Disseminated pruritic papules
Schneider S, Seale L, Pritchett E. Disseminated pruritic papules. Journal of the American Academy of Dermatology 2018; 79(3 Suppl 1):AB111.
Journal of the American Academy of Dermatology
A 60-year-old Arabic man with a medical history of diabetes mellitus was admitted to the hospital for an unprovoked deep vein thrombosis with pruritus, nonproductive cough, and abdominal pain. His pruritus had been ongoing over the preceding four months and he has developed diffuse erythematous to hyperpigmented papules with some having a central keratotic core and others with hemorrhagic crusting. He had minimal to no improvement in his pruritus on mid-potency topical corticosteroids in combination with antihistamines. Over the course of his hospitalization, the patient had a cat scan that demonstrated hepatocellular carcinoma with metastatic pulmonary disease and peritoneal carcinomatosis. A biopsy was performed of his skin lesions that demonstrated acquired perforating disorder. Acquired perforating dermatosis is a disease of adults most commonly seen in patients with acute renal failure or diabetes mellitus. Here, we describe the case of a patient who developed acquired perforating dermatosis in the setting of devastating liver disease due to hepatocellular carcinoma. In addition, acquired perforating dermatosis is most commonly seen on the lower extremities but in this case we describe a patient with disseminated lesions. The patient’s treatment was escalated to high-potency topical corticosteroids and hydroxyzine; however, given his underlying malignancy, his prognosis is quite poor.
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