Bibliographic record
Abstract
Background Acquired perforating dermatosis (APD) is a rare skin condition characterized by the transepidermal elimination of dermal materials. It is often associated with systemic diseases such as chronic kidney disease and diabetes mellitus, and it has also been reported in patients with systemic lupus erythematosus (SLE). The occurrence of APD in SLE patients is infrequently documented, with only 2 prior case reports.[1,2] Allopurinol has been utilized in a few case reports as a treatment for this condition, suggesting its potential efficacy in managing APD.[3] Case We present a 64-year-old male with a complex medical history, diagnosed with SLE/scleroderma (SSc) overlap. He exhibited photosensitive rashes, Raynaud’s phenomenon, telangiectasis, and arthritis. The patient had previously shown intolerance to several immunosuppressive agents, including hydroxychloroquine, mycophenolate mofetil, and azathioprine. Initial treatments with Benlysta (belimumab) and chloroquine were effective but lost efficacy by 2020. He developed painful, ulcerated mucocutaneous lesions with purplish borders and inflamed mucosa over his arms and back. Serological testing revealed positive ANA, anti-Sm, and anti-RNP antibodies, alongside elevated inflammatory markers (ESR and CRP). Skin biopsy in November confirmed the diagnosis of acquired perforated dermatosis. After conventional therapies failed, the patient was treated with allopurinol, resulting in significant improvement in skin lesions and associated symptoms. By May 2024, most lesions had healed, and his quality of life improved (Figure). This case underscores that APD can be a significant complication in SLE patients, often misdiagnosed as cutaneous lupus or vasculitis. Allopurinol appears effective for APD, highlighting the need for accurate diagnosis in similar cases. Treatment options may include topical steroids, antihistamines, antibiotics, isotretinoin, hydroxychloroquine, colchicine, and rituximab, depending on the underlying condition. Although the exact mechanism of action of allopurinol is unknown, it is speculated to inhibit xanthine oxidase, decreasing oxygen free radicals that damage collagen and potentially inhibit collagen cross-linking. Conclusion Acquired perforating dermatosis in the context of SLE can respond favorably to allopurinol. Proper recognition and diagnosis are critical to prevent mismanagement as cutaneous lupus or vasculitis, ensuring optimal patient outcomes. [1.] Ohashi T. J Dermatol 2016;43(9):1097-9. [2.] Alenzi F. Medicine (Baltimore) 2022;101(48):e32138. [3.] Palmeiro AG. An Bras Dermatol 2024;99(1):148-9.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".