Prurigo pigmentosa from contact allergy to chrome in detergent

Pigmented contact dermatitis: A brief review

Hyperpigmentation is one of the common pigmentary complaints that brings the patient to dermatology services. Though there are multiple etiologies for hyperpigmentation, pigmented contact dermatitis (PCD) remains a common diagnosis. The cosmetics containing dyes, preservatives, fragrances, bactericidal, emulsifiers/surfactants, and vehicles are the potential sources, and paraphenylenediamine, benzyl salicylate, brilliant lake red R, thiomersal and gallate mix are some of the most commonly implicated allergens.

The clinical manifestation includes diffuse or patchy brown to blue-black pigmentation of the cheeks, the outer surface of ears, preauricular region, temporal area, nape of the neck, and upper back. Patch testing plays a pivotal role in the diagnosis of PCD and the testing series has to be selected according to the representative population. Given the chronicity of the disease, counseling patients against the use of cosmetics is challenging as the pigmentation tends to persist for longer durations inspite of stopping cosmetics. The pillars of treatment in PCD include recognition of the culprit allergen and preventing further exposure along with pharmacological therapy. This review provides a brief overview and an insight into the etiopathogenesis and management of PCD.

A Case of Exfoliative Vesiculobullous Prurigo Pigmentosa Cured by Doxycycline and Topical Tacrolimus

Prurigo pigmentosa is a rare inflammatory skin disease characterized by an unexpected onset of diffuse erythematous papules and macules usually on the chest, neck, and back. These generally resolve, leaving reticular hyperpigmentation. Rarely, vesicular or bullous forms have been reported. We present a case of exfoliative vesiculobullous prurigo pigmentosa in a 13-year-old boy. He presented with symmetrical eruption of papules and vesicles on his back, neck, and chest in the last 10 days, causing pruritis and prickling sensation. Within a few days, the bullous lesions and all affected areas of the skin showed exfoliation. Histological study and clinical findings indicated the condition to be vesiculobullous prurigo pigmentosa with exfoliation. Treatment with doxycycline 200 mg/day and topical tacrolimus ointment showed a good response. The lesions resolved, leaving a light-brown reticulated hyperpigmentation. In conclusion, this was a case of exfoliative vesiculobullous prurigo pigmentosa in an adolescent man successfully treated with doxycycline and topical tacrolimus as an effective and safe treatment option.

Prurigo Pigmentosa-Report of 3 Cases From Brazil and Literature Review

Prurigo pigmentosa (PP) is a rare inflammatory disease of the skin of uncertain etiology first reported in Japan. It is typified by recurrent eruptions of itching urticarial macules, papules, vesicopapules, and plaques with a reticular arrangement that quickly resolve leaving a net-like pigmentation. The disease presents specific histopathological features. Herein, 3 cases of PP in Brazilians with no Japanese ancestry are reported and a revision of all previous English-language case reports indexed on PubMed is provided. Two articles with original case reports not listed on PubMed were also included. Our patients are 2 women and 1 man at the ages of 39, 33, and 22 years, respectively. All 3 presented findings in consonance with previous cases of PP and were diagnosed based on clinicopathological correlation. They were successfully treated with oral minocycline or doxycycline. In our literature review, a total of 210 previously reported cases were included. Although PP seemed to be restricted to Japanese patients in the first years after its recognition, the geographic boundaries of the disease are continuously expanding. Korea responded for 83 previous cases and Japan for 53. The mean age was 24.4 years, with 84.3% of the cases occurring between 11 and 30 years of age. The female/male rate was 2.6 and the most affected anatomical sites were back, chest, and neck. We do believe that the rarity of case reports in western countries may represent lack of awareness about the disease by dermatologists and dermatopathologists in these regions.

Prurigo Pigmentosa: Literature Review

Prurigo pigmentosa, also referred to as Nagashima's disease, is a rare inflammatory skin condition of unknown etiology. It typically presents as pruritic erythematous papules, papulovesicles, and vesicles appearing in a reticular pattern on the back, chest, or neck. The histological features of prurigo pigmentosa vary according to the stage of the disease. Early-stage disease is characterized by a superficial perivascular infiltrate of neutrophils; spongiosis and necrotic keratinocytes commonly appear in later stages. The etiology of prurigo pigmentosa has yet to be determined. Oral minocycline is usually the first-line therapy for prurigo pigmentosa. However, doxycycline, macrolide antibiotics, and/or dapsone (diaminodiphenyl sulfone) may be indicated for some patients. We describe the key features of prurigo pigmentosa, including the epidemiology, clinical and histologic presentation, differential diagnosis, postulated pathogenesis, and treatment options for this condition.

