Abstract
Acquired reactive perforating collagenosis (ARPC) is a rare skin disease characterized by transepidermal elimination of altered collagen, and is often complicated with diabetes mellitus and chronic renal failure. We report a case of ARPC in a 26-year-old Japanese woman with type 1 diabetes mellitus with end-stage renal disease undergoing hemodialysis. Although she had been treated with insulin after diabetes was diagnosed when she was 9 years old, her diabetic control remained poor. In 2001, when she was 23 years old, she suffered from itchy papules, nodules, and erosions on the extensor surface of the legs and back, clinically diagnosed as ARPC in 2001. Although she had taken local treatment including corticosteroid and anti-histamic medicine for 4 years, these treatments were not fully effective. After she started hemodialysis in May, 2002, she was admitted for clinical assessment for renal transplantation in March 2004. After admission, she took a 1800 kcal, protein uptake 40 g of medical nutrition therapy and intensive insulin injection for glycemic control and 100 mg of allopurinol administration once a day for ARPC. Two weeks after allopurinol administration, her itching disappeared and her itchy papules, nodules, and erosions responded well 8 weeks after allopurinol administration. ARPC pathology is not fully understood and treatment remains difficult. Our report implies that allopurinol and aggressive control of blood glucose are effective against ARPC.
