Reactive perforating collagenosis associated with underlying malignancy

S ir, We were interested in the recent report by Chae et al. of a patient with reactive perforating collagenosis (RPC) and periampullary carcinoma. 1 The authors suggest RPC should be considered a paraneoplastic condition. We report a further case of RPC associated with underlying malignancy. A 75‐year‐old lady presented with a 6‐month history of nausea, anorexia, 10 kg weight loss and an itchy rash on her back. There was a history of hysterectomy and bilateral salpingo‐oophorectomy for endometrial carcinoma 20 years previously and also a 20‐year history of non‐insulin‐dependent diabetes. Her medications consisted of metformin, isosorbide mononitrate, atenolol, bendrofluazide and nifedipine. On examination there were multiple dome‐shaped papules with saucer‐like rims and distinctive central dark brown crusts on her back ( Fig. 1a). Several crusts were attached to the underlying lesions through a fine pedicle (Fig. 1b). She also had ichthyosis on her abdomen and back. Systemic examination revealed a tender, palpable liver edge.