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Alenizi D. Post bariatric surgery prurigo pigmentosa in an adolescent. Pediatr Dermatol 2024; 41:490-492. [PMID: 37965759 DOI: 10.1111/pde.15477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/04/2023] [Indexed: 11/16/2023]
Abstract
Prurigo pigmentosa is an inflammatory skin condition that is characterized by the presence of pruritic reticulated hyperpigmented papules or vesicles of the upper trunk. Previously, this condition was rarely encountered until the rise in popularity of weight reduction methods. Even with the increased prevalence, most affected patients are still adults. We present the case of an adolescent who was successfully treated with doxycycline and encouraged to resume eating.
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Affiliation(s)
- Dhaifallah Alenizi
- Department of Medicine, Dermatology, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
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Nellore A, Maher E, Abate M. Prurigo Pigmentosa Induced by a Ketogenic Diet. Cureus 2023; 15:e39498. [PMID: 37362479 PMCID: PMC10290557 DOI: 10.7759/cureus.39498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Prurigo pigmentosa is an important cause of reticular pruritic rash that has been under-reported in the United States. To ensure proper patient care, it is important for dermatologists to be aware of its presentations and associated factors. Here, we present an uncommon case of prurigo pigmentosa induced by a ketogenic diet and discuss the links between this condition and the state of ketosis, a relationship every provider should be conscious of.
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Affiliation(s)
- Aditya Nellore
- Dermatology, Saint Louis University School of Medicine, Saint Louis, USA
- Internal Medicine, Saint Luke's Hospital, Chesterfield, USA
| | - Eamonn Maher
- Dermatology, University of Minnesota Medical School, Minneapolis, USA
- Dermatology, Saint Louis University School of Medicine, Saint Louis, USA
| | - Mallory Abate
- Dermatology, The Dermatology Clinic, Baton Rouge, USA
- Dermatology, Saint Louis University School of Medicine, Saint Louis, USA
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Muacevic A, Adler JR, Aljuhani SS, Baltow BA, Al Hawsawi K. Prurigo Pigmentosa: A Case Report With Unusual Presentation. Cureus 2022; 14:e32242. [PMID: 36620814 PMCID: PMC9815784 DOI: 10.7759/cureus.32242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Prurigo pigmentosa (PP) is an idiopathic cutaneous inflammatory disorder. Here we report a 50-year-old healthy male of Arabic descent who presented with a six-month history of very itchy persistent skin lesions on his back. Skin examination revealed multiple brownish non-scaly excoriated papules and patches in the midline of his lower back. The differential diagnosis includes lichen planus (LP), confluent and reticulated papillomatosis (CARP), and PP. Skin biopsy revealed acanthosis, spongiosis, and dyskeratotic keratinocytes in the epidermis. The dermis showed mild perivascular lymphocytic infiltrate. Based on the previous clinicopathological findings, the patient was diagnosed with PP. He was prescribed doxycycline 100 mg once daily (OD) for two months. Two months after treatment, all lesions disappeared completely. After one year at the follow-up, he presented with a recurrence of the same skin lesions at the same site. We restarted him on doxycycline treatment.
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A Review of the Multi-Systemic Complications of a Ketogenic Diet in Children and Infants with Epilepsy. CHILDREN 2022; 9:children9091372. [PMID: 36138681 PMCID: PMC9498174 DOI: 10.3390/children9091372] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022]
Abstract
Ketogenic diets (KDs) are highly effective in the treatment of epilepsy. However, numerous complications have been reported. During the initiation phase of the diet, common side effects include vomiting, hypoglycemia, metabolic acidosis and refusal of the diet. While on the diet, the side effects involve the following systems: gastrointestinal, hepatic, cardiovascular, renal, dermatological, hematologic and bone. Many of the common side effects can be tackled easily with careful monitoring including blood counts, liver enzymes, renal function tests, urinalysis, vitamin levels, mineral levels, lipid profiles, and serum carnitine levels. Some rare and serious side effects reported in the literature include pancreatitis, protein-losing enteropathy, prolonged QT interval, cardiomyopathy and changes in the basal ganglia. These serious complications may need more advanced work-up and immediate cessation of the diet. With appropriate monitoring and close follow-up to minimize adverse effects, KDs can be effective for patients with intractable epilepsy.
