Pityriasis amiantacea following bone marrow transplant

Pityriasis amiantacea (PA) is a hair disorder characterized by matting of multiple hair shafts, typically occurring as an idiopathic condition. A 67-year-old woman with multiple myeloma who developed PA following a bone marrow transplant with melphalan conditioning is described.She noted initial changes in scalp hair regrowth 4 weeks posttransplant. During the next 4 months she developed multiple lesions of PA that rapidly responded to management, including mineral oil under occlusion in the evening followed by daily shampooing with alternating coal tar, salicylic acid, and ketoconazole shampoos. We review medications that have been associated with PA and conditions related to PA, including atopic dermatitis, bacterial infection, fungal infection, psoriasis, and seborrheic dermatitis. Our patient developed PA that was associated with either melphalan conditioning, bone marrow transplant, or both.

Pityriasis amiantacea: a case report

Pityriasis amiantacea (PA) is a papulosquamous condition of the scalp,characterized by asbestos - like thick scales attached to the hair shaft. It is thought to represent a reaction pattern to inflammatory skin disorders like psoriasis, seborrhoeic dermatitis, tinea capitis, atopic dermatitis and lichen planus, rather than a distinctive disease. The scaling may be localised or generalised, depending on the underlying condition and its duration.This report highlights the clinical features of pityriasis amiantacea secondary to atopic dermatitis and the differential features of other papulo-squamous scalp disorders such as scalp psoriasis, seborrhoeic dermatitis and lichen planus.Scalp psoriasis and seborrhoeic dermatitis are the commonest causes of PA as well as the closest differentials hence should be excluded in all cases. The longterm sequelae of PA include scalp fibrosis and permanent hair loss hence should be identified and treated promptly. The management modalities of PA will also be discussed.

Extensive Darier's disease with pityriasis amiantacea, alopecia and congenital facial nerve palsy

We present a 65-year-old man with Darier disease with pityriasis amiantacea on the scalp, alopecia, and congenital facial nerve palsy.

Pityriasis alba revisited: perspectives on an enigmatic disorder of childhood

Pityriasis alba (PA) is a localized hypopigmented disorder of childhood with many existing clinical variants. It is more often detected in individuals with a darker complexion but may occur in individuals of all skin types. Atopy, xerosis, and mineral deficiencies are potential risk factors. Sun exposure exacerbates the contrast between normal and lesional skin, making lesions more visible and patients more likely to seek medical attention. Poor cutaneous hydration appears to be a common theme for most risk factors and may help elucidate the pathogenesis of this disorder. The end result of this mechanism is inappropriate melanosis manifesting as hypopigmentation. It must be differentiated from other disorders of hypopigmentation, such as pityriasis versicolor alba, vitiligo, nevus depigmentosus, and nevus anemicus. Alleviation of the various risk factors via patient education on proper skin care and hygiene, use of lubricants and emollients, topical corticosteroid therapy in the presence of inflammation, and the novel administration of topical anti-inflammatory drugs such as calcineurin inhibitors can play a crucial role in promoting remission or resolution.

Origin, clinical presentation, and diagnosis of hypomelanotic skin disorders

Hypomelanotic skin disorders are cutaneous pigmentary disorders characterized by a reduced melanin content in the skin that results in a lightening of the skin. Establishing the correct diagnosis for hypomelanotic skin disorders requires a good history, a detailed physical examination, the use of special lighting techniques, such as Wood's light, and sometimes a biopsy of the abnormally pigmented skin and the normally pigmented skin. This article focuses on the origin, clinical presentation, and diagnosis of acquired hypomelanotic skin disorders. An algorithm for the diagnostic approach to these hypomelanoses is given.

The frequency of common skin conditions in preschool-aged children in Australia: seborrheic dermatitis and pityriasis capitis (cradle cap)

OBJECTIVE

To determine the prevalence and severity of seborrheic dermatitis and pityriasis capitis in Australian preschool-aged children.

DESIGN

A stratified cross-sectional skin survey using cluster sampling of centers throughout Victoria, Australia.

SETTING

The study population included children attending child care centers, preschools, and Maternal and Child Health Centers, with the reference population being Australian children 5 years and younger.

PARTICIPANTS

Of the 1,634 children in the original sample, 1.116 children aged 11 days to 5 years 11 months were included in the study.

