What are the other Names for this Condition? (Also known as/Synonyms)

• Acquired Perforating Collagenosis
• APD (Acquired Perforating Dermatosis)

What is Acquired Perforating Dermatosis? (Definition/Background Information)

• Acquired Perforating Dermatosis (APD) is an uncommon skin condition that occurs mostly in individuals undergoing dialysis
• The cause of the condition is unknown, but some researchers believe that it may be due to metabolic imbalance within the body, commonly caused by diabetes
• Acquired Perforating Dermatosis is mostly seen in adults, who have poorly-controlled diabetes. It is a chronic condition
• Acquired Perforating Dermatosis is characterized by the presence of multiple papules on the trunk and head and neck region that is accompanied by severe itching. The itching is a key feature of APD
• The treatment for Acquired Perforating Dermatosis may include the use of topical steroid creams and moisturizers, phototherapy, and adequately managing the underlying condition
• Individuals who respond to treatment have better prognosis than those who do not respond well to treatment

Who gets Acquired Perforating Dermatosis? (Age and Sex Distribution)

• Acquired Perforating Dermatosis (APD) is uncommon in the general population. It is observed in a 1:10 incidence ratio in those undergoing dialysis (due to kidney failure)
• This subset of individuals includes adults in the 30-80 years’ age group
• It can affect both males and females and no gender preference is observed
• The condition can occur worldwide; individuals of all racial and ethnic background may be affected. But, there is a higher incidence of APD among African Americans for unknown reasons

What are the Risk Factors for Acquired Perforating Dermatosis? (Predisposing Factors)

Apart from undergoing dialysis procedure due to improper kidney function, the risk factors for Acquired Perforating Dermatosis (APD) include the following:

• Kidney failure
• Liver disease
• Poorly-controlled diabetes
• Other skin and systemic diseases with severe pruritus, including lymphoma, liver disease, insect bites, and scabies
• Certain medications can trigger APD, including TNF inhibitors, epidermal growth factor receptor inhibitors, antivirals, and monoclonal antibodies

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Acquired Perforating Dermatosis? (Etiology)

• The exact cause of Acquired Perforating Dermatosis development is unknown
• Some experts believe that it is due to the formation of abnormal mineral deposits resulting from a metabolic imbalance in the body

What are the Signs and Symptoms of Acquired Perforating Dermatosis?

The signs and symptoms of Acquired Perforating Dermatosis include:

• A collection of skin papules with a central keratotic plug
• It occurs most frequently on the legs, and is also seen on the chest, back, arms, head and neck region, including the face and scalp
• The skin lesions can be extremely itchy

It is difficult to predict who gets mild or severe symptoms.

How is Acquired Perforating Dermatosis Diagnosed?

The following are the diagnostic methods that may be used for Acquired Perforating Dermatosis:

• A thorough physical examination and a complete medical history are very crucial
• A diagnosis of Acquired Perforating Dermatosis may be arrived at clinically by analyzing the signs and symptoms against a background of dialysis history. A skin biopsy is usually not needed
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Acquired Perforating Dermatosis?

The complications due to Acquired Perforating Dermatosis (APD) may include:

• APD can be a longstanding and chronic condition
• Chronic and severe itching can result in scarring of the skin, leading to self-image issues, emotional and psychological stress
• Bacterial and fungal infections: APD can cause continuous itching and scaling of the skin, which creates skin moistness, providing a suitable environment for bacteria and fungi to grow and thrive

How is Acquired Perforating Dermatosis Treated?

Treatment strategies that may be adopted in the management of Acquired Perforating Dermatosis include:

• The treatment and management of the underlying condition is very important
• Use of topical steroids
• Topical retinoids, such as tretinoin, are also used in conjunction with steroids
• Phototherapy: The use of light to treat the condition
• Vitamin A therapy: The use of oral vitamin A to treat the skin condition
• Cryotherapy: The use of very low temperature liquid nitrogen or solid carbon dioxide (dry ice) to help remove the skin lesions
• For mild skin conditions, self-care measures are recommended, such as washing with mild (antibacterial) soap, and applying warm compress
• Follow-up care with regular screening and checkups are important

A few self-care tips and home remedies for Acquired Perforating Dermatosis (APD) may include:

• Completely avoid scratching the affected areas
• A comfortable, cool bath may help soothe the skin; but, avoid excessive washing and scrubbing of skin
• Wear smooth cotton clothes
• Use only mild perfumes, soaps, and detergents
• Keeping the skin moist can help in reducing the signs and symptoms caused by APD

How can Acquired Perforating Dermatosis be Prevented?

• Currently, there are no specific methods or guidelines to prevent Acquired Perforating Dermatosis (APD). The condition predominantly occurs in individuals who are undergoing regular dialysis
• However, proper control of diabetes and other infectious disease can lower one’s risk for APD

What is the Prognosis of Acquired Perforating Dermatosis? (Outcomes/Resolutions)

• The prognosis of Acquired Perforating Dermatosis is dependent upon the underlying condition associated with it
• Regular follow up visits with healthcare providers are important

Additional and Relevant Useful Information for Acquired Perforating Dermatosis:

Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition.