Case reportAcquired perforating folliculitis in chronic renal failure: report of two cases

Background Patients with chronic renal failure, regardless of its cause, with/without hemodialysis/peritoneal dialysis, showed cutaneous alterations. Two patients had a follicular hyperkeratotic papular eruption, with clinical and histological features of perforating folliculitis. Methods A dermatological examination and multiple skin biopsies were done. Results We diagnosed acquired perforating folliculitis in two chronic renal failure patients on hemodialysis. The lesions were located predominantly on the lower extremities with hyperkeratotic papules and small nodules. Microscopically, the papule always affected the follicular structure. The follicle was widely dilated and packed with keratotic material, necrotic debris and degenerated basophilic coarse connective fibers passing which passed through follicular perforations. Conclusion Acquired perforating folliculitis is a cutaneous manifestation in chronic renal failure, with/without hemodialysis treatment, that can mimic essential primary perforating folliculitis. Transepidermal elimination mechanisms and the distinction between primary and acquired perforating dermatoses are discussed.