Interdisciplinary approach to the management of patients with perforating dermatosis (clinical case)

Abstract

The aim of this work is to describe a clinical case of acquired perforating dermatosis within the context of an interdisciplinary approach to patient management, taking into account a comprehensive therapeutic and dermatological diagnostic and therapeutic algorithm.

Materials and methods. A personal observation is described of a 70-year-old patient with clinical manifestations of acquired perforating dermatosis and multimorbid somatic pathology, the verification of which was carried out taking into account the results of laboratory and instrumental diagnostic methods. The dermatological diagnosis was established based on the morphological assessment of a skin biopsy.

Results. A clinical case of a patient with skin lesions of the trunk and upper extremities is described. Visual manifestations of dermatosis are represented by a papular rash with a central depression, erosions, hyperkeratotic changes, and pronounced itching, which in general mimic a wide range of nosologies: from lichen planus, prurigo to multiple keratoacanthomas. Given such clinical non-specificity of the pathological process on the skin, only morphological diagnostics can contribute to the final verification of the dermatological diagnosis. In addition, an important aspect was the assessment of the patient’s somatic status, which revealed the presence of multimorbidity, in particular concomitant cardiovascular pathology, chronic kidney disease, cryptogenic liver cirrhosis, and portal hypertension. The general therapeutic direction of this disease is to compensate for the underlying somatic pathology. That is why, given the clinical complexity of the condition, patients in this category require the mandatory involvement of physicians from related specialties. In this case, the patient requires constant therapeutic support, including in the conditions of an inpatient ward. Given the severe general status of the patient, it was decided, in parallel with the treatment of somatic pathology, to have a rather gentle effect on the efflorescence, only with the use of systemic antihistamines and topical therapy with glucocorticosteroids. The positive dynamics within the skin justify the expediency of continuing the planned comprehensive therapeutic tactics.

Conclusions. Morphological examination is the gold standard for verifying pathological processes in the skin. Considering the rather variable nosologies in the context of multimorbidity in one patient, as well as the clear dependence of the course of dermatosis on somatic pathology, a mandatory stage in the management of such patients is the joint interdisciplinary work of specialists of both dermatological and therapeutic profiles.