获得性反应性穿通性胶原病2例报道及临床与病理的联系

Acquired Reactive Perforating Collagenosis: A Report of 2 Cases and the Correlation between Clinical and Pathological Features

摘要: 获得性反应性穿通性胶原病(ARPC)为少见穿通性皮肤病，多继发于糖尿病等系统性疾病，易误诊。本文报道2例合并2型糖尿病的ARPC病例，结合临床及治疗转归分析与病理的联系。患者均为中老年男性，以顽固性瘙痒、多部位角化性丘疹伴中央角质栓为主要表现，组织病理示表皮角化异常、真皮胶原变性及炎性细胞浸润，确诊为ARPC。结合病史提示，长期高血糖致周围神经病变引发瘙痒，反复搔抓破坏皮肤屏障，诱发胶原变性穿通排出。在控制血糖基础上，予外用0.1%糠酸莫米松乳膏、口服抗组胺药物及屏障修复治疗1个月后，2例患者瘙痒视觉模拟评分(VAS)均显著下降，皮损基本消退。本研究提示临床需重视糖尿病相关ARPC的筛查与综合管理，以减少误诊并改善预后。

Abstract: Acquired reactive perforating collagenosis (ARPC) is a rare perforating dermatosis frequently secondary to systemic diseases such as diabetes mellitus, with a high risk of misdiagnosis. This study reports two cases of ARPC complicated with type 2 diabetes mellitus, analyzing the correlation between clinical manifestations, therapeutic outcomes, and histopathological features. Both patients were middle-aged to elderly males presenting with refractory pruritus, multiple hyperkeratotic papules with central keratotic plugs, and histopathological findings of epidermal hyperkeratosis, dermal collagen degeneration, and inflammatory cell infiltration, confirming ARPC. Clinical history indicated that chronic hyperglycemia-induced peripheral neuropathy triggered pruritus, and repeated scratching disrupted the skin barrier, leading to transepidermal elimination of degenerated collagen. With glycemic control, topical 0.1% mometasone furoate cream, oral antihistamines, and skin barrier repair therapy was administered. After one month, both patients showed significant reduction in pruritus visual analogue scale (VAS) scores and near-complete resolution of skin lesions. This study underscores the importance of screening for and implementing comprehensive management of diabetes-associated ARPC to reduce misdiagnosis and improve prognosis.