Treatment of acquired reactive perforating dermatosis – a systematic review

Abstract

Reactive perforating dermatosis is a rare chronic skin disease defined by the transepidermal elimination of collagen and/or elastin. In the acquired form in adults, it is frequently associated with diseases such as diabetes and chronic renal failure. No systematic reviews of treatment options are available for this disease. The aim of this systematic review is to summarize all reported treatment options for acquired reactive perforating dermatosis (ARPD). This is a systematic review based on a MEDLINE search of articles in English and German from 1990 to 2016. Most medical literature on the treatment of ARPD is limited to individual case reports and small series of patients. Various therapies that have been tried include antihistamines, topical keratolytics, corticosteroids, tretinoin, oral drugs such as allopurinol or antibiotics, and phototherapy or photochemotherapy. While there are no specific criteria for the evidence-based selection of treatment options for ARPD, the first priority in management of these conditions should be treatment of an underlying disease if present. None of the described modalities has been approved for first-line therapy. It is recommended to choose a combination of drugs that reduce itching and assist in the resolution of the skin lesions at the same time.

Acquired perforating dermatosis: clinicopathologic study of a 10‐year period at a tertiary teaching hospital

“…In contrast with previous series, only 37.8% of the patients had a complete response, emphasizing the need for other treatment options . Successful outcomes with tetracyclines, allopurinol, phototherapy, systemic retinoids, and systemic steroids have been reported . In this series, few patients were treated with doxycycline and allopurinol, and both drugs were not an effective treatment alternative.…”

“…2,3 Successful outcomes with tetracyclines, allopurinol, phototherapy, systemic retinoids, and systemic steroids have been reported. [2][3][4][30][31][32] In this series, few patients were treated with doxycycline and allopurinol, and both drugs were not an effective treatment alternative. Acitretin, systemic steroids, and phototherapy were the treatments associated with the best outcome and should be considered in the management of patients with disseminated lesions and severe pruritus, as well as in those who have a poor response to topical therapies.…”

“…The management of APD is challenging, and the evidence‐based support for treatment comes from small case series and individual case reports . Treatment of underlying systemic diseases should always be considered and, sometimes, complete resolution of the dermatosis might be achieved.…”

“…Although hypertension and cardiovascular diseases were frequent comorbidities in this study, we hypothesize that these dis- The management of APD is challenging, and the evidencebased support for treatment comes from small case series and individual case reports. 30 Treatment of underlying systemic diseases should always be considered and, sometimes, complete resolution of the dermatosis might be achieved. The association of topical steroids with oral antihistamines is usually the first modality of treatment.…”

Clinical characteristics and prognosis of acquired perforating dermatosis: A case report

“…Currently, there is no definitive or efficient treatment for APD (5,8,22,23). Topical steroids and oral antihistamines are the most commonly prescribed drugs, which primarily aim to control the symptoms (5,8,22,23).…”