Low iron stores can cause pruritus. This detects diabetes. This is essential to make a diagnosis. The epidermis is typically perforated by disrupted collagen bundles extruding through the epidermis, forming a plug with a cup-shaped epidermal depression. There is usually a mild perivascular mononuclear cell infiltrate.
Mild acanthosis is observed in the surrounding epidermis.
Collagen stains are positive, but elastin stains typically fail to demonstrate the presence of elastin within the perforation. There have been 2 case reports of elastin being found in the central crater. Treatment of the lesions is unsatisfactory. The lesions are self-healing in any case. There are anecdotal reports of isotretinoin and PUVA being used successfully.