Prurigo pigmentosa in Korea: clinicopathological study

BACKGROUND

Prurigo pigmentosa (PP) is an inflammatory dermatosis characterized by recurrent pruritic erythematous papules, mainly located on the trunk. It was first described by Nagashima in 1971 in Japan. Since then, more than 300 cases have been reported in Japan, but reports from other parts of the world are quite rare.

MATERIALS AND METHODS

We studied clinical and histopathological data from six patients with PP diagnosed in our hospital and 43 patients (18 reports) who were diagnosed with PP in Korea between 1988 and 2008.

RESULTS

The number of Korean patients reported in recent years is higher than the number of other non-Japanese patients reported. Clinicopathological characteristics in Korean patients were not significantly different from those previously reported. Therapeutic results with minocycline were successful in our patients.

CONCLUSIONS

We suspect that PP is not uncommon in Korea, and the disease may be underestimated. Strict restriction of diet as well as known associated factors like wet condition are suggested as one of the important factors contributing to the occurrence of PP in Korea.

Prurigo pigmentosa associated with an atopic diathesis in a 13-year-old girl

We report an Italian prepubescent girl with the typical clinical and histologic features of prurigo pigmentosa associated with an atopic diathesis. The dermatitis disappeared after treatment with minocycline, leaving a brown, reticulated hyperpigmentation, with no recurrence. The association with an atopic diathesis could justify, in this instance, the major susceptibility to environmental factors claimed by some authors as triggering factors for prurigo pigmentosa. To our knowledge, this is only the second occurrence of this disease in a prepubescent patient reported in the literature.

Prurigo pigmentosa: not an uncommon disease in the Turkish population

BACKGROUND

Prurigo pigmentosa (PP) is a rare inflammatory dermatosis of unknown etiology. It is characterized by erythematous papules of the trunk that resolve leaving a reticulate hyperpigmentation. The original report from Japan in 1971 was followed by new cases, mostly of Japanese origin.

METHODS

We scrutinized PP cases diagnosed in our clinic and reviewed the English, German, French, and Turkish language literature.

RESULTS

We report six additional Turkish patients. We found more than 40 cases reported from various countries outside Japan. The patients had different racial origins. The number of Turkish patients reported in recent years is higher than the number of other non-Japanese patients reported.

CONCLUSIONS

The disease is not uncommon in the Turkish population. It may be underestimated in other countries with Caucasian populations. Therapeutic results with tetracycline and doxycycline was successful in our patients.

Contact hypersensitivity to stainless steel cages (chromium metal) in hairless descendants of mexican hairless dogs

Canine allergic contact hypersensitivity is an uncommon skin disease as compared with human beings because hair coat is a good natural barrier to environmental contactants. In our colony of hairless dogs housed in stainless steel cages, we have encountered spontaneously occurring contact hypersensitivity. The author has attempted to study the toxicological effects of environmental sensitizing substances on the canine skin. The purpose of this study is to elucidate dermatological characteristics in canine species with contact hypersensitivity. This skin lesion was investigated by patch tests, macroscopic observations, and histopathological examinations. Patch tests exhibited positive reactions to potassium dichromate. Macroscopically, early lesions were macules and/or papules and they gradually progressed to severe inflammatory dermatitis over the dorsum. In the chronic phase, lichenification, kyperkeratosis, hyperpigmentation, dryness, scaliness, and fissuring were observed in the skin. Avoidance of contact with the stainless steel cages resulted in clinical improvement. Histopathologically, the epidermis apparently showed hyperkeratosis, thickening, hyperplasia, and rete ridge formation. Lichenified lesions had clumps of melanin granules in the stratum basale and spinosum. In the dermis, there was marked edema and dense mononuclear cell infiltration. Vasodilation, hemorrhage, and hyperplasia of sebaceous glands were also found. Both dermal mast cells and epidermal Langerhans cells significantly increased in the skin lesions, as compared with nonlesional sites. The present results revealed that constant contact with stainless steel cages (chromium metal) caused contact hypersensitivity in hairless dogs with very sparse hairs.

