Reactive perforating collagenosis of diabetes mellitus

Acquired perforating collagenosis: is it due to damage by scratching?

“…Ultrastructural studies have given some insight into the development of APC lesions, 2 but so far they do not provide a straightforward explanation for the formation of transepithelial channels around extruded dermal matrix material in the affected patients. Proposed explanations include a foreign‐body reaction against collagen, 2 although it appears normal on electron microscopy, 1 and an abnormal keratinization secondary to this reaction, although electrophoresis does not show abnormal keratin bands 2,3 , 11 . There is some support for the assumption that patients with diabetes mellitus might, in general, be more prone to such an abnormal pattern of wound healing and altered handling of the exposed collagen matrix after trauma 10 .…”

Reactive Perforating Collagenosis and Acquired Perforating Dermatosis: Presentation of Two Cases

“…According to another hypothesis, the disease is an epithelial disorder associated with abnormal keratinization, in which collagen is altered secondarily. This would explain the absence of granulomatous inflammation and also the therapeutic response to retinoids (17). Finally, it seems that the increase in vitamin A levels noticed during hemodialysis plays a role (4,18).…”

Effective treatment of uremic pruritus and acquired perforating dermatosis with amitriptyline

“…Keratinisation of the basal layer incites a dermal inflammatory reaction, resulting in the transepidermal elimination of keratin and other connective tissue elements . Other postulated mechanisms include increased serum fibronectin, transforming growth factor‐β3 overexpression and abnormal metalloproteinase reactivity …”