INTERVENTION

Parents completed a questionnaire recording demographic information and personal and family history of skin problems and related diseases. A dermatologist performed a total skin examination, including the diaper area for children younger than 12 months.

MAIN OUTCOME MEASURE

The age- and sex-specific prevalence rates and site and severity of seborrheic dermatitis and pityriasis capitis were measured.

RESULTS

The overall age- and sex-adjusted prevalence of seborrheic dermatitis was 10.0% (95% confidence interval [CI], 8.2%-11.7%): 10.4% (95% CI, 7.8%-12.9%) in boys and 9.5% (95% CI, 7.0%-12.0%) in girls. This was highest in the first 3 months of life, decreasing rapidly by the age of 1 year, after which it slowly decreased over the next 4 years. Most (71.9%) had disease classified as minimal to mild. Pityriasis capitis occurred in 41.7% (95% CI, 38.8%-44.6%) of the 1,116 children examined, with 85.8% categorized as minimal to mild only.

CONCLUSIONS

Seborrheic dermatitis and pityriasis capitis are common in early childhood. Most children have minimal to mild disease that would require little if any treatment. Education programs directed at those caring for preschool-aged children are needed to provide information on simple preventative measures and treatment, if necessary, that could easily reduce the morbidity associated with these very common conditions.

Pityriasis alba: a study of pathogenic factors

BACKGROUND

The aetiology of pityriasis alba (PA), a common dermatosis in childhood, is still controversial. The objective of this study was to assess the possible aetiopathogenic factors of this disease in infants.

METHODS

Forty-four patients with PA and 31 healthy children were examined and compared. Personal hygiene habits, sun exposure, presence of Staphylococcus aureus in nasal fossae and presence of major or minor signs of atopy were assessed during anamnesis and physical examination. Susceptibility to ultraviolet (UV) B radiation was measured by the onset of a contact hypersensitivity reaction to diphenylcyclopropenone in individuals sensitized in previously irradiated areas.

RESULTS

The prevalence of PA was higher in individuals with darker skin, in high phototype categories, as well as in males. The number of daily baths and sun exposure between 10.00 h and 15.00 h were significantly higher in the PA group when compared with controls (P = 0.03 and P = 0.0015, respectively). The presence of atopy signs was more common in pityriasis patients (P = 0.002). Susceptibility to UVB radiation was 29.6% in the PA group vs. 29.0% in the control group; nevertheless, important differences were found after stratification in order to control possible confounding factors. The presence of S. aureus in the nostrils was equal in both groups.

CONCLUSIONS

Our results confirm that PA, in our population, is more prevalent in males and in individuals in higher phototype categories. In those with inadequate personal hygiene and sun exposure habits the disease is more accentuated, demonstrating that the xerosis presenting in individuals with atopic diathesis is an important element in the development of the disease. S. aureus is not an important aetiopathogenic factor in PA. Susceptibility to UVB becomes important when related to the patient's phototype.

[Pityriasis rotunda: second Tunisian case]

Pityriasis Rotunda is a dermatosis well known in Japan and Black Africa. Its unusual in Europe and North Africa. Several authors consider that Pityriasis Rotunda is an acquired ichtyose and that it represents a real paraneoplastic syndrome. We report the case of Tunisian men suffering from a Pityriasis Rotunda associated to a dilatation of branch.

Pityriasis rotunda

Pityriasis rotunda is an uncommon cutaneous disorder consisting of asymptomatic, strikingly circular, scaly lesions on the trunk and extremities, with the histologic appearance of ichthyosis vulgaris. Previous cases have been described in Japanese, South African, and West Indian persons, usually in association with an underlying serious systemic disease. A case of pityriasis rotunda in a 32-year-old black man in whom no diagnosable disorder could be demonstrated is presented.

Pigmenting pityriasis alba

We conducted a prospective study of 20 patients with pigmenting pityriasis alba (PPA) over a period of two years. Characteristic morphology revealed a central zone of bluish hyperpigmentation surrounded by a hypopigmented, slightly scaly halo of variable width. All patients displayed lesions on the face. Concomitant extrafacial involvement was uncommon. A significant finding was an associated dermatophyte infection in 13 patients (65%). These patients all received griseofulvin 10 mg/kg/day for eight weeks, resulting in the resolution of PPA in seven within 4 to 20 weeks. These were also treated with 1% hydrocortisone. Biopsy specimens from two patients showed similar features, namely, a subacute dermatitis with variable pigment incontinence. Immunohistochemical labeling revealed a preponderance of T lymphocytes. Pigmenting pityriasis alba seems to be a variant of classic pityriasis alba showing a strong association with dermatophyte infection, especially tinea capitis. It may be related to lichenoid melanodermatitis.