Prurigo Pigmentosa Successfully Treated with Low-Dose Isotretinoin

BACKGROUND/AIMS

Prurigo pigmentosa (PP) is an uncommon inflammatory disease with pruritic reddish papules, papulovesicules or vesicules that are symmetrically localized on the trunk and nape, accompanied by reticular hyperpigmentation. Currently available therapeutic options seem somewhat unsatisfying. Herein, we report an 18-year-old female with PP successfully treated with low-dose isotretinoin.

METHODS

The patient presented with a symmetrical pruritic eruption on the lateral sides of her trunk with erythematous papules on a hyperpigmented background. Based on the typical clinical and associated histological findings, the patient was diagnosed as PP and a treatment with low-dose isotretinoin 0.3 mg/kg/day (20 mg/day) was started.

RESULTS

After a total of 3 months of 20 mg/day isotretinoin therapy, all erythematous macules and papules resolved and the residual pigmentation had almost disappeared.

CONCLUSION

Low-dose isotretinoin is not only adequate for the improvement of erythematous lesions, it also helps resolve the reticular hyperpigmentation of PP. Further studies are needed to observe the efficacy of isotretinoin in the treatment of PP.

[Prurigo pigmentosa]

Prurigo pigmentosa is an infrequent inflammatory dermatosis of unknown etiology, characterized by recurrent episodes of pruritic erythematous papules which develop into intense reticulated pigmentation. It has been referenced most frequently in young women in Japan. Only thirty cases have been described outside of Japan. We describe a 32-year-old Spanish female who developed a pruritic dermatosis with the clinical characteristics and histopathological findings of prurigo pigmentosa. We review the epidemiological, clinical and histopathological characteristics of this peculiar skin disease.

Prurigo pigmentosa in a patient with primary biliary cirrhosis and Sjögren syndrome

A 44-year-old Japanese woman suddenly developed severely pruritic erythematous papules on her trunk in a symmetrical distribution. Biopsy specimens showed the typical histopathological findings of prurigo pigmentosa. She had had recurrent episodes of high fever spikes for several years, and lost 10 kg in the last year. She was diagnosed as primary biliary cirrhosis (PBC) associated with subclinical Sjögren syndrome (SjS). Predonisolone (60 mg/day) for two weeks was effective for the PBC and fever, but not for the prurigo pigmentosa. PBC may be involved in the pathogenesis of this rare skin disease.

Prurigo pigmentosa: a distinctive inflammatory disease of the skin

More than 200 patients with prurigo pigmentosa, a disease described first by Nagashima in 1971, have been reported on in Japan, but only 28 non-Japanese patients have come to notice as of today. In order to establish reliable, repeatable criteria for diagnosis of the disease, we studied 25 patients with prurigo pigmentosa and reviewed the literature pertaining to it as recorded in another 182 patients.Clinically, prurigo pigmentosa presents itself as pruritic urticarial papules, papulovesicles, and vesicles arranged in reticular pattern and distributed symmetrically on the back, neck, and chest. Lesions involute in a matter of days, leaving behind netlike pigmentation. Exacerbations and recurrences are the rule. Histopathologically, prurigo pigmentosa begins with a superficial perivascular infiltrate of neutrophils. Shortly thereafter, neutrophils are scattered in dermal papillae and then sweep rapidly through an epidermis in which spongiosis, ballooning, and necrotic keratocytes are accompaniments. En route, abscesses may form in the surface epithelium. Very soon, eosinophils and lymphocytes come to predominate over neutrophils in a dermal infiltrate that assumes a patchy lichenoid pattern. Intraepidermal vesiculation follows on spongiosis and ballooning and, sometimes, subepidermal vesiculation on vacuolar alteration at the dermo-epidermal junction. As the epidermis becomes hyperplastic, parakeratotic, and slightly hyperpigmented, melanophages begin to appear in the dermis. Studies by immunofluorescence are negative invariably. Dapsone or minocyclin are effective treatments; both of those agents inhibit migration and/or function of neutrophils. The cause and pathogenesis have yet to be determined. Prurigo pigmentosa is unique among inflammatory diseases of the skin and the singularity of it is manifest both clinically and histopathologically.