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Kyrle’s disease: a cutaneous manifestation of diabetes mellitus

A 52-year-old female patient presented to the dermatology department with complaints of itchy skin lesions all over the body for past 3 months. She was a known case of type 2 diabetes mellitus for 10 years which was poorly controlled on oral antidiabetes medications. On cutaneous examination, multiple, discrete, hyperpigmented, hyperkeratotic papules with central keratotic plugs were present over the neck, trunk, abdomen (figure 1A), gluteal region (figure 1B) and lower limbs with few lesions showing koebnerisation. The differential diagnoses considered on initial examination were prurigo nodularis and perforating dermatosis such as Kyrle’s disease, perforating folliculitis and reactive perforating collagenosis. Laboratory investigations revealed poorly controlled diabetes with HbA1c of 11.4% and fasting glucose of 278 mg/dL. Her liver, thyroid and renal …