Medical Care
Treatment of reactive perforating collagenosis lesions is often unsatisfactory; in many cases, the lesions are self-healing, but usually are recurrent.
Anecdotal reports describe successful therapy for reactive perforating collagenosis with retinoids, [24] allopurinol, [25, 8] doxycycline, [26] UVB, [27] and psoralen ultraviolet light A. [28] Phototherapy is a good choice for patients with coexistent renal disease and associated pruritus. Narrowband UVB phototherapy has been helpful in a case of familial reactive perforating collagenosis in a child. [29] Narrowband UVB phototherapy combined with doxycycline was successful in treating acquired reactive perforating collagenosis in a 32-year-old male. [30]
Topical steroids are usually not helpful, but intralesional steroids have been successful. [1]
Emollients and systemic antihistamines seem helpful in controlling pruritus.
In cases of acquired reactive perforating collagenosis, García-Malinis et al recommend discontinuing treatment with biologics. [31] A 23-year-old patient with acquired reactive perforating collagenosis was successfully treated with an 8-week course of itraconazole, even though there was no fungal infection present. [32] Additionally, Ying et al report favorable results with dupilumab monotherapy in 2 elderly patients with acquired reactive perforating collagenosis associated with atopic dermatitis. [33]
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Typical keratotic papules.
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Cup-shaped invagination of the epidermis associated with a keratin plug containing inflammatory debris and collagen fibers.
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Vertically orientated collagen fibers are extruded into the overlying keratin plug.
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An elastic van Gieson stain demonstrating the expulsion of collagen fibers (red) into the overlying keratin plug.
