Dermoscopic pattern of Kyrle's disease,

AnBrasDermatol.2020;95(2):244---246

Anais

Brasileiros

de

Dermatologia

IMAGES

IN

DERMATOLOGY

Dermoscopic

pattern

of

Kyrle’s

disease

夽,夽夽

Ozlem

Ozbagcivan

_,

_Banu

_Lebe

_,

_Emel

_Fetil

a_{DepartmentofDermatology,DokuzEylulUniversitesi,Balcova,Izmir,Turkey} b_{DepartmentofPathology,DokuzEylulUniversitesi,Balcova,Izmir,Turkey}

Received11March2019;accepted6July2019 Availableonline12February2020

KEYWORDS

Dermoscopy; Metabolic; Pruritus; Skindiseases

Abstract TheclinicaldiagnosisofKyrle’sdiseasemaysometimesbechallenging,duetothe clinicalsimilarity oflesions tootherpruritic dermatosis.Although thedermoscopy isbeing increasinglyusedindailypractice,thereisinsufficientdatainliteraturedescribingthe dermo-scopicpatternsofKyrle’sdisease,sinceonlyonereporthasbeenpublishedtodate.Hereinwe reportourdermoscopicobservationwithadditionaldiagnostictipsinacasewhowasdiagnosed withKyrle’sdiseasehistopathologically.

©2020SociedadeBrasileiradeDermatologia.PublishedbyElsevierEspa˜na,S.L.U.Thisisan openaccessarticleundertheCCBYlicense(http://creativecommons.org/licenses/by/4.0/).

TheclinicaldiagnosisofKyrle’sdiseasemaysometimesbe challenging,duetotheclinicalsimilarityoflesionstoother pruriticdermatosis.Withtheincreasinguseofdermoscopy indailypractice,somedermoscopicpatternsareusefulfor therecognitionofthisspectrumofskindisordersinrecent publications.1---7_{However,thereisinsufficientdatain}

litera-turedescribingthedermoscopicpatternsofKyrle’sdisease, sinceonly onereporthasbeenpublishedtodate.1_Herein

wereportourdermoscopicobservationwithadditional diag-nostictipsinacasewhowasdiagnosedwithKyrle’sdisease histopathologically.

夽 _{Howtocitethisarticle:OzbagcivanO,LebeB,FetilE.}

Dermo-scopicpatternofKyrle’sdisease.AnBrasDermatol.2020;95:244---6.

夽夽_{Study conductedat the Department of Dermatology,Dokuz}

EylulUniversitesi,Balcova,Izmir,Turkey.

∗_{Correspondingauthor.}

E-mail:ozlem.ozbagcivan@deu.edu.tr(O.Ozbagcivan).

A61-year-oldwomenpresented witha1month history of pruritic lesionsover thewhole body. Her past medical history included type 2 diabetes mellitus and end stage renal disease on peritoneal dialysis. Physical examination revealed multiple, erythematous, excoriated umbilicated papuleswithcentraladherentkeratoticplugs(Fig.1). Lab-oratory investigationsshowed elevated blood glucose and creatinine levels. A biopsy specimen obtained from the back revealed a cup shaped epidermal invagination con-taining degeneratedcollagen andelasticfibers withfibrin exudate(Fig.2).Theabsenceofhairstructureandthe pres-enceofinflammatorydebriswithintheinvaginationswere highlysuggestiveofKyrle’sdisease.Dermoscopic examina-tionrevealeda4-zonalconcentricpatternincludingacrust in the center of the lesion, surrounded with a keratotic scale;astructurelesswhitish-grayarea;astructurelesspink area includingdotted vessels; a structureless brown area withaperipheralscale(Fig.3A).

https://doi.org/10.1016/j.abd.2019.07.007

0365-0596/©2020SociedadeBrasileiradeDermatologia.PublishedbyElsevierEspa˜na,S.L.U.ThisisanopenaccessarticleundertheCC BYlicense(http://creativecommons.org/licenses/by/4.0/).

DermoscopicpatternofKyrle’sdisease 245

Figure 1 Multiple, erythematous, excoriated umbilicated papuleswithcentraladherentkeratoticplugs.

Figure 2 A cup shaped epidermal invagination containing degenerated collagen and elastic fibers with fibrin exudate (Hematoxylin&eosin,×10).

Kyrle’s disease is one of the rare variants of primary perforating disorders, characterized by transepidermal eliminationofabnormalendogenousmaterials.Thedisease affectsmore commonly 30---50-year-old females, presents with pruritic hyperkeratotic and ulcerated nodules, and papules with a central keratotic plug mostly located on extensorsurfaceofupperandlowerlimbs,andonthetrunk. Althoughtheexactpathogenesisremainsunknown,its asso-ciation has been reported sparsely with renal disorders, uremicpatientsondialysis,diabetesmellitus,liverdisease andparaneoplasticsyndromes,tuberculosisandsomefungal diseases.8

Overthelastfewyears,dermoscopyhasbeenshownto facilitatetheclinicalrecognitionofseveraldermatological disorders,thus reducingthenumberofbiopsies.Recently, Russoetal.reportedthedermoscopicfindingsofKyrle’s dis-easedescribinga3-zonalconcentricpattern,characterized bybrightwhitish-brownishscalesinthecenter,a structure-lesswhitish-grayareasurroundingthecentralcrusts,anda peripheral,brown, delicate pigmentation.1 _{In our case of}

Kyrle’sdisease, weobserved a 4-zonalconcentricpattern withthe addition of a pink structureless area containing dottedvessels,betweenthestructurelesswhitish-grayarea and peripheral, brown pigmentation. Moreover, a periph-eralscale surroundingthe peripheral brown pigmentation wasalsoevident.Werelatedthecentralcrusttothedebris thatfill the erosionin the epidermis; thehypopigmented structurelessareatotheflatteningofthedermoepidermal junctionbyepidermal invagination; thepink structureless area with dotted vessels to the active dermal inflam-mationand increasedvascularity during the inflammation process;andthehyperpigmentedstructurelessareatothe melanocytes, inflammatory cells and increased pigmenta-tionof the basal keratinocytesin inflammatory processes (Fig.3B).

In conclusion, we report an additional case of Kyrle’s disease with its detailed dermoscopic features showing a strong correlation with the histological aspect of the disease. Although histopathology is still the gold

stan-A

B

Figure3 (A)Dermoscopicimage ofalesioninKyrle’sdisease (non-polarizeddermoscopy40_×).A 4-zonalconcentric pattern includingacrust inthecenterofthelesion,surroundedwithakeratoticscale(blackarrow);astructurelesswhitish-grayarea (dark-redarrow);astructurelesspinkarea(bluearrow)includingdottedvessels(redcircles);astructurelessbrownareawitha peripheralscale(greenarrow).(B)SchematicillustrationofthelesionsinKyrle’sDisease.

246 OzbagcivanOetal. dard exam for this dermatosis, the familiarity with the

dermoscopic findings of perforating diseases should be increased with such reports to get more reliable clinical interpretation.

Financial

support

Authors’

contributions

Ozlem Ozbagcivan: Approval of the final version of the manuscript; elaboration and writing of the manuscript; intellectualparticipationinthepropaedeuticand/or ther-apeuticconductofthestudiedcases;criticalreviewofthe literature;criticalreviewofthemanuscript.

Banu Lebe: Approval of the final version of the manuscript;obtaining, analysis, andinterpretation of the data;criticalreviewofthemanuscript.

Emel Fetil: Approval of the final version of the manuscript;criticalreviewofthemanuscript.

Conflicts

of

interest

References

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