An Bras Dermatol 2016 Sep-Oct;91(5 suppl 1):10-13

Universidade Federal do Estado do Rio de Janeiro (UNIRIO) - Rio de Janeiro (RJ), Brazil.

Perforating dermatoses are a group of skin diseases characterized by transepidermal elimination of dermal material. The disease is divided into two groups: the primary group and the secondary group. The classical or primary perforating dermatoses are subdivided into four types according to the eliminated dermal materials: Kyrle disease, perforating reactive collagenosis, elastosis perforans serpiginosa, and perforating folliculitis. Read More

J Am Acad Dermatol 2016 Sep;75(3):e99-e101

Dermatology Unit, Second University of Naples, Naples, Italy.

J Dermatol 2017 Jun 23;44(6):721-722. Epub 2016 Jul 23.

Department of Dermatology, Hirosaki University School of Medicine, Aomori, Japan.

Rom J Intern Med 2016 Jan-Mar;54(1):66-9

Acquired perforating disorders are a group of uncommon skin conditions characterized by transepidermal extrusion of altered dermal material, most often associated with diabetes mellitus and chronic kidney failure. Delusional parasitosis is a primary psychiatric disorder in which affected patients have fixed, false beliefs that their skin is infested by parasites, in the absence of any evidence supporting their statements. A 69 year old malepatient addressed the Dermatology Department for a skin eruption consisting of multiple umbilicated keratotic papules with a generalized distribution. Read More

Case Rep Dermatol 2016 Jan-Apr;8(1):5-9. Epub 2016 Jan 20.

Dermatology Department, University Hospital, Sana'a University, Sana'a, Yemen.

Kyrle disease (KD) and Flegel disease (FD) are rare variants of primary perforating dermatoses, characterized by transepidermal elimination of abnormal endogenous materials. We describe a 6-year-old Yemeni girl with a 2-year history of generalized asymptomatic, small, reddish-brown keratotic papules with a lenticular central keratotic plug. Although these features are synonymous with FD, the histology of a punch biopsy was consistent with KD. Read More

J Am Podiatr Med Assoc 2015 Sep;105(5):451-5

We report two cases of biopsy-confirmed Kyrle disease. Kyrle disease is one of the perforating dermatoses associated with diabetic patients undergoing renal dialysis. In this report, we describe the clinical and histopathologic features, the differential diagnoses, and successful treatment of this unusual disorder. Read More

Cleve Clin J Med 2015 Apr;82(4):216

Department of Dermatology, Division of Dermatopathology and Cutaneous Immunopathology, Mayo Clinic, Rochester, MN, USA. E-mail:

J BUON 2014 Jan-Mar;19(1):317-8

Dept. of Dermatology, "A. Sygros" Hospital, Athens, Greece.

Eur J Dermatol 2013 Nov-Dec;23(6):864-71

Dermatology Clinic.

Background: Acquired perforating dermatosis (APD) is a rare group of skin disorders characterized by transepidermal elimination of dermal tissue material. There are only a few studies of APD.

Objective: We aimed to review the clinicopathologic features of patients with APD and evaluate the outcomes of treatments. Read More

Indian J Pathol Microbiol 2013 Oct-Dec;56(4):355-8

Department of pathology, K. J. Somaiya Medical College and Research Centre, Mumbai, Maharashtra, India.

Background: Perforating disorders of the skin, is an often overlooked entity characterized by transepidermal elimination of material from the upper dermis and are classified histopathologically according to the type of epidermal disruption and the nature of the eliminated material. They include Kyrle's disease, perforating folliculitis, reactive perforating collagenosis, and elastosis perforans serpiginosa.

Aim: The aim of this study was to delineate the clinical and histopathological features of perforating disorders of the skin. Read More

BMJ Case Rep 2014 Jan 15;2014. Epub 2014 Jan 15.

Konya Training and Research Hospital, Konya, Turkey.

