The pathogenesis of the transepithelial elimination of the collagen bundles in acquired reactive perforating collagenosis

Abstract

Two cases of acquired reactive perforating collagenosis with poorly controlled diabetes mellitus were studied by histochemistry and by electron microscopy. In excoriated wound the necrotic mass on the bottom of the ulcer contained the collagen bundles which were continuous with the collagen bundles in the reticular layer. In the developing stage, the epidermis regenerated between the necrotic mass and the reticular dermis, and the collagen bundles in the reticular dermis were in continuity with those in the necrotic mass through the epithelial tunnels. The collagen in the epidermal channels did not degenerate ultrastructurally. In the mature lesion, collagen bundles being eliminated through the epidermis were surrounded by the fibroblasts at the basal cell layer. Collagen fibers were seen in the cytoplasm of these fibroblasts. From these findings, the mechanisms of the formation of the eruption in acquired reactive perforating collagenosis might be as follow: 1) In the developing stage, the regeneration of epidermis progresses between the necrotic mass and the reticular dermis, and among the collagen bundles. As a result, the collagen bundles remain in the channels of the epidermis. And then, 2) the regenerated epidermis makes the thick horny layer. As a result, the necrotic masses are lifted up and the collagen bundles are pulled up from the dermis through the epidermal channels.

Sirolimus-Induced Inflammatory Papules with Acquired Reactive Perforating Collagenosis

“…ARPC has been described in association with diabetes, chronic renal disease and malignancy and following various inflammatory cutaneous conditions [18, 19]. It corresponds to a transepidermal elimination of necrotic collagen during a peculiar pattern of epidermal regeneration [20]. Overexpression of TGF-β3 has been implicated in the pathogenesis of ARPC [21].…”

Acquired Perforating Dermatosis in a Patient with Poland Syndrome

“…Fretzin et al [25]found the extruded collagen histochemically altered but morphologically intact. The ultrastructural integrity was also confirmed by Yanagihara et al [26]. The collagen fibres eliminated through the epidermis showed normal periodicity [27].…”

Colagenosis perforante reactiva adquirida: Caso clínico

“…Nuestros pacientes cumplen con los criterios clínicos propuestos por Faver, sin embargo, en el diagnóstico histopatológico no se evidencia necrosis de las bandas de colágeno. Esto coincide con reportes que describen que las fibras colágenas no presentan degeneración obvia 8,9 .…”

“…Las enfermedades que más se asocian a la colagenosis perforante reactiva adquirida son la diabetes mellitus y la insuficiencia renal crónica [5][6][7][8][9][10][11][12][13][14][15] , ambas patologías presentes en nuestras pacientes. En un estudio inglés hecho en una población de insuficientes renales crónicos en hemodiálisis, se demostró que 11% presentaba colagenosis perforante reactiva adquirida 15 .…”