Acquired perforating collagenosis associated with ranibizumab injection and succesfully switched to aflibercept

Objective: To report a case of acquired reactive perforating collagenosis (ARPC) triggered by an intravitreal ranibizumab injection that was successfully treated by switching to aflibercept (AFL). Methods: A 73-year-old Caucasian man with an occult choroidal neovascular membrane in the right eye received three-monthly intravitreal ranibizumab injections. Two weeks after the second ranibizumab injection, he complained about a generalized, excessively pruriginous eruption that was further exacerbated by the third injection. On the basis of clinical and histological findings, he was diagnosed with ARPC and treated with narrow band ultraviolet-B (NBUVB) phototherapy. Results: He was subsequently switched to intravitreal AFL injections administered according to a pro re nata regimen. Following NBUVB phototherapy, three additional AFL injections were required. Still, the reactive perforating collagenosis was in remission and the choroidal neovascular membrane was inactive. Conclusions: Our case is the first report of ARPC after ranibizumab injections. Both the skin lesions and the choroidal neovascular membrane were successfully treated after switching to AFL.