Case Of Prurigo Pigmentosa Research Articles

Prurigo pigmentosa and diabetes: A case report

Sir, Prurigo pigmentosa is a rare inflammatory disease first reported in 1971 by Nagashima et al. as a “peculiar pruriginous dermatosis with gross reticular pigmentation” in Japan [1], where the largest number of such cases have been described, with only several cases having been described elsewhere. Herein, we report a new case of prurigo pigmentosa. A 32-year-old Moroccan female presented at our dermatology department with a several-week-old history of pruritic eruptions on the chest, abdomen, lumbosacral area, and neck. According to the patient, the onset was marked by itchy papules coalescing to plaques, secondarily becoming hyperpigmented reticulated macules. The patient was treated with antifungal drugs without improvement. Additionally, the patient had recently been diagnosed with type II diabetes and was treated by oral antidiabetics. A physical examination revealed hyperpigmented macules arranged in a reticulate pattern, mainly on the chest, abdomen, lumbosacral area, and neck (Figs. 1 and 2). She had no acanthosis nigricans or other associated symptoms. The main diagnoses considered were pityriasis versicolor, confluent and reticulated papillomatosis of Gougerot–Carteaud, and prurigo pigmentosa. A histological examination revealed a discreetly atrophic epidermis surmounted by compact orthokeratotic hyperkeratosis and slight basal pigmentation. The dermis was the site of perivascular mononuclear infiltrates associated with a small number of melanophages. Periodic acid–Schiff staining was negative. This was consistent with the diagnosis of prurigo pigmentosa.

Keto Rash: Ketoacidosis-Induced Prurigo Pigmentosa

A 37-year-old male patient has suffered from pruritic eruptions for 2 weeks and had a weight loss of 20 kg in 3 months. Associated symptoms included drowsiness, generalized weakness, nausea, nocturia, polydipsia, and polyphagia. On examination, pruritic erythematous papuloplaques mixed with brownish reticular hyperpigmentation were noted mainly on the back (Figure 1). Laboratory data revealed a serum glucose level of 805 mg/dL (44.68 mmol/L), high glycohemoglobin level (17.5%; reference range:<5.7 %), high serum level (7.2 mmol/L; reference range, <0.6 mmol/L), and high urinary ketone level (4+; reference range, negative). Histopathology revealed basket weave hyperkeratosis and perivascular lymphocytic infiltrate with many neutrophils in the dermis (Figure 2). On the basis of clinical and pathological findings, prurigo pigmentosa associated with diabetic ketoacidosis (keto rash) was diagnosed. Slit-lamp examination suggested no diabetic retinopathy. The patient received glucose-insulin-potassium and fluid regimen for diabetes ketoacidosis control. The skin eruption responded well with gradual resolution 2 weeks after the above-mentioned management and topical steroid treatment.Figure 2A, Histopathology revealed basket weave hyperkeratosis, parakeratosis, and superficial perivascular inflammatory cells infiltration in the upper dermis (hematoxylin and eosin stain, original magnification 40×). B, In higher magnification, sections revealed mild exocytosis, basal cell vacuolization, and superficial perivascular lymphocytic infiltration with neutrophils (hematoxylin and eosin stain, original magnification 200×).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Prurigo pigmentosa causes acquired diffuse reticulate pigmented eruptions on the trunk and commonly affects young patients.1Rotstein H. Mason G.H. A peculiar pruriginous dermatoses with gross reticular pigmentation.Australas J Dermatol. 1992; 33: 56-59Crossref PubMed Scopus (6) Google Scholar It is characterized by intensely pruritic symmetrical urticarial, erythematous papuloplaques coalescing into reticulated hyperpigmentation, which is usually distributed on the trunk and neck. The pathomechanisms are proposed to be neutrophil-mediated inflammation triggered by metabolic and environmental factors, and the role of ketoacidosis is increasingly reported.2Beutler B.D. Cohen P.R. Lee R.A. Prurigo pigmentosa: literature review.Am J Clin Dermatol. 2015; 16: 533-543Crossref PubMed Scopus (49) Google Scholar Patients with the underlying disease of anorexia nervosa and diabetes and on a ketogenic diet may be at a high risk of developing prurigo pigmentosa. With an increasing prevalence of ketogenic diets, the cases of prurigo pigmentosa are more commonly reported.3Michaels J.D. Hoss E. DiCaudo D.J. Price H. Prurigo pigmentosa after a strict ketogenic diet.Pediatr Dermatol. 2015; 32: 248-251Crossref PubMed Scopus (20) Google Scholar Management includes controlling blood sugar level and treatment with minocycline, doxycycline, or dapsone. Here, we present this case to raise awareness of distinct skin eruptions that can occur in the setting of diabetic ketoacidosis, or in patients on a ketogenic diet.

A case of prurigo pigmentosa supposedly relevant to contact allergy to metal

A case of prurigo pigmentosa supposedly relevant to contact allergy to metal

Prurigo pigmentosa: role of ICAM-1 in the localization of the eruption

Immunohistochemical studies were carried out on the skin lesions of two cases of prurigo pigmentosa. There was a predominance of CD4+ cells in the dermal infiltrate, whereas those lymphocytes in the epidermis were mainly CD8+ cells. The majority of dermal and epidermotropic lymphocytes showed an intense expression of lymphocyte function-associated antigen 1 (LFA-1). The number of CD1+ cells was increased in the epidermis. There was intense expression of ICAM-1 by keratinocytes in the erythematous papules. Focal expression of ICAM-1 was still observed in the residual pigmented areas and could explain the recurrence of the lesions at these sites.

A case of prurigo pigmentosa considered to be contact allergy to chromium in an acupuncture needle.

A 53-year-old male developed prurigo pigmentosa on his back, after undergoing acupuncture for 3 years. The eruptions were ceased on discontinuing the therapy but recurred with its resumption. The acupuncture needle contained 18.12% chromium. Erythema was induced by patch testing with potassium dichromate, and a flare-up was observed in the area of the patch test on resumption of acupuncture. We consider that the eruptions were induced by contact allergy to the chromium component of the acupuncture needles.

Prurigo pigmentosa

We present two cases of prurigo pigmentosa, a little-known dermatosis characterized by itchy red papules which coalesce to give a reticular pattern evolving into a reticulate hyperpigmented mottling. The histological features are non-specific and some patients with this disorder respond dramatically to dapsone.