eMedicine Specialties > Dermatology > Diseases of the Dermis
Reactive Perforating Collagenosis: Differential Diagnoses & Workup
Updated: Oct 30, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
Elastosis Perforans Serpiginosum
Kyrle Disease
Perforating Folliculitis
Prurigo Nodularis
Workup
Laboratory Studies
- The purpose of any investigation is to search for underlying causes, particularly causes of pruritus.
- Urea and creatinine determinations are needed to detect any underlying renal impairment. A creatinine clearance test and other more complex renal investigations may be required.
- Ferritin levels and a full blood cell count can help detect anemia. Low iron stores can cause pruritus.
- Random glucose testing can help detect diabetes.
- Skin biopsy is essential to make a diagnosis.
Histologic Findings
The histology varies with the stage of the reactive perforating collagenosis. Early lesions show epidermal hyperplasia associated with underlying degenerate basophilic collagen fibers. In established lesions, a cup-shaped depression of the epidermis associated with a keratin plug containing parakeratosis, inflammatory debris and collagen fibers can be seen.
Cup-shaped invagination of the epidermis associated with a keratin plug containing inflammatory debris and collagen fibers.
Vertically orientated basophilic collagen fibers are seen in the underlying dermis, with focal extrusion through the epidermis.
The epidermis is atrophic and may show ulceration. However, at the edges of the cup-shaped invagination, the epidermis is hyperplastic. Additionally, a mild perivascular lymphohistiocytic infiltrate can be seen.
Extruded collagen fibers may be demonstrated with elastic van Gieson (EVG) staining, which stains the fibers red. No extrusion of elastic fibers should be seen (staining black with EVG).
An elastic van Gieson stain demonstrating the expulsion of collagen fibers (red) into the overlying keratin plug.
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Differential Diagnoses & Workup: Reactive Perforating Collagenosis |
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References
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Faver IR, Daoud MS, Su WP. Acquired reactive perforating collagenosis. Report of six cases and review of the literature. J Am Acad Dermatol. Apr 1994;30(4):575-80. [Medline].
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Kiliç A, Gönül M, Cakmak SK, Gül U, Demiriz M. Acquired reactive perforating collagenosis as a presenting sign of hepatocellular carcinoma. Eur J Dermatol. Jul-Aug 2006;16(4):447. [Medline].
Chae KS, Park YM, Cho SH, Cho BK. Reactive perforating collagenosis associated with periampullary carcinoma. Br J Dermatol. Sep 1998;139(3):548-50. [Medline].
Yazdi S, Saadat P, Young S, Hamidi R, Vadmal MS. Acquired reactive perforating collagenosis associated with papillary thyroid carcinoma: a paraneoplastic phenomenon?. Clin Exp Dermatol. May 5 2009;[Medline].
Calista D, Morri M. Acquired reactive perforating collagenosis induced by indinavir in 2 patients with HIV disease. Eur J Dermatol. Jan-Feb 2008;18(1):84-5. [Medline].
Berger RS. Reactive perforating collagenosis of renal failure/diabetes responsive to topical retinoic acid. Cutis. Jun 1989;43(6):540-2. [Medline].
Brinkmeier T, Schaller J, Herbst RA, Frosch PJ. Successful treatment of acquired reactive perforating collagenosis with doxycycline. Acta Derm Venereol. 2002;82(5):393-5. [Medline].
Vion B, Frenk E. [Acquired reactive collagen disease in the adult: successful treatment with UV-B light]. Hautarzt. Jul 1989;40(7):448-50. [Medline].
Serrano G, Aliaga A, Lorente M. Reactive perforating collagenosis responsive to PUVA. Int J Dermatol. Mar 1988;27(2):118-9. [Medline].
Further Reading
Keywords
reactive perforating collagenosis, acquired perforating dermatosis, perforating disorders, Kyrle's disease, elastosis perforans serpiginosa, perforating folliculitis






Differential Diagnoses & Workup: Reactive Perforating Collagenosis