Saray Y, Seçkin D, Bilezikçi B
Başkent University Faculty of Medicine, Department of Dermatology, Ankara, Turkey.
J Eur Acad Dermatol Venereol. 2006 Jul;20(6):679-88. doi: 10.1111/j.1468-3083.2006.01571.x.
The term of acquired perforating dermatosis (APD) comprises the perforating dermatoses occurring in adult patients. Clinical and histological features of the disease are not uniform, and may resemble any of the four classic perforating disorders: elastosis perforans serpiginosa, reactive perforating collagenosis, perforating folliculitis or Kyrle's disease. Chronic renal failure and/or diabetes mellitus usually accompany this skin disease.
The aim of this study was to delineate the clinical and histopathological features of acquired perforating dermatosis and to investigate the potential relationship between this disease and associated conditions.
Twenty-two patients with acquired perforating dermatosis were enrolled in this study. Clinical findings of acquired perforating dermatosis and the spectrum of associated diseases were investigated. Haematoxylin and eosin sections were re-examined, and immunohistochemical stainings (elastic van Gieson and Masson trichrome stains) and periodic acid-Schiff stain were also used for histopathological evaluation.
Different clinical types of lesions resembling reactive perforating collagenosis, perforating folliculitis or Kyrle's disease were observed. Histopathological features were consistent with any of the four types of perforating dermatoses. Most of the patients (86.4%) had at least one systemic disease. Chronic renal failure (72.7%) and diabetes mellitus (50%) were the most commonly associated conditions. Most of the patients with diabetes mellitus (90.9%) had chronic renal failure due to diabetic nephropathy. All of the patients with chronic renal failure were on dialysis treatment. The other associated conditions were hepatitis (27.3%), anti-HCV Ab-positivity (13.6%), hypothyroidism (9.1%) and tuberculosis lymphadenitis (4.5%). Of the 22 patients, 13.6% were otherwise healthy, and 9.1% were renal transplant recipients.
Clinicopathological findings of our study indicate that the cases with APD represent the broad spectrum of perforating disorders rather than the variants of the same disease. Although APD is frequently associated with diabetes mellitus and chronic renal failure, this skin disorder may also develop in patients with other systemic disorders, and in those without any medical problems. This skin disease is probably linked to dialysis treatment in patients with chronic renal failure due to diabetes mellitus or other causes.
获得性穿通性皮肤病（APD）这一术语涵盖发生于成年患者的穿通性皮肤病。该疾病的临床和组织学特征并不一致，可能类似于四种经典穿通性疾病中的任何一种：匐行性穿通性弹力纤维病、反应性穿通性胶原病、穿通性毛囊炎或 Kyrle 病。慢性肾衰竭和/或糖尿病通常伴随这种皮肤病。
本研究旨在描述获得性穿通性皮肤病的临床和组织病理学特征，并探讨该疾病与相关疾病之间的潜在关系。
本研究纳入了 22 例获得性穿通性皮肤病患者。对获得性穿通性皮肤病的临床发现及相关疾病谱进行了研究。苏木精-伊红切片进行了重新检查，免疫组织化学染色（弹性 Van Gieson 染色和 Masson 三色染色）以及过碘酸-希夫染色也用于组织病理学评估。
观察到不同临床类型的皮损，类似于反应性穿通性胶原病、穿通性毛囊炎或 Kyrle 病。组织病理学特征与四种穿通性皮肤病中的任何一种一致。大多数患者（86.4%）至少有一种全身性疾病。慢性肾衰竭（72.7%）和糖尿病（50%）是最常见的相关疾病。大多数糖尿病患者（90.9%）因糖尿病肾病而患有慢性肾衰竭。所有慢性肾衰竭患者均接受透析治疗。其他相关疾病包括肝炎（27.3%）、抗 HCV 抗体阳性（13.6%）、甲状腺功能减退（9.1%）和结核性淋巴结炎（4.5%）。22 例患者中，13.6%无其他疾病，9.1%为肾移植受者。
我们研究的临床病理结果表明，APD 病例代表了广泛的穿通性疾病谱，而非同一疾病的不同变体。虽然 APD 常与糖尿病和慢性肾衰竭相关，但这种皮肤疾病也可能在患有其他全身性疾病的患者以及无任何医疗问题的患者中发生。这种皮肤病可能与因糖尿病或其他原因导致慢性肾衰竭的患者的透析治疗有关。
