A 65-year-old female patient with a history of long-standing chronic renal failure, renal transplantation in 1999, who refused at 8 months, on three-week hemodialysis since 2000, and secondary hypertension.
Treated with erythropoietin, folic acid, atenol, and lasartan.
It was characterized by a four-month history of pruritic lesions in hands, forearms and back.
Physical examination revealed diffuse hyperpigmentation, erosions, ulcers and crusted papules, preferentially located on the back of the hands, forearms, anterior chest and interscapular region.
Biopsy of the lesions showed ulcerated skin and fibrinolytic crust.
The bottom of the ulcer with collagen bundles of vertical disposition, adjacent epidermis with hyperorthokeratosis, acanthosis and mild spongiosis.
The dermis showed a mild inflammatory infiltrate with lymphocytic and perivascular infiltrates, with some overlapocytes and neutrophils and hemorrhagic foci.
The reported findings were compatible with reactive perforating collagen.
Oral antihistamines and clobetasol 0.05% + chloramphenicol 2% were indicated, with partial response at one year of follow-up.
