This patient is a 57-year-old man with diabetes, end stage renal disease on dialysis and congestive heart failure. He has these lesions over most of his arms and legs and they are horribly pruritic. He has scratched until several of them are open sores. What does he have?
I am pretty sure he has Kyrle’s Disease. The lesions begin as small papules with silvery scales that eventually grow to about 1.5 cm in diameter to form red-brown nodules with a central keratin (horny) plug that may come out of the skin. The lesions occur mostly on the arms and legs, but can also occur on the head and neck. They heal spontaneously but new ones continue to develop. Although they are not painful, the itching can be intense.
Since I’m not a dermatologist, I won’t pretend to have expertise beyond saying that it is one of the “perforating dermatoses.” The exact cause of the disease is unknown (and genetics may play a factor) but it occurs more often in patients with the following disorders (which accounts for why I have seen this rare problem several times):
- Diabetes mellitus
- Renal disease
- Liver disease
- Congestive heart failure
Additional reading on Kyrle’s Disease: