A 48-year-old woman with diabetes presents seeking treatment for an extremely itchy dermatitis primarily affecting her back and scalp. Suffering from progressive renal failure, she is currently on dialysis. The itching has failed to subside with topical prescription therapies and antihistamines. Examination reveals multiple erythematous, hyperkeratotic papules of the affected areas, many of which are excoriated.
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Kyrle disease is an uncommon disorder that affects individuals with diabetes and end-stage renal disease. Age of onset is between 30 and 50 years, and the majority of cases occur in women. It is classified as a reactive perforating collagenosis; related disorders include elastosis perforans serpiginous and perforating folliculitis.1 The etiology is uncertain, although it is postulated that chronic pruritus in predisposed patients induces rupture of collagen fibers with consequent elimination.2
Kyrle disease is characterized by crops of papules and nodules on the legs and, to a lesser extent, on the arms and trunk. Individual lesions are deep red in color and contain a characteristic keratin plug. Less severe cases may improve with topical retinoic acid.3 Oral retinoids and ultraviolet therapy have proven of value in more extensive cases.1,4
- Mullins TB, Bhimji SS. Reactive perforating collagenosis. Treasure Island (FL): StatPearls Publishing; 2018 Jan-
- Saray Y, Seçkin D, Bilezikçi B. Acquired perforating dermatosis: clinicopathological features in twenty two cases. J Eur Acad Dermatol Venereol. 2006;20:679-688.
- Petrozzi JW, Warthan TL. Kyrle disease. Treatment with topically applied tretinoin. Arch Dermatol. 1974;110(5):762-765.
- Matsuzaki Y, Yokoyama S, Rokunohe A, Minakawa S, Nakano H, Sawamura D. Successful treatment of Kyrle disease with narrowband ultraviolet B. J Dermatol. 2017;44(6):721-722.