PMC4809472_01
Giant ARPC. A, Erythematous, umbilicated papules and plaques with central adherent thick hyperkeratotic cores are seen on the upper and lower extremities. Representative lesions are seen on her left lateral thigh. The largest keratotic cores measure up to 2 cm. B, Evidence of koebnerization on the forearm.
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On examination, discrete, erythematous, umbilicated papules and plaques with central, adherent, 1- to 2-cm hyperkeratotic cores were seen on the upper and lower extremities (Fig 1, A). Koebnerization was apparent on the forearms (Fig 1, B).
Histopathologic sections from punch biopsy specimen. A large epidermal ulcer is evident with vertically oriented collagen fibers (arrow) extruding from the dermis into the overlying thick scale-crust. (Hematoxylin-eosin stain.)
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Vertically oriented, brightly eosinophilic collagen fibers were seen in the dermis, epidermis, and scale crust (Fig 2), confirming the diagnosis of ARPC.
Resolving lesions of reactive perforating collagenosis after 10 months of glycemic control. Residual postinflammatory hyperpigmented macules at the site of prior lesions on the left lateral thigh.
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However, after 10 months of glycemic control and chemotherapy, her lesions were significantly improved, with resolution of the hyperkeratotic cores and residual postinflammatory hyperpigmented macules (Fig 3).