Obsessive-compulsive disorder in patients with chronic pruritic conditions: case studies and discussion

BACKGROUND

Relatively few persons with obsessive-compulsive disorder (OCD) come to psychiatric clinics for treatment. Our hypothesis was that patients with a form of OCD that involves compulsive hand and body washing might initially seek treatment from a dermatologist.

OBJECTIVE

Our purpose was to screen patients attending a dermatology clinic to determine the frequency of OCD cases and to help dermatologists recognize this disorder.

METHODS

Randomly selected patients who presented with one of several chronic pruritic conditions were interviewed to determine the presence of anxiety disorders.

RESULTS

A significantly high percentage of the patients (14%) were found to have previously undiagnosed OCD. Case studies of five of these patients are presented.

CONCLUSION

A significant number of patients with undiagnosed OCD appear to present to dermatology clinics. Identification and referral for psychiatric consultation may aid in the treatment of both OCD and concomitant dermatologic conditions.

Mucha-Habermann disease in a child: possible association with measles vaccination

A 2.5-year-old boy presented with skin lesions consistent with Mucha-Habermann disease, which appeared about 5 days after an injection of freeze-dried live attenuated measles vaccine. He responded to both oral and topical corticosteroid therapy. To my knowledge, this represents the first such association of Mucha-Habermann disease with virus vaccination.

[Lichenoid pityriasis (parapsoriasis guttata) in children. Report of 17 cases]

Seventeen cases of pityriasis lichenoides diagnosed over a nine-year period in children under 15 years of age are reported. Patients with this benign disease develop papular skin lesions covered with thick, coherent scales which detach in a single piece (reminiscent of sealing wax). Pruritus is not marked. Lesions may be necrotic (Mucha Habermann's small pox-like form, n = 6) or mild (leukodermic form, n = 2). Half of the patients studied developed several episodes and total duration of the disease exceeded two years in one third of cases. Recovery occurred after one or two episodes in half the children. Scars developed in some patients with severely necrotic lesions. None of the patients developed lymphoma. All patients with lymphomatoid papulosis progressing to lymphoma reported in the literature were adults. Pathogenesis of pityriasis lichenoides remains unknown but may involve lymphocytic vasculitis. No truly effective therapy is available. However, oral macrolides can be used especially in patients with early manifestations suggesting an infectious disease. Emollients, heliotherapy and ultraviolet therapy may also be recommended.

Severe febrile Mucha-Habermann's disease in children: case report and review of the literature

Mucha-Habermann disease, or pityriasis lichenoides et varioliformis acuta, is usually a benign, papulosquamous, cutaneous disorder. It has also been reported in a severe form with fever and systemic symptoms both in children and adults. We report a 12-year-old boy with the febrile, ulceronecrotic type. A review of similar cases in the literature shows a 16% frequency of acute necrotic lesions, as well as rare complications such as fever, superinfected lesions, bacteremia (most often with Staphylococcus aureus), and rheumatologic manifestations such as arthritis and scleroderma. There is no definitive treatment, but tetracycline, erythromycin, methotrexate, and ultraviolet light are used most frequently. The most common histologic feature is mononuclear perivascular infiltrates. Mucha-Habermann disease can mimic other common entities such as varicella and insect bites.

Pityriasis lichenoides in children: a long-term follow-up of eighty-nine cases

Pityriasis lichenoides is usually classified into an acute and a chronic form. From a review of 89 cases of the disease seen since 1974 it seems that a more realistic classification into three main groups, according to the distribution of pityriasis lichenoides lesions, could be made, namely, a diffuse, a central, and a peripheral form, each characterized by a different clinical course. Conversely, no correlations were detected in our series between the severity of skin lesions and their distribution or the overall course of the disease. None of our cases suggests the possible evolution of pityriasis lichenoides into lymphomatoid papulosis. Although no infectious causative agent has been identified, a viral origin seems likely in some cases. Most patients responded favorably to UVB irradiation. Our conclusions are (1) that pityriasis lichenoides is probably a clinical disorder with a diverse etiology and (2) that its classification by distribution seems more useful than its subdivision into an acute and a chronic form.

