Kyrle's Disease  

Presented by:

Henry Foong MRCP (UK),

Ipoh, Malaysia,

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).


Exam 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.

Diagnosis: Perforating disorder - Kyrle's disease

Differentials: Perforating folliculitis, reactive perforating collagenosis.

Progress: 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.


Dr. 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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