Reactive Perforating Collagenosis. Presented by David F. Fretzin, MD
A 24-year-old married woman has a history of persistent scattered lesions since the age of 5 years. They occur following minor trauma, especially insect bites, and develop from a small papule to variably sized, crusted, and occasionally exudative nodules. There is minor pain with the onset of the lesion and some pruritus subsequently. Individual lesions heal slowly during several months, frequently leaving a small scar or leukodermic patch (Fig 1). There was no family history of skin disease.A section of a nodule from her forearm shows a centrally ulcerated, crusted lesion with pseudoepitheliomatous hyperplasia of the adjacent epidermis. The crusted portion contains necrotic debris consisting of neutrophils and refractile collagen bundles. Narrow collagen bundles perforate the adjacent epithelium into the central crust. Variable degrees of necrobiosis, chronic inflammation, and reactive granulation tissue are present beneath the central ulcer! Stains for elastic fibers in the debris are negative
Fretzin DF. CHICAGO DERMATOLOGICAL SOCIETY. Arch Dermatol. 1974;109(5):750–751. doi:10.1001/archderm.1974.01630050076036
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