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The Cutting Edge: Challenges in Medical and Surgical Therapies | Feb 2012

Treatment of Acquired Perforating Dermatosis With Cantharidin

Jessica Wong, BMedSci; Robert Phelps, MD; Jacob Levitt, MD

Arch Dermatol. 2012;148(2):160-162. doi:10.1001/archdermatol.2011.350.

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Many treatments have been proposed for acquired perforating dermatosis (APD), with varying success. In general, treatment is unsatisfactory and definitive resolution of existing lesions is difficult to achieve.

Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia (Ms Wong); and Departments of Pathology (Dr Phelps) and Dermatology (Dr Levitt), The Mount Sinai Medical Center, New York, New YorkCorrespondence: Jacob Levitt, MD, Department of Dermatology, The Mount Sinai School of Medicine Center, 5 E 98th St, Fifth Floor, PO Box 1048, New York, NY 10023 (jacoblevittmd@gmail.com).

Accepted for Publication: August 11, 2011.

Author Contributions: All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Levitt. Acquisition of data: Wong, Phelps, and Levitt. Analysis and interpretation of data: Wong, Phelps, and Levitt. Drafting of the manuscript: Wong, Phelps, and Levitt. Critical revision of the manuscript for important intellectual content: Wong, Phelps, and Levitt. Administrative, technical, or material support: Wong, Phelps, and Levitt. Study supervision: Levitt.

Financial Disclosure: None reported.

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Figure 1. A, Acquired perforating dermatosis of the leg before treatment —note lichenified, hyperpigmented papules with central keratotic core. B, Acquired perforating dermatosis of the leg 7 days after cantharidin application, before debridement —note vesicle formation at the site of cantharidin application. Inset: Close-up of a debrided papule after cantharidin treatment; the hyperkeratotic core remains attached to the blister roof. C, Acquired perforating dermatosis of the leg 2 months after treatment and debridement; the lichenified papules and hyperkeratotic cores are no longer present, and the leg is smooth. D, Acquired perforating dermatosis of the leg 5 months after treatment. Treated lesions are smooth; however, a few new lesions have formed.

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Figure 2. A, The epidermis shows an invagination filled with a large column of orthokeratotic and parakeratotic keratin. The adjacent dermis shows focal fibrosis and a mixed neutrophilic and mononuclear infiltrate (hematoxylin-eosin; original magnification ×10). B, A subepidermal bulla is shown with detachment of the epidermis, the dermis, and foci of dyshesion and necrosis (hematoxylin-eosin; original magnification ×10).

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Wong J, Phelps R, Levitt J. Treatment of Acquired Perforating Dermatosis With Cantharidin. Arch Dermatol. 2012;148(2):160-162. doi:10.1001/archdermatol.2011.350.

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