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      FAMILIAL REACTIVE PERFORATING COLLAGENOSIS

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          Abstract

          Background:

          Reactive perforating collagenosis (RPC) is one of the rare forms of transepidermal elimination in which genetically altered collagen is extruded from the epidermis. This disease usually starts in early childhood as asymptomatic umbilicated papules on extremities, and the lesions become more conspicuous with age.

          Aims:

          The objective of our study was to determine the clinico-pathological features of RPC and the response to various treatment modalities.

          Methods:

          Ten patients of RPC, belonging to five different families, were studied clinically. Various laboratory investigations were carried out and diagnosis was made by histopathology of the lesions. Patients were given various topical and oral treatments.

          Results:

          RPC is familial in most cases without any definite inheritance pattern. It begins in childhood and the lesions are usually recurrent and become profuse and large with age. Systemic diseases have no role in the onset of lesions.

          Conclusion:

          Oral and topical retinoids in combination with emollients is the best treatment option.

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          Most cited references16

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          The perforating disorders.

          This article reviews the diseases that may show epidermal perforation as a histologic feature. Many of these represent examples of transepithelial elimination (TEE), a mechanism by which the skin rids itself of abnormal substances. After a review of disorders in which perforation is an occasional finding, four diseases that have been considered essential perforating disorders are discussed: elastosis perforans serpiginosa (EPS), reactive perforating collagenosis (RPC), perforating folliculitis (PF), and Kyrle 's disease (KD). A review of the literature, including recent reports of perforating diseases associated with chronic renal failure, suggests that there may be considerable clinical and histologic overlap among PF, KD, and the adult form of "perforating collagenosis." A working classification for the perforating disorders is suggested.
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            Acquired reactive perforating collagenosis: four patients with a giant variant treated with allopurinol.

            Reactive perforating collagenosis (RPC) is one of the four essential acquired perforating dermatoses. The condition is characterized by the transepidermal elimination of altered collagen. This paper describes four patients with a giant variant of RPC which has not previously been documented. Three of the patients had associated diabetes mellitus and one had chronic renal failure secondary to fetal scarring. Three of the four patients had a significant improvement in their lesions and symptoms following treatment with allopurinol.
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              Familial reactive perforating collagenosis: a clinical, histopathological study of 10 cases.

              To study the clinical and histopathological features of familial reactive perforating collagenosis (RPC). Ten patients, including affected siblings in three, took part in the study. Parental consanguinity was present in one. Histopathological study was performed in all patients. The eruptions appeared mainly during infancy or early childhood as papules showing a central plug, which subsided within 10 weeks. Areas commonly affected were the face, extremities and trunk. Rare sites were the scalp, ears and buttocks. One pregnant woman, in whom RPC had first manifested around puberty, had relatively widespread lesions. In those with seasonal variation, recurrences were seen a little more frequently in summer than in winter owing to the longer duration of the former. Histopathology confirmed the diagnosis with follicular involvement in four cases. In two patients whose backs were also affected, the lesions went unnoticed, as they were small and inconspicuous. In addition, the brother of a girl with RPC who claimed to be free of the dermatosis, had facial scars suggestive of RPC in the past. Familial RPC can remain quiescent for a long period and the inherited defect not only shows extreme variability in expression but also demonstrates that lesions can be few and localized so as to escape notice in individuals and family members presenting with this benign, uncommon and self-subsiding dermatosis. In all patients topical retinoic acid was helpful in early regression. Sunscreens may mitigate the severity of RPC in those whose lesions are precipitated in summer but this needs further evaluation.
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                Author and article information

                Journal
                Indian J Dermatol
                IJD
                Indian Journal of Dermatology
                Medknow Publications (India )
                0019-5154
                1998-3611
                Oct-Dec 2009
                : 54
                : 4
                : 334-337
                Affiliations
                From the Departments of Dermatology, STD & Leprosy and Pathology, SKIMS Medical, College Hospital, India.
                [1 ] From the Departments of Dermatology, SKIMS Soura, Srinagar, India.
                Author notes
                Address for correspondence: Dr. Yasmeen J Bhat, Department of Dermatology, STD & Leprosy, SKIMS MCH Srinagar, India. E-mail: yasmeen_bhat2001@ 123456yahoo.co.in
                Article
                IJD-54-334
                10.4103/0019-5154.57608
                2807708
                20101333
                199e2176-0e26-4a06-98e2-3a4fad122ee6
                © Indian Journal of Dermatology

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : August 2008
                : February 2009
                Categories
                Original Article

                Dermatology
                transepidermal elimination,familial,umbilicated,retinoids
                Dermatology
                transepidermal elimination, familial, umbilicated, retinoids

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