Foong MRCP (UK),
February 4th, 2001
Madam N is a 51-year-old woman with a 2-month history of itchy, occasional
tender erythematous lesions on the lower limbs. It started around
her knees and subsequently spread proximally to the thighs. The lesions
heal with post inflammatory pigmentation. She is otherwise well and
has no constitutional symptoms. She is known to have diabetes for
the last 18 years and is on oral hypoglycaemics (diamicron).
showed multiple discrete 2-4mm erythematous papules on the legs, knees
and thighs bilaterally. Some of the papules appeared umbilicated and
few 8-12mm has huge central keratotic plugs.
Perforating disorder - Kyrle's disease
Perforating folliculitis, reactive perforating collagenosis.
Did a biopsy to confirm diagnosis and blood chemistry to check renal
function/urinalysis. Treatment is difficult. Plan to put her on potent
topical steroids, under occlusion and possibly intra lesional triamcinolone.
Wonder if there is any role for retinoids - acetretin? I think cyclosporin
would work but worry about costs and nephrotoxicity.
Amanda Oakley's Comments (8/10/01):
I had a patient with diabetes and renal failure whose very extensive
perforating lesions cleared amazingly well with oral isotretinoin
40 mg daily for 4 or 5 months.
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