Endocrine Abstracts

JOINT1925

Introduction: Kyrle’s disease (MK) belongs to the group of acquired perforating dermatoses. It is a rare pathology characterized by transepidermal removal of keratotic material. We report the case of a diabetic patient with MK.

Observation: This is a 47-year-old patient, diabetic for 15 years on insulin at the degenerative complication stage: hypertensive for 3 years and chronic renal disease for 2 years on treatment, amputation of the right big toe 6 years ago. Consulted for multiple ulcerated nodules of the lower limbs for several months, with loss of substance in the pulp of the big toe. The whole evolving in a context of feverish sensations and conservation of the general state. clinical suspicion of the diagnosis was confirmed by histological examination of a skin biopsy. This revealed a crater-shaped lesion filled with keratotic material, showing an image of incipient epidermal elimination on one cut level. The epidermis was acanthosic with significant compact parakeratotic hyperkeratosis and a slightly inflammatory dermis. The diagnosis of MK was therefore accepted. The patient was put on emollient and antihistamines.

Discussion: Acquired perforating dermatoses are rare pathologies characterized by transepidermal elimination of certain dermal constituents. Acquired MK is characterized by an invagination of the epidermis with keratotic content. MK is often associated with diabetes mellitus (50%) and chronic end-stage renal disease (70%). Diabetes is in the insulinocarrying stage. The pathophysiology of MK is still unknown, but hypotheses have suggested the role of cutaneous trauma and diabetic vasculopathy. Treatment is mainly symptomatic, based on emollients and keratolytics. Other options include topical or systemic retinoids, surgery or CO2 laser and phototherapy.

Conclusion: MK is a rare papulokeratotic dermatosis. It should be particularly sought after in diabetics. Diagnosis is confirmed by histology.