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Daneshpazhooh M, Nikyar Z, Kamyab Hesari K, Rostami E, Taraz Jamshidi S, Mohaghegh F. Remission of Prurigo Pigmentosa after Breaking Ketogenic Diet and Resuming Regular Diet. Adv Biomed Res 2022; 11:70. [PMID: 36325168 PMCID: PMC9621347 DOI: 10.4103/abr.abr_138_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 11/24/2022] Open
Abstract
Prurigo pigmentosa (PP) is a rare skin disorder presenting as erythematous urticarial papules on the chest and leaving reticulated pigmentation. Although the etiology of PP is unknown, conditions associated with ketosis such as diabetes mellitus, ketogenic diet (KD), and anorexia nervosa are implicated. Herein, we report a 21-year-old woman who developed PP after adhering to a KD and responded to resuming a regular diet.
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Affiliation(s)
- Maryam Daneshpazhooh
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Mashhad, Iran
| | - Zahra Nikyar
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Mashhad, Iran,Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Mashhad, Iran,Address for correspondence: Dr. Zahra Nikyar, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. E-mail:
| | - Kambiz Kamyab Hesari
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Mashhad, Iran
| | - Ehsan Rostami
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Mashhad, Iran
| | - Shirin Taraz Jamshidi
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Mohaghegh
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Mashhad, Iran
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Alkhouri F, Alkhouri S, Potts GA. Prurigo Pigmentosa Following a Keto Diet and Bariatric Surgery. Cureus 2022; 14:e24307. [PMID: 35602831 PMCID: PMC9121908 DOI: 10.7759/cureus.24307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/18/2022] Open
Abstract
Prurigo pigmentosa (PP) is a rare pruritic condition with idiopathic etiology that affects mostly females. It most commonly presents as a rash on the neck and trunk. We report the occurrence of PP in a young woman on two separate occasions; her first episode was following a ketogenic diet and second after undergoing a laparoscopic gastric sleeve surgery. This presents as a unique case because, to our knowledge, PP has only been reported in a small number of cases in the Western world. This presentation could be suggestive of a stronger relationship between PP and the metabolic state of the body. It also outlines the effectiveness of treatment options currently in use for treating PP.
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Shahrigharahkoshan S, AlHalees Z, Pehr K. Ketogenic diet-induced prurigo pigmentosa: a rising association. Int J Dermatol 2021; 61:779-782. [PMID: 34826138 DOI: 10.1111/ijd.15991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/27/2021] [Accepted: 11/06/2021] [Indexed: 11/30/2022]
Abstract
Prurigo pigmentosa (PP) is an uncommon inflammatory dermatosis first described in 1971. It is characterized by recurrent crops of pruritic erythematous papulovesicles that resolve with a macular reticulated hyperpigmentation. The exact etiology is yet to be determined, however with the expanded application of the ketogenic diet (KD) in recent years, conditions accompanied with ketosis are more commonly being described in association with PP. Antibiotics as well as resolution of ketosis can effectively treat the dermatitis. Given the publicity and growing popularity of the ketogenic diet and numerous references to the "Keto-Rash" on social media, we reviewed the KD-induced PP cases to raise awareness of this increasingly recognized entity and provide an update to clinicians, particularly dermatologists, regarding this possible side effect of KD.
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Affiliation(s)
| | - Zeinah AlHalees
- Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Kevin Pehr
- Division of Dermatology, McGill University, Montreal, QC, Canada.,Jewish General Hospital and Lady Davis Institute for Medical Research, Montreal, QC, Canada
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Mufti A, Mirali S, Abduelmula A, McDonald KA, Alabdulrazzaq S, Sachdeva M, Yeung J. Clinical manifestations and treatment outcomes in prurigo pigmentosa (Nagashima disease): A systematic review of the literature. JAAD Int 2021; 3:79-87. [PMID: 34409375 PMCID: PMC8362297 DOI: 10.1016/j.jdin.2021.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prurigo pigmentosa (PP) is a rare inflammatory dermatosis characterized by pruritic erythematous papules that coalesce to form a reticulate pattern. PP is often misdiagnosed, and patients are treated with ineffective therapies. Although the majority of reports about PP are from East Asia, patients of all backgrounds can be affected. OBJECTIVES To perform a systematic review of reported PP cases with the purpose of summarizing the clinical presentation and treatment of PP. METHODS MEDLINE and Embase were searched for original articles describing PP. We identified 115 studies from 24 countries representing 369 patients to include in the analysis. RESULTS Of the 369 patients included in the analysis, the mean age was 25.6 years (range: 13-72 years) with 72.1% (266 of 369) female. Risk factors or aggravating factors were described in 52.3% (193 of 369) of patients and included dietary changes (25.5%, 94 of 369), friction (8.4%, 31 of 369), sweat (7.6%, 28 of 369), and ketonuria (5.1%, 19 of 369). Of those patients who experienced PP following dietary changes, 40.4% (38 of 94) started a ketogenic diet. Minocycline monotherapy was the most frequently prescribed treatment for PP (20.9%, 77 of 369), achieving complete resolution in 48.1% (37 of 77) of patients. CONCLUSIONS PP is sometimes associated with ketogenic diets and can be effectively managed with oral tetracyclines.
