Kyrle Disease Clinical Presentation

  • Author: Daniel J Hogan, MD; Chief Editor: William D James, MD   more...
 
Updated: Apr 20, 2012
 

History

A history of an eruption of characteristic skin lesions exists, with duration ranging from 4 months to 43 years. The lesions may be asymptomatic, but tenderness and especially pruritus are reported. Without treatment, the eruption is persistent. However, the condition has been reported to clear following therapy of the underlying systemic disease (eg, diabetes mellitus, renal failure).

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Physical

The primary lesion is a small papule with silvery scale. This eventually enlarges to form a red-brown papule or nodule with a central keratin plug. Some, but not all, of the lesions appear to be follicular. These may coalesce to form larger keratotic plaques. Koebnerization is not ordinarily described as such, but a striking linearity of lesions sometimes is noted. The papules, nodules, and plaques of Kyrle disease tend to occur primarily on the legs, but also develop on the arms and in the head and neck region. Involvement of palms and soles is rare. Ocular changes, including keratotic lesions of conjunctiva and cornea, have been described in a single case report.[6] Note the image below.

A typical lesion of Kyrle disease with central kerA typical lesion of Kyrle disease with central keratotic crater.
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Causes

As indicated above, debate about the precise pathophysiology of the disease exists. Some cases appear to be idiopathic or inherited, but other examples of Kyrle disease are associated with systemic disorders. A case report by Kasiakou et al[7] noted regression of lesions following antimicrobial therapy, suggesting a role for bacterial infection in pathogenesis. The following list includes several of the associated systemic disorders:

  • Diabetes mellitus
  • Hepatic abnormalities (primary sclerosing cholangitis,[8] alcoholic cirrhosis)[9]
  • Congestive heart failure
  • Renal disease - Chronic renal failure, albuminuria, elevated serum creatinine level, abnormal creatinine clearance, polyuria
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Contributor Information and Disclosures
Author

Daniel J Hogan, MD  Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, and Canadian Dermatology Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Marjan Garmyn, MD, PhD  Professor, Faculty of Medicine, Katholieke Universiteit Leuven, Belgium; Chair and Adjunct Head, Department of Dermatology, University of Leuven, Belgium

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, James W. Patterson, MD, to the development and writing of this article.

References

  1. Carter VH, Constantine VS. Kyrle's disease. I. Clinical findings in five cases and review of literature. Arch Dermatol. Jun 1968;97(6):624-32. [Medline].

  2. Constantine VS, Carter VH. Kyrle's disease. II. Histopathologic findings in five cases and review of the literature. Arch Dermatol. Jun 1968;97(6):633-9. [Medline].

  3. Rapini RP, Herbert AA, Drucker CR. Acquired perforating dermatosis. Evidence for combined transepidermal elimination of both collagen and elastic fibers. Arch Dermatol. Aug 1989;125(8):1074-8. [Medline].

  4. White CR Jr, Heskel NS, Pokorny DJ. Perforating folliculitis of hemodialysis. Am J Dermatopathol. Apr 1982;4(2):109-16. [Medline].

  5. Hurwitz RM, Melton ME, Creech FT 3rd, Weiss J, Handt A. Perforating folliculitis in association with hemodialysis. Am J Dermatopathol. Apr 1982;4(2):101-8. [Medline].

  6. Alyahya GA, Heegaard S, Prause JU. Ocular changes in a case of Kyrle's disease. 20-year follow-up. Acta Ophthalmol Scand. Oct 2000;78(5):585-9. [Medline].

  7. Kasiakou SK, Peppas G, Kapaskelis AM, Falagas ME. Regression of skin lesions of Kyrle's disease with clindamycin: implications for an infectious component in the etiology of the disease. J Infect. Jun 2005;50(5):412-6. [Medline].

  8. Kahana M, Trau H, Dolev E, Schewach-Millet M, Gilon E. Perforating folliculitis in association with primary sclerosing cholangitis. Am J Dermatopathol. Jun 1985;7(3):271-6. [Medline].

  9. Salomon RJ, Baden TJ, Gammon WR. Kyrle's disease and hepatic insufficiency. Arch Dermatol. Jan 1986;122(1):18-9. [Medline].

  10. Khandpur S, Bansal A, Ramam M, et al. Verrucous tuberculid mimicking Kyrle disease. Int J Dermatol. Dec 2007;46(12):1298-301. [Medline].

  11. Saleh HA, Lloyd KM, Fatteh S. Kyrle's disease. Effectively treated with isotretinoin. J Fla Med Assoc. Jun 1993;80(6):395-7. [Medline].

  12. Bolognia JL, Rapini RP, Jorizzo JL, eds. Perforating Diseases. In: Dermatology. Vol 2. 2nd ed. St. Louis, Mo: Mosby; 2008:Chapter 95.

  13. Price ML, Jones EW, MacDonald DM. Flegel's disease, not Kyrle's disease. J Am Acad Dermatol. Jun 1988;18(6):1366-7. [Medline].

 
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A typical lesion of Kyrle disease with central keratotic crater.
 
 
 
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