Pityriasis rosea-like eruption associated with BCG vaccination

We report a case of a pityriasis rosea-like eruption in a 12-year-old boy several days following BCG vaccination. It is suggested that the BCG vaccination be included in the etiology of pityriasis rosea-like eruptions.

Pityriasis folliculorum revisited

Six cases of facial erythema with follicular plugging are described. These cases correspond with characteristics of the disorder pityriasis folliculorum, a presumed demodicidosis. Treatment modalities included topical tretinoin, gamma benzene hexachloride (lindane) lotion, and 1% permethrin cream rinse.

Pityriasis rotunda as a cutaneous marker of hepatocellular carcinoma: a comparison with its prevalence in other diseases

In an attempt to substantiate the claim that pityriasis rotunda may be a useful cutaneous marker of hepatocellular carcinoma in South African Blacks, the prevalence of the rash in 63 unselected South African Blacks with this tumour was compared to that in 63 matched patients with active tuberculosis, 63 with other malignant tumours, and 63 with various forms of chronic benign hepatic disease. The prevalence of pityriasis rotunda in hepatocellular carcinoma was 15.9%, which was appreciably greater (P = 0.0005) than the overall prevalence of the rash (2.6%) in the controls. The prevalence was 4.8% for tuberculosis (P = 0.038), 0% for other malignant diseases (P = 0.0007), and 3.2% for chronic benign hepatic disease (P = 0.015). We conclude that the presence of pityriasis rotunda is a useful pointer to the diagnosis of hepatocellular carcinoma in South African Blacks.

Pityriasis rosea in Lagos

A recent 5-year period study of the incidence of pityriasis rosea among dermatologic outpatients was conducted at the Lagos University Teaching Hospital. Three hundred fifty-two patients with pityriasis rosea were seen. The average annual incidence was 4.8 per 100 dermatologic patients. Women predominated by a margin of 1.2:1.0. More than 91% of the patients were between the ages of 5 and 35 years, with a peak at ages 10-14. The incidence of the disease was significantly higher in the early part of the rainy season. No declining incidence was observed over the years. A blood picture of a leukopenia with relative lymphocytosis was observed early in the disease. Ampicillin, when consumed after the onset of the eruption, made the patient with pityriasis rosea clinically worse.

Pityriasis lichenoides et varioliformis acuta and acquired toxoplasmosis

A patient presented with a typical pityriasis lichenoides et varioliformis acuta (PLEVA) and disclosed serological evidence of an active and recent toxoplasmosis. Specific treatment of toxoplasmosis promptly and definitively resolved PLEVA lesions. Serological tests for Toxoplasma gondii should be performed in all PLEVA patients.

Pityriasis rosea and the need for a serologic test for syphilis

A rapid plasma reagin (RPR) test was performed in fifty patients with a clinical diagnosis of pityriasis rosea to determine the frequency of syphilis as the underlying cause of the eruption. In none of the fifty patients was syphilis the cause. Experience in diagnosing skin diseases, frequency of syphilis in the community served, and the characteristics of the individual eruption are important factors in the decision to perform an RPR test.

Pityriasis rotunda in a white patient. Report of the second case and review of the literature

A 19-year-old white woman with pityriasis rotunda in whom no diagnosable disorder could be demonstrated is reported on herein. Pityriasis rotunda has been described in Oriental and black patients, usually in association with certain serious systemic diseases. Our patient appeared to have the second reported case of pityriasis rotunda in white persons. In both cases the dermatosis occurred in an otherwise healthy individual. Physicians should be alert to the possible occurrence of pityriasis rotunda in white patients. The literature on pityriasis rotunda is reviewed.

Pityriasis rosea update: 1986

Pityriasis rosea is a common self-limited dermatologic disorder. It appears to be a nonspecific cutaneous reaction pattern with a large number of causes. Current evidence indicates that a cell-mediated immune mechanism may be important in its pathogenesis.

Pityriasis rotunda. A cutaneous marker of hepatocellular carcinoma in South African blacks

Although paraneoplastic phenomena occur frequently in patients with hepatocellular carcinoma, cutaneous changes have rarely been reported. During the past two years, ten South African blacks with hepatocellular carcinoma and pityriasis rotunda have been seen in a single hospital. The rash affected the trunk, especially the lower back and buttocks. The lesions ranged in size from 1.5 to 25 cm and were always multiple. They had a characteristic circular or arcuate configuration with scaling and varying degrees of hyperpigmentation. Pityriasis rotunda may prove to be a useful cutaneous marker of hepatocellular carcinoma in South African blacks.

