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Dermatology
Perforating Diseases
Built from Dermatology, 5th Edition
What’s inside
10 sections · 63 slides
What Perforating Diseases Are
Papules where connective tissue is pushed out through the skin
- What "perforating" means in skin disease
- Three prototype perforating diseases
- Classifying the primary perforating diseases
- Key features to recognise
History and Epidemiology
How these diseases were first described, and how common they are
- How the perforating diseases were named
- How common these diseases are
Pathogenesis
How connective tissue ends up outside the skin
- A foreign-body-like reaction in the skin
- The itch-scratch-plug cycle in acquired disease
- A proposed molecular pathway
- Other proposed mechanisms
Reactive Perforating Collagenosis
Collagen pushed out after minor skin trauma
- Familial reactive perforating collagenosis
- Reactive perforating collagenosis of the arm
- A single keratotic papule after trauma
- Other forms of reactive perforating collagenosis
Elastosis Perforans Serpiginosa
Elastic tissue pushed out, often on the neck
- What elastosis perforans serpiginosa is
- Genetic diseases linked to EPS
- Elastosis perforans serpiginosa in Marfan syndrome
- Typical appearance and course of EPS
- Elastosis perforans serpiginosa on the neck
- Penicillamine-induced EPS
- Penicillamine-induced elastosis perforans serpiginosa
Acquired Perforating Dermatosis
Adult-onset perforation linked to diabetes and kidney disease
- Acquired perforating dermatosis: definition
- Who is most at risk on dialysis
- Other triggers besides scratching
- Acquired perforating dermatosis of the legs
- The diagnostic clue: a central keratotic core
- Widespread and generalized disease
- Acquired perforating dermatosis in diabetes
- Acquired perforating dermatosis in chronic kidney disease
- Acquired perforating dermatosis on the arm
- Kyrle disease and the naming debate
- Perforating calcific elastosis
- Perforating calcific elastosis of the abdomen
- The major primary perforating diseases at a glance
- Major perforating diseases
Pathology
What the biopsy shows in each type of perforating disease
- Shared microscopic features
- Reactive perforating collagenosis under the microscope
- Special stains show collagen elimination in red
- Distinguishing RPC from EPS on biopsy
- Elastosis perforans serpiginosa under the microscope
- Acquired perforating dermatosis can eliminate both
- Distinctive fibers in penicillamine-induced EPS
- Variable histology in acquired disease
- More acquired perforating dermatosis histology
- Epidermis "clutching" elastic tissue in EPS
Differential Diagnosis
Telling perforating disease apart from its look-alikes
- Conditions that mimic perforating disease
- Differential diagnosis of perforating diseases
- Why one biopsy is not always enough
- Diagnostic approach to a primary perforating disease
- Beyond the primary diseases: secondary perforation
- Secondary perforating diseases
Treatment
Mostly anecdotal evidence, with phototherapy the best-supported option
- General treatment principles
- Local treatment options for EPS
- Managing widespread acquired disease
- Treatment options at a glance
- Treatment of perforating diseases
Summary
Pulling the perforating diseases together
- Quick differentiator: RPC vs EPS vs acquired disease
- Take-home points
- References
- References (continued)
- References (continued)
- References (continued)
- Dermatology, 5th Edition (2-Volume Set)