Morton C A, Henderson I S, Jones M C, Lowe J G
Department of Dermatology, Ninewells Hospital, Dundee, U.K.
Br J Dermatol. 1996 Nov;135(5):671-7.
A perforating disorder of the skin developing in association with chronic renal failure and often also diabetes, acquired perforating dermatosis (APD), affects up to 10% of patients receiving maintenance haemodialysis in North America. The prevalence of this condition in British dialysis patients has not yet been ascertained. We have undertaken a skin survey of our dialysis population (n = 80) to determine the prevalence and clinical presentation of APD, with subsequent assessment of disease management and outcome. Of 72 patients who participated in the survey, eight were found to have APD, seven of whom were also diabetic. Skin lesions had developed pre-dialysis in two patients, on commencement of dialysis in one, and after 1-3 years on dialysis in the remaining five. Patients typically presented with pruritic dome-shaped papules with central crusts arising on the trunk and extensor limb surfaces. Histological examination of biopsy specimens revealed two types of lesion, typified by either narrow or broad ulcer craters, each showing perforation of both collagen and elastic fibres. Topical/intradermal steroid or topical retinoid were effective therapies in certain of our patients. Clinical clearance was achieved after 3-12 months of treatment in five patients with improvement in the remaining two patients who received treatment. Of the four patients who were alive at 2-year review, three remained clear, while one patient continued to develop new lesions. We report an 11% prevalence of APD in our dialysis population, suggesting the disorder to be as prevalent in patients with chronic renal failure in Britain as in North America. An association of the disorder with long-standing diabetes was confirmed.
获得性穿通性皮肤病（APD）是一种与慢性肾衰竭相关且常伴有糖尿病的皮肤穿通性疾病，在北美接受维持性血液透析的患者中，其发病率高达10%。目前尚未确定这种疾病在英国透析患者中的患病率。我们对我们的透析人群（n = 80）进行了皮肤调查，以确定APD的患病率和临床表现，随后评估疾病的管理和预后。在参与调查的72名患者中，发现8例患有APD，其中7例同时患有糖尿病。两名患者在透析前出现皮肤病变，一名患者在开始透析时出现，其余五名患者在透析1 - 3年后出现。患者通常表现为躯干和四肢伸侧表面出现瘙痒性圆顶状丘疹，中央有结痂。活检标本的组织学检查显示有两种类型的病变，以狭窄或宽阔的溃疡坑为典型特征，每种病变均显示胶原纤维和弹性纤维均有穿通。局部/皮内类固醇或局部维甲酸对我们的某些患者是有效的治疗方法。五名患者在治疗3 - 12个月后临床症状消除，其余两名接受治疗的患者病情有所改善。在2年复查时仍存活的4名患者中，3名病情持续缓解，而1名患者继续出现新的病变。我们报告我们的透析人群中APD的患病率为11%，这表明该疾病在英国慢性肾衰竭患者中的患病率与北美一样高。该疾病与长期糖尿病的关联得到了证实。
