Treatment of acquired perforating dermatosis with cantharidin

摘要

A 65-year-old woman presented with a 6-month history of pruritic, hyperpigmented papules with central, hyper-keratotic plugs on her bilateral lower extremities , (Figure 1 A). There were no papules on her trunk, head, upper extremities, volar surfaces, or mucous membranes. Her medical history was significant for chronic renal failure treated for the past 4 years with peritoneal dialysis, a 30-year history of insulin-dependent diabetes mellitus, hypercholesterolemia, hypertension, coronary artery bypass, hypothyroidism, and hyperparathyroid-ism. There was no family history of similar skin lesions. A biopsy specimen from a lesion on the left leg revealed keratotic plugs filled with laminated orthokeratotic and parakeratotic keratin and debris. Beneath the plug, the epidermis was thinned and the dermis showed a neutro-philic infiltrate and foci of fibrosis (Figyre 2A). Tri-chrome stain showed rare focal collagen extruding through the base. The surrounding skin showed features of lichen simplex chronicus. The clinical and his-topathologic features supported the diagnosis of an acquired perforating disorder associated with renal disease.