Pityriasis rotunda: two cases in black Americans

Pityriasis rotunda is an uncommon cutaneous disorder consisting of asymptomatic, perfectly circular, scaling plaques on the trunk and extremities. Histopathologic findings are consistent with ichthyosis vulgaris. The majority of cases are seen in association with an underlying disease, and most authors believe that this entity represents a form of acquired ichthyosis. Previous cases have been restricted to certain geographic and ethnic groups (most commonly Japanese and South African Bantu). We report two cases of pithyriasis rotunda, both occurring in black Americans. We believe that these are the first reported cases seen in Americans.

Pityriasis rosea

Pityriasis rosea is a common, self-limited, scaling disorder of unknown etiology, seen predominantly in young adults. The lesions, typically found on the trunk and proximal extremities, are ovoid, salmon-colored and symmetric. A "herald patch" appears in 70 percent of cases. Variants appear frequently. Papular, urticarial, vesicular or hemorrhagic lesions may be seen. Management with antipruritic lotions, emollients or antihistamines may be necessary to relieve itching.

[Observations on pityriasis rosea patients]

In the Institute of Skin and Veneral Diseases 252 patients suffering from pityriasis rosea were treated yearly since 1970. As opposed to descriptions published so far several differences were observed. The disease occurs not only in young adults, but also in infants and in old age. It may be observed not only in certain months, but throughout the year. The disease becomes manifest more frequently in workers of larger collectives. It does not leave behind prolonged immunity, but may return after an intervall of 1-12 years with milder symptoms. The repeated incidence was 3,57 per cent. Recurrence was observed in two cases within one family. P.r. was followed by herpes zoster in 3 cases, which is indicative of increased susceptibility for viral infection. The point of attack of the supposed pathogen is the pharyngeal mucous membrane, which may explain the difficulty of isolation of the unknown virus as this region has a rich microflora.

Recent upper respiratory tract infection and pityriasis rosea: a case-control study of 249 matched pairs

A sample of 249 patients was drawn from an original population of 939 patients with pityriasis rosea identified in an earlier population-based study of pityriasis rosea in Rochester, Minnesota. A control was selected for each case, matched for age, sex, and year of diagnosis. Comparison was made with regard to recent immunization, history of atopy, and recent infection. A statistically significant number of patients had experienced recent upper respiratory tract infection (P less than 0.005). The association between recent infection and pityriasis rosea is discussed.

Pityriasis rosea in Rochester, Minnesota, 1969 to 1978

A population-based epidemiologic study of pityriasis rosea was developed for Rochester, MN, for a recent 10-year period. Nine hundred thirty-nine patients with pityriasis rosea (340 male patients and 599 female patients) who resided within Rochester city limits at the time the diagnosis was made were included. The average annual incidence rate of this disease was 172.2 per 100,000 person-years (158.9 per 100,000, adjusted to the 1970 U.S. white population). Female patients predominated by a margin of 1.5:1.0. More than 75% of the patients were between the ages of 10 and 35 years, with a mean age of 22.7 years and a range of 10 months to 78 years. There was a recurrence of the illness in 1.8% of the patients after an average of 4.5 years of follow-up. The highest rate was noted in 1972, following which there was a steady and significant decline in incidence. The incidence of the disease was significantly higher in the colder months than in the warmer season. Patients in twenty-one close-contact pairs experienced the disease at varying intervals. Recent past infections or history of atopy was noted in nearly one third of the cases.

Case clustering in pityriasis rosea: support for role of an infective agent

One hundred and twenty-six cases of pityriasis rosea seen over two years in north Staffordshire were analysed for clustering in time and space. A statistically significant degree of clustering was found; this was evident among female patients considered separately but not among male patients. The incidence of the condition was higher in patients working in, or attending, educational establishments. These findings support the hypothesis that pityriasis rosea is caused by an infective agent. A search for an infective organism and a transmission mechanism now seems justifiable.

Pityriasis rosea. Viral complement fixation studies

Eleven patients were seen for pityriasis rosea and underwent acute and convalescent viral complement fixation tests for several respiratory viruses and Mycoplasma. Several patients (6/11) gave a history of antecedent upper respiratory illness; however, no significant rise in titer was seen on any of the complement fixation tests.