jun 7; Accepted Nov This article has been cited by other articles in PMC. Abstract Acquired reactive perforating collagenosis ARPC is commonly recognized as an unusual skin reaction to superficial trauma that is observed in patients with a certain genetic predisposition or underlying diseases, such as diabetes mellitus or renal diseases.

Keywords: Acquired reactive perforating collagenosis, Diabetes mellitus. Introduction Acquired reactive perforating collagenosis ARPC is a skin disorder that is characterized by the transepidermal elimination of altered collagen through the epidermis [ 1 ]. Case Report A year-old woman presented with a 4 month history of skin eruption and pruritus on her lower extremities. Open in a separate window. Figure 1. Figure 2. Figure 3. Van Gieson simple staining showed degenerated collagen fibres.

Footnotes Conflict of interest statement: The authors declare that they have no conflict of interest to the publication of this article. References 1. Khan Y, Swain JP. Acquired reactive perforating collagenosis in an insulin dependent diabetes mellitus patient. J Indian Med Assoc. Reactive perforating collagenosis. Arch Dermatol. Reactive perforating collagenosis associated with scabies in a diabetic.

J Eur Acad Dermatol Venereol. Perforating disorder caused by salt-water application and its experimental induction. Int J Dermatol. Up-regulation of transforming growth factor-beta3 and extracellular matrix proteins in acquired reactive perforating collagenosis.

J Am Acad Dermatol. Indian J Pathol Microbiol. Schmults CA. Acquired reactive perforating collagenosis. Dermatol Online J.

Cutaneous mucormycosis secondary to acquired reactive perforating collagenosis. Acquired reactive perforating collagenosis with papillary thyroid carcinoma: a paraneoplastic phenomenon?

Clin Exp Dermatol. Acquired reactive perforating collagenosis: current status. J Dermatol. Perforating collagenosis. Med Pregl. Support Center Support Center. External link. Please review our privacy policy.

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Acquired Reactive Perforating Collagenosis

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