allopurinol and Collagen-Diseases

Acquired reactive perforating dermatosis is characterized by umbilicated erythematous papules and plaques with firmly adherent crusts. Histopathological examination shows a typical cup-shaped ulceration in the epidermis containing cellular debris and collagen. There is transepidermal elimination of degenerated material with basophilic collagen bundles. The etiology and pathogenesis of acquired reactive perforating dermatosis are unclear. Metabolic disorders and malignancies are associated with this dermatosis. Associated pruritus is regarded as a key pathogenic factor. Constant scratching may cause a repetitive trauma to the skin. This pathogenesis may involve a genetic predisposition. The trauma may lead to degeneration of the collagen bundles. Treatment of acquired reactive perforating dermatosis follows a multimodal approach. Apart from the treating any underlying disease, treatment of pruritus is a major goal. Systemic steroids and retinoids, as well as UVB phototherapy are well-established treatment options. Some patients may also benefit from oral allopurinol.

Topics: Allopurinol; Collagen Diseases; Combined Modality Therapy; Diagnosis, Differential; Humans; Immunosuppressive Agents; Retinoids; Skin Diseases, Genetic; Steroids; Ultraviolet Therapy

Acquired reactive perforating collagenosis is a unique perforating dermatosis, characterized clinically by umbilicated hyperkeratotic papules or nodules and histologically by a focal hyperkeratosis in direct contact with transepidermal perforating dermal collagen. Several inflammatory or malignant systemic diseases may coexist with acquired reactive perforating collagenosis. The possible biochemical or immunological mechanisms of the systemic diseases, potentially responsible for the development and appearance of acquired reactive perforating collagenosis, are still under investigation. Several topical treatments, ultraviolet B phototherapy and allopurinol p.o. administration may be effective.

Topics: Allopurinol; Collagen; Collagen Diseases; Comorbidity; Diabetes Mellitus; Female; Humans; Male; Skin Diseases; Ultraviolet Therapy

Topics: Allopurinol; Antimetabolites; Collagen Diseases; Humans; Keratosis; Skin; Treatment Outcome

Topics: Allopurinol; Collagen Diseases; Diabetes Complications; Humans; Incidental Findings; Male; Middle Aged; Oxidative Stress; Scleredema Adultorum

Topics: Allopurinol; Antimetabolites; Collagen Diseases; Diabetes Complications; Humans; Hydronephrosis; Kidney Calculi; Male; Middle Aged; Skin; Skin Diseases

A 60-year-old man with diabetes mellitus and chronic renal insufficiency needing hemodialysis was admitted with a 3 months history of multiple hyperkeratotic papules on the trunk and extremities partly ulcerated with a keratotic central plug.. Laboratory tests revealed elevated levels of blood urea nitrogen, creatinine, and HbA (1c). Histopathology showed vertical strands of collagen perforating from the ulcerated lesions. COURSE, DIAGNOSIS AND TREATMENT: The biopsy specimen was consistent with acquired reactive perforating collagenosis. The progression was stopped and secondary wound healing was initiated after two weeks of therapy with allopurinol and PUVA.. Acquired reactive perforating collagenosis should be considered when ulcera with oystershell-like keratotic plugs are found especially in patients with predisposing diseases like diabetes and renal insufficiency. A good interdisciplinary cooperation between internist and dermatologist is crucial for the early recognition by histopathology and the immediate treatment.

Topics: Allopurinol; Antimetabolites; Blood Urea Nitrogen; Collagen Diseases; Creatinine; Diabetes Mellitus, Type 2; Glycated Hemoglobin; Humans; Kidney Failure, Chronic; Male; Middle Aged; PUVA Therapy; Skin; Skin Diseases; Skin Ulcer; Treatment Outcome

Reactive perforating collagenosis (RPC) is one of the four essential acquired perforating dermatoses. The condition is characterized by the transepidermal elimination of altered collagen. This paper describes four patients with a giant variant of RPC which has not previously been documented. Three of the patients had associated diabetes mellitus and one had chronic renal failure secondary to fetal scarring. Three of the four patients had a significant improvement in their lesions and symptoms following treatment with allopurinol.

Topics: Adult; Aged; Allopurinol; Collagen Diseases; Dermatologic Agents; Diabetes Complications; Female; Humans; Male; Skin Diseases

Acquired reactive perforating collagenosis (ARPC) developed in an 81-year-old woman two weeks after curettage of seborrheic keratoses. Treatment with allopurinol and antipruritic ointment was given. After four months, there was complete re-epithelialization, leaving atrophic scars.

Topics: Aged, 80 and over; Allopurinol; Antipruritics; Collagen Diseases; Curettage; Drug Combinations; Female; Humans; Keratosis, Seborrheic; Skin Diseases; Treatment Outcome

The authors present a case of acquired reactive perforating collagenosis developed in a nondiabetic hemodialysis patient, who was treated successfully with allopurinol. Treatment of acquired reactive perforating collagenosis is difficult and often ineffective. The patient had been unresponsive to conventional treatments, but the pruritus was controlled, and skin lesions subsequently resolved after the treatment with allopurinol. Possible mechanisms of allopurinol treatment for acquired reactive perforating collagenosis are discussed.

Topics: Allopurinol; Collagen Diseases; Enzyme Inhibitors; Humans; Male; Middle Aged; Pruritus; Renal Dialysis; Skin Diseases, Metabolic

Topics: Allopurinol; Collagen Diseases; Female; Free Radical Scavengers; Humans; Middle Aged; Pruritus

We present a case of widespread reactive perforating collagenosis in a 63-year-old woman undergoing haemodialysis after diabetic nephropathy, who was treated successfully with allopurinol. The patient responded well and rapidly to a dose of 100 mg allopurinol daily. It is suggested that more patients with reactive perforating collagenosis may benefit from allopurinol therapy.

Topics: Allopurinol; Collagen Diseases; Diabetic Nephropathies; Female; Free Radical Scavengers; Humans; Kidney Failure, Chronic; Middle Aged; Renal Dialysis

Perforating disorders represent a heterogenous group of dermatoses characterized by transepithelial elimination of dermal structures. Primary perforating disorders should be distinguished from secondary perforating disorders in which perforation with transepithelial elimination is a rare component of a variety of dermatoses. The primary perforating disorders are hyperkeratosis follicularis et parafollicularis in cutem penetrans (Kyrle's disease), elastosis perforans serpiginosa and perforating folliculitis. Acquired reactive perforating dermatosis (also known as acquired reactive perforating collagenosis) together with the hereditary variant of the reactive perforating collagenosis represent further examples of the primary perforating disorders. We report on 84 year old and 96 year old female patients with an acquired perforating dermatosis. Both of the patients additionally showed diabetes and hyperuricemia. Oral administration of allopurinol (100 mg daily) led to a healing of the disseminated skin lesions in 1-2 weeks. After a follow-up period of 6 months, both patients were in complete remission. On one hand, these results prove again the existence and the severity of this disease, and on the other hand suggest an immunomodulating or differentiation-promoting action in addition to the uricostatic effect of allopurinol.

Topics: Aged; Aged, 80 and over; Allopurinol; Antimetabolites; Antioxidants; Collagen Diseases; Female; Gout; Gout Suppressants; Humans; Keratosis; Skin; Skin Ulcer; Treatment Outcome