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Perforating dermatoses are a group of skin diseases with different causes, characterized by elimination of certain skin components (such as elastic fibers and collagen fibers). Some of these diseases are hereditary and appear during childhood, while others arise in adulthood and may be secondary to skin infections, systemic diseases, drugs, and trauma. In some cases no cause can be identified. Acquired perforating dermatoses, the most frequent group of perforating dermatoses arising in adults, are usually associated with diabetes mellitus and/or chronic renal failure on dialysis.
Perforating dermatoses arising in children may resolve spontaneously, however a complete medical evaluation should be performed because other genetic disorders may be associated. In adults, when the underlying cause is not obvious, blood tests for renal and liver function and glucose tolerance may be helpful.
Pruritus is the main complaint in the majority of patients (both children and adults). Patients with acquired perforating dermatosis should be aware that control of the primary disease may improve skin symptoms. Minimizing pruritus is important because lesions may develop in traumatized or scratched skin. Both topical or intralesional corticosteroids, topical anesthetics and antipruritic agents, as well as oral antihistamines, other systemic drugs and phototherapy may minimize pruritus. In patients on dialysis, changing the type of dialysis tubing or the equipment employed, may improve the dermatosis.
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