Perforating dermatosesL87.1

Perforating dermatoses are a heterogeneous group of diseases characterized by a transepidermal expulsion of collagen and/or elastin through the skin (Schmults CA 2002). As prototypes of a perforating dermatosis the "Elastosis perforans serpiginosa", the "Reactive perforating collagenosis" are considered (see overview).

• Reactive perforating collagenosis
• Perforating folliculitis (Folliculitis perforans)
• elastosis perforans serpiginosa
• Kyrle's disease
• Perforating granuloma anulare
• Perforating pseudoxanthoma
• Acquired perforating dermatoses in the context of underlying diseases such as diabetes mellitus and chronic terminal renal failure.

Aetiopathogenetically, perforating skin diseases can be divided into 2 categories (Lukasz J et al. 2018):

• Inherited perforating dermatoses
• Acquired perforating dermatoses

The treatment of perforating dermatoses is not uniformly standardized. There are no controlled studies and no treatment guidelines. To be mentioned:

• Topical intralesional corticosteroids
• Topical retinoids
• Topical vitamin D analogues (e.g. Maxacalcitol)
• Topical cantharidine (Wong J et al. 2012)
• Systemic Retinoids: Acitretin mg/day (Satchell AC et al. 2001)
• Systemic antihistamines possibly in combination with UVB irradiation
• Allopurinol (100 mg/day): Smaller studies exist (Lukacs J et al. 2018). Possibly in combination with antibiotics and PUVA therapy.
• Systemic antibiotics: Successes have been achieved with clindamycin, flucloxacillin, levofloxacin, doxycycline, roxithromycin and minocycline (see below for an overview of these drugs, Lukacs J et al. 2018).
• Dapsone (50mg/day): A case report exists with a positive result (Tsuboi H et al. 2004)
• Amitryptyline (initial 10mg- as maintenance therapy 25mg/day): Treatment protocols for 2 patients are available (Yong A et al. (2014)
• Phototherapy (PUVA and NB-UVB): There are numerous case reports on these forms of therapy (see below Lukacs J et al. 2018)

1. Lukacs J et al (2018) Treatment of acquired reactive perforating dermatosis - a systematic review. JDDG 16: 825-844
2. Satchell AC et al (2001) Reactive perforating collagenosis. A condition that may be underdiagnosed. Australas J Dermatol 42: 284-287
3. Schmults CA (2002) Acquired reactive perforating collagenosis. Dermatol online J 8: 8
4. Tsuboi H et al (2004) Acquired perforating collagenosis in a patient with lung fibrosis. J Dermatol 3:916-919
5. Wong J et al (2012) Treatment of acquired perforating dermatosis with cantharidine. Arch Dermatol 148: 160-162
6. Yong A et al (2014) Effective treatment of uremic pruritus and acquired perforating dermatosis with amitryptiline. Australas J Dermatol 55: e54-57