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Affiliation(s)
- Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sara Mirali
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Abrahim Abduelmula
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Katherine Ann McDonald
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shaikhah Alabdulrazzaq
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Muskaan Sachdeva
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
- Probity Medical Research Inc, Waterloo, Ontario, Canada
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Yang J, Jiao S, Zhang M. Use of minocycline for the treatment of prurigo pigmentosa with intraepidermal vesiculation: a case report. J Int Med Res 2021; 49:3000605211015593. [PMID: 34038199 PMCID: PMC8161857 DOI: 10.1177/03000605211015593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Pruritus pigmentosa is a skin disease mainly characterized by pruritus, inflammatory rash and reticular and macular pigmentation. The disease more commonly affects young women and may persist for several years. In this article, we report a case of a 20-year-old female patient who presented with erythema and blisters on the neck and trunk with pruritus for 20 days. Dermatological examination revealed a reticular distribution of erythema on the chest and abdomen and some areas of erythema covered with crusts. Additionally, blisters and bullae with clear fluid and negative Nikolsky's sign were noted. On the neck and back, erythema was also in a reticular distribution, and erythema secondary to erosion and/or crusts was present. In addition, histopathological analysis of the lesions showed hyperkeratosis and intraepidermal multilocular vesiculation and confirmed increased migration of inflammatory cells into the epidermis and infiltration of inflammatory cells, including lymphocytes, histiocytes and eosinophils, in the superficial dermis. The expression levels of IgG, IgM, IgA and C3 were all negative. This patient was diagnosed with prurigo pigmentosa, and the condition improved after treatment with minocycline.
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Affiliation(s)
- Jie Yang
- The Fifth People's Hospital of Hainan Province, Haikou, Hainan, China
| | | | - Min Zhang
- The Fifth People's Hospital of Hainan Province, Haikou, Hainan, China
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Page G, Page B, Beltraminelli H, Borradori L, Schlapbach C. Prurigo Pigmentosa: Demographics and Characteristics in 14 Caucasian Patients. Dermatology 2021; 237:878-883. [PMID: 33592602 DOI: 10.1159/000514026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prurigo pigmentosa (PP) is an inflammatory dermatosis typically reported in young Asian women and characterized by recurrent papulovesicular lesions resolving with a postinflammatory reticulated hyperpigmentation. METHODS We have included all consecutive patients with PP diagnosed in our tertiary center between 2013 and 2020. The clinical information was retrospectively collected from medical records. RESULTS We identified 14 patients with PP. The median age at the time of diagnosis was 29.5 years (range 17-43 years), while the female-to-male ratio was 13:1. Diagnostic delay varied from 10 days to 10 years (mean of 25 months). Light microscopy studies consistently showed presence of a lymphohistiocytic infiltrate in combination in 40% of cases with neutrophils. Interface changes were found in 60% of cases. In 6 (43%) of 14 cases, there was a chronological relationship between the starting of a new diet and the development of the first flares. Treatment with doxycycline in 9 patients resulted in a complete regression of the lesions. LIMITATION This was a retrospective study in a tertiary referral hospital. CONCLUSIONS Our observations indicate that PP is not so rare in Europe as previously thought and is often diagnosed after a long delay. Demographics, clinical characteristics and triggering factors in Caucasian patients are similar to those described in the Asian population. Diagnosis is based on the peculiar recurrent course and distinctive clinicopathological features. Tetracyclines represent the first-line therapy in PP.
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Affiliation(s)
- Gonzague Page
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Basile Page
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,
| | - Helmut Beltraminelli
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luca Borradori
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Schlapbach
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Alshaya MA, Turkmani MG, Alissa AM. Prurigo pigmentosa following ketogenic diet and bariatric surgery: A growing association. JAAD Case Rep 2019; 5:504-507. [PMID: 31205990 PMCID: PMC6558236 DOI: 10.1016/j.jdcr.2019.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mohammed A. Alshaya
- Dermatology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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