2023
DOI: 10.3390/dermatopathology10030029
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Perforating Gout: Expanding the Differential for Transepidermal Elimination

Abstract: Perforating dermatoses are dermatologic disorders with transepidermal elimination (TE) of dermal substances. While TE is typically associated with collagen and elastin, it can also occur as a secondary event in other processes, and it is important to keep a broad differential. We present a case of perforating tophaceous gout, which underscores the need for a thoughtful approach to perforating disorders. An updated review of recent literature is also presented.

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“…Common clinical differential diagnoses to consider facing a centrally ulcerated, keratotic, plugged, and umbilicated papule or nodule include keratoacanthoma, squamous cell carcinoma, molluscum contagiosum, prurigo nodularis, common wart, etc., but, usually, these entities are easy to distinguish histologically. Nevertheless, some other rare perforating conditions including inflammatory, tumoral, or deposition diseases may present as a single papular, nodular, ombilicated, or crateriform lesion: perforating granuloma annulare [ 13 ], involuted Spitz naevus with transepidermal elimination [ 14 ], perforating pilomatricoma [ 15 ], perforating metastasis from an ovarian adenocarcinoma [ 16 , 17 ], amyloïdosis, calcinosis cutis, osteoma cutis [ 18 ], the verrucous variant of perforating collagenoma or ARPC [ 19 ], and perforating gout [ 20 ].…”
Section: Discussionmentioning
confidence: 99%
“…Common clinical differential diagnoses to consider facing a centrally ulcerated, keratotic, plugged, and umbilicated papule or nodule include keratoacanthoma, squamous cell carcinoma, molluscum contagiosum, prurigo nodularis, common wart, etc., but, usually, these entities are easy to distinguish histologically. Nevertheless, some other rare perforating conditions including inflammatory, tumoral, or deposition diseases may present as a single papular, nodular, ombilicated, or crateriform lesion: perforating granuloma annulare [ 13 ], involuted Spitz naevus with transepidermal elimination [ 14 ], perforating pilomatricoma [ 15 ], perforating metastasis from an ovarian adenocarcinoma [ 16 , 17 ], amyloïdosis, calcinosis cutis, osteoma cutis [ 18 ], the verrucous variant of perforating collagenoma or ARPC [ 19 ], and perforating gout [ 20 ].…”
Section: Discussionmentioning
confidence: 99%