Reactive perforating collagenosis is a very rare skin disorder whereby there is an elimination of altered protein substance (called collagen) through the layer of skin (called epidermis). The two distinct forms are an inherited form that manifests in childhood and an acquired form that occurs in adulthood.

Reactive perforating collagenosis is the most common type of primary perforating dermatosis. It is characterised by the transepithelial elimination of collagen from the dermis through the epidermis to the skin surface.

It is also called the itching of renal failure, since it is very commonly seen in diabetic patients with renal failure on prolonged dialysis.

The major abnormality is focal damage to collagen followed by the elimination of the disrupted collagen through the epidermis.

Cold or superficial blunt trauma often precipitates the lesions, especially in the inherited form. The acquired form usually occurs in patients with diabetes or chronic renal failure, especially those receiving dialysis. Acquired perforating collagenosis is more common, occurring in as many as 10% of patients receiving maintenance hemodialysis.


  • Red-brown umbilicated papules and nodules, often with a cup-shaped depression, central keratotic crust, and erythematous halo
  • Variable in shape and size, usually up to 10 mm in diameter
  • Lesions are typically intensely itchy; pain or tenderness is rare
  • Koebner phenomenon is a common.
  • Commonly located on trunk or extensor aspect of the limbs but can be widespread occurring anywhere on the skin
  • Hands, elbows, and knees are the common initial sites
  • The lesions are intensely itchy, leaving some scarring after resolution.

The inherited form usually presents in infancy or early childhood. The acquired form occurs in adults.

Small, asymptomatic keratotic papules develop after minor trauma. The lesions start as pin-sized lesions, and they grow into larger papules over a few weeks. They heal with residual minor scarring.

Intense itching is a feature of acquired perforating collagenosis. In this condition, a history of diabetes or renal failure is often elicited.

  1. Conventional treatment:

Topical steroids are usually not helpful. Emollients and systemic antihistamines seem helpful in controlling severer form of itching.

  1. Homeopathic treatment:

This is a rare disease, though homeopathy has good treatment to offer, Reactive perforating collagenosis should find good control measure. Homeopathy is expected to relive the symptom, intense itching in particular and the skin lesions. Homoeopathic medicines when used constitutionally according to the person's symptomatology, it can work remarkably well.

Few suggestive homoeopathic remedies are as followed.

Graphites, sulphur,tuberculinum,baccilinum,apis,rhus tox,croton tig.