Acquired Reactive Perforating Collagenosis
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IMAGES IN NEPHROLOGY
Acquired Reactive Perforating Collagenosis Namrata Singhania1 · Girish Singhania2 · Laith Al‑Rabadi3 Received: 23 April 2020 / Accepted: 6 July 2020 © Japanese Society of Nephrology 2020
Keywords Hemodialysis · Reactive perforating collagenosis
Description 65-year-old male with a history of end-stage renal disease on hemodialysis for 1.5 years and type 2 diabetes came with complaints of malaise and itchy skin lesions. Recently, at an outside facility, diagnosis of calciphylaxis was made and he was on sodium thiosulfate with no improvement. He had no history of malignancy. Examination showed multiple nontender erythematous papules and eschars covering upper extremity (Fig. 1), several digits, and knuckles (Fig. 2). His serum calcium was 9 mg/dL, phosphorus 5.6 mg/dL and 25-hydroxy Vitamin D 36 ng/mL. Bone scan showed renal osteodystrophy with uptake in soft tissue thighs. Skin biopsy showed acquired reactive perforating collagenosis (ARPC). ARPC is characterized by umblicated hyperkeratotic nodules or papules which histologically are in contact with transepidermal perforating dermal collagen. It associated with diabetes, chronic renal insufficiency and malignancy [1, 2]. The skin lesions are initiated by scratching. The lesions are usually self-healing while topical treatments and ultraviolent B may be effective.
Fig. 1 Erythematous papules in upper extremity
* Namrata Singhania [email protected] 1
Department of Hospital Medicine, Mount Carmel East Hospital, 6001, E Broad St, Columbus, OH 43213, USA
2
Dvision of Hospital Medicine, CHI St Vincent Infirmary, Little Rock, AR 72205, USA
3
Divison of Nephrology, University of Utah, Salt Lake City, UT 84132, USA
Fig. 2 Multiple non-tender erythematous papules and eschars in multiple digits and knuckles
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Compliance with ethical standards Conflict of interest The author(s) declare that they have no conflict of interest. Research involving human participants and/or animals This article does not involve research using human participants or animals. Informed consent Informed consent was obtained from the patient.
References 1. García-Malinis AJ, Del Valle Sánchez E, Sánchez-Salas MP, Del Prado E, Coscojuela C, Gilaberte Y. Acquired perforating
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Clinical and Experimental Nephrology dermatosis: clinicopathological study of 31 cases, emphasizing pathogenesis and treatment. J Eur Acad Dermatol Venereol [Internet]. Blackwell Publishing Ltd; 2017 [cited 2020 Mar 20];31:1757–63. Available from: https://www.ncbi.nlm.nih.gov/ pubmed/28300323. 2. Karpouzis A, Giatromanolaki A, Sivridis E, Kouskoukis C. Acquired reactive perforating collagenosis: Current status. J Dermatol [Internet]. Blackwell Publishing Ltd; 2010 [cited 2020 Jun 12];37:585–92. Available from: https://doi.wiley.com/10.11 11/j.1346-8138.2010.00918.x. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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