Kyrle's disease (KD) is a dermatosis which was first described by Kyrle as "hyperkeratosis follicularis et parafollicularis in cutem penetrans" in 1916. Perforating dermatoses are a heterogeneous disorder group characterised by transepithelial elimination. KD has been seen in association with multiple disorders, including diabetes mellitus, renal and liver diseases, congestive heart failure, hyperlipidaemia, infective diseases and abnormal metabolism of vitamin A. Read More

Int J Dermatol 2011 Sep;50(9):1170-2

Case Rep Dermatol 2011 Sep 29;3(3):209-11. Epub 2011 Sep 29.

Department of Dermatology, University Hospital Regensburg, Regensburg.

A 59-year-old man with chronic renal failure and diabetes mellitus presented with pruritic crusted lesions which histologically were perforating disorders, showing features of both Kyrle disease and acquired perforating collagenosis. The mechanisms of transepidermal elimination and the classification of perforating disorders are briefly discussed. Additionally, we question the concept of perforation, as epidermal damage and exposure of subepidermal substances may artificially present as perforation. Read More

Int J Dermatol 2007 Dec;46(12):1298-301

Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.

Cutaneous tuberculosis shows wide clinical variation depending upon the virulence of the organism and host immunity. Tuberculids are difficult to diagnose since the organism often cannot be identified or isolated by microscopy, culture or polymerase chain reaction. The diagnosis rests primarily on the identification of a tuberculous focus elsewhere in the body and response to antitubercular therapy. Read More

Int J Dermatol 1992 Feb;31(2):117-8

Department of Dermatology, Guatemalan Social Security Hospital.

A 48-year-old man, in a chronic hemodialysis program, had numerous skin lesions develop that consisted of follicular papules and small hyperkeratotic nodules, located on the trunk, hips, and upper and lower extremities (where the lesions were more numerous). The nodules measured 3 to 5 mm and had a dark discoloration (Figs 1 and 2). Four months previously, the patient noticed the appearance of disseminated papular and pruritic lesions. Read More

Int J Dermatol 1991 Mar;30(3):211-2

Department of Dermatology, Tokyo University Hospital, Japan.

Z Hautkr 1990 Sep;65(9):847-50

Abteilung für Dermatologie und Venerologie, Bundeswehrzentralkrankenhaus Koblenz.

Based on a case of our own observation, we present the characteristic features of a rare skin disease: hyperkeratosis follicularis et parafollicularis in cutem penetrans, i.e. Kyrle's disease. Read More

Z Hautkr 1990 Jan;65(1):53-61

Klinikum Steglitz der Freien Universität Berlin.

We report on a 32-year-old female patient with chronic diabetes mellitus, type I, and chronic renal failure, who developed the typical clinical picture of hyperkeratosis follicularis et parafollicularis in cuteum penetrans (Kyrle's disease) within one year. Histological examination revealed a defective epidermal differentiation with hyper- and parakeratosis as well as premature keratinization as early as in the epidermal basal cell layer. Studies on lectin binding showed that the glycosylation process was impaired in both the epidermis and the basement membrane zone of the lesional skin. Read More

Z Hautkr 1989 Apr;64(4):286, 289-91

Zentrum der Dermatologie und Venerologie, Abt. I, J.W. Goethe-Universität, Frankfurt am Main.

We report on a 50-year-old woman having suffered from atypically located Kyrle's disease for 2 years. Especially the palmoplantar areas were affected by keratotic erythematous papules showing the typical histologic picture of Kyrle's disease. Treatment with acitretin (initial dose 30 mg/day) resulted in almost complete remission after 6 months. Read More

Dermatol Monatsschr 1989 ;175(8):504-10

In the group of perforating skin diseases with transepithelial elimination the hyperkeratosis follicularis et parafollicularis in cutem penetrans is very rare. By means of casuistics the clinical and histological features are discussed. Re-PUVA as a feasible therapy variant was performed. Read More

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