Mortality in Patients with Acquired Perforating Dermatosis: Results from the First Multicenter Case-Control Study

Introduction: Mortality data in patients with acquired perforating dermatosis (APD) are limited. Objectives: To assess, for the first time, the risk of all-cause mortality in adult patients with APD and to explore associated systemic comorbidities. Methods: This retrospective multicenter case-control study included adult patients diagnosed with APD and age-, sex-, and year-matched controls. We evaluated overall survival and the prevalence of seven major comorbidities: systemic malignancy, chronic obstructive pulmonary disease (COPD), severe liver disease, diabetes mellitus, arterial disease, hypertension, and dyslipidemia. Statistical analyses included univariate comparisons (Fisher’s exact test and logistic regression), Kaplan–Meier survival estimates with log-rank tests, and multivariate Cox proportional hazards models. Results: Fifty-one patients with APD and 102 controls (1:2 ratio) were finally included in this investigation. Patients with APD had a significantly increased risk of mortality compared to controls (log-rank test, P<0.001). In the multivariate Cox regression analysis, arterial disease emerged as the sole independent predictor of mortality (adjusted hazard ratio [HR]:7.716; 95% confidence interval [CI]: 2.774–21.464; P<0.001). Conclusions: This is the first study to identify a potential association between APD and increased all-cause mortality, primarily driven by coexisting arterial disease. These findings highlight the importance of comprehensive management in APD patients and emphasize the dermatologist’s role in multidisciplinary care aimed at improving long-term outcomes.