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A 32 year-old woman, at 17 weeks gestation, presented to dermatology with a pruritic
erythematous urticarial-like eruption present on the trunk and limbs. A diagnosis
of polymorphic eruption of pregnancy (PEP) was made and the patient was referred for
ultraviolet B TL01 phototherapy. However at 24 weeks gestation, a separate papular
eruption on the forearms and lower limbs was noted, mainly appearing at sites of superficial
trauma. This eruption then evolved into tender, umbilicated nodules with a central
keratin plug, in keeping with acquired reactive perforating collagenosis (ARPC) (Fig. 1). Phototherapy had not yet commenced at this stage. Histological evaluation revealed
cup-shaped invagination of the epidermis with keratinous material along with evidence
of transepidermal elimination of collagen, confirming the clinical diagnosis. The
patient subsequently commenced phototherapy to treat both the PEP and ARPC, with clinical
improvement.
Fig. 1Umbilicated nodules with a central keratin plug.
