Extremely itchy, crusting nodules appeared on the arms and legs of a 42-year-old woman who was undergoing renal dialysis.
Extremely itchy, crusting nodules appeared on the arms and legs of a 42-year-old woman who was undergoing renal dialysis. This was Kyrle's disease (hyperkeratosis follicularis et parafollicularis in cutem penetrans), a chronic condition that is most often seen in the setting of renal dialysis but may also occur in conjunction with diabetes mellitus or internal malignancy. Acquired perforating folliculitis/dermatitis has been proposed as a catch-all term for this condition and is accepted by many practitioners as a synonym.
Kyrle's disease usually remits with renal transplant or management of the internal malignancy. It may improve with better diabetic control. Otherwise, it is notoriously difficult to manage. Drs Charles E. Crutchfield III and Eric J. Lewis of Minneapolis offer a clinical pearl: occlude the most troublesome lesions with a thick application of a class 1 corticosteroid, such as halobetasol or clobetasol, under a thin plastic dressing, such as one of the DuoDerm® products (which vary in thickness), for 1 week. In the case of this patient, such treatment was given a few lesions at a time, over a period of several weeks, with successful results.