Acute lichenoid and varioliform pityriasis in a pediatric patient.

BACKGROUND: Pityriasis lichenoides et varioliformis acuta (PLEVA) is a rare dermatosis recognized as a benign condition of unknown etiopathogenesis. It is more common in pediatric patients and young adults and is characterized by multiple small or large erythematous plaques spread over the trunk and extremities. CASE REPORT: We describe the case of a 5-year-old male, previously healthy, with multiple erythematous lesions that disappeared leaving hypopigmented macules. The biopsy reported histological changes suggestive of mycosis fungoides. After a second revision of lamellae in this hospital, lymphocytic vasculitis (LV) with focal epidermal necrosis consistent with acute pityriasis lichenoides (PL) was identified. CONCLUSIONS: The existing knowledge about PLEVA lacks a consensus in specifying its classification, etiopathogenesis, diagnosis, and treatment, so this clinical condition represents a medical challenge. The diagnosis is made by clinical suspicion and confirmed by histology. The objective of this article was to report a case of PLEVA with an atypical presentation due to its histopathological findings, being the first report showing LV in children, as well as a review of the literature.

INTRODUCCIÓN: La pitiriasis liquenoide y varioliforme aguda (PLEVA) es una dermatosis poco frecuente, de etiopatogenia desconocida y evolución autolimitada. Es más común en pacientes pediátricos y adultos jóvenes, y está caracterizada por la presencia de múltiples placas eritematoescamosas pequeñas o grandes, diseminadas en el tronco y las extremidades. CASO CLÍNICO: Se describe el caso de un escolar de 5 años, de sexo masculino, previamente sano, que presentó múltiples cuadros de lesiones eritematosas que desaparecían dejando máculas hipopigmentadas. La biopsia reportó cambios histológicos sugestivos de micosis fungoide. Se realizó una segunda revisión de laminillas, identificando vasculitis linfocítica con necrosis epidérmica focal, consistente con pitiriasis liquenoide aguda. CONCLUSIONES: El conocimiento acerca de la PLEVA carece de un consenso que especifique su clasificación, etiopatogenia, diagnóstico y tratamiento, por lo que esta condición clínica representa un desafío médico. El diagnóstico se realiza por sospecha clínica y se confirma por histología. El objetivo de este artículo fue reportar un caso de PLEVA con presentación atípica por los hallazgos histopatológicos, siendo este el primer reporte de vasculitis linfocítica en niños, y además se realiza una revisión de la literatura.

Adverse impact of occupational exposure on Laborers of cement industry have scalp psoriasis and Pityriasis amiantacea with deficiency of zinc and selenium: impact of mineral supplement.

The relationship between occupational exposure and different skin diseases including scalp psoriasis and Pityriasis amiantacea has been studied. The information about imbalance of essential trace elements in psoriatic patients is still scarce. In the present follow-up study, the scalp hair and blood samples of patients (labors of cement factory) have different skin disorders (plaque's psoriasis and Pityriasis amiantacea) and were analyzed for zinc (Zn) and selenium (Se) before and after treatment with mineral supplements. For comparative purposes, both biological samples of referents who do not have any skin disease (office workers and labors of cement industry) were also analyzed for Zn and Se using an atomic absorption spectrometer. The result indicates a significant decrease in the concentrations of Se and Zn in both biological samples of patients with scalp psoriasis and P. amiantacea as compared with referents/controls, whereas the referent labor has not any skin disease with 15-25% lower values of both essential trace elements as compared to office worker, possibly due to poor diet.

Expression Levels of Inflammatory and Oxidative Stress-Related Genes in Skin Biopsies and Their Association with Pityriasis Alba.

Background and objectives: Pytiriasis alba (PA) is a common skin disorder which affects 80% of children between six and 16 years. The etiology of PA is unclear, but hypo-pigmented patches in photo-exposed zones characterize the disease. Because the high ultraviolet exposition of the skin promotes an acute inflammatory response and an increase of oxidative stress (OS), this study aimed to evaluate the expression levels of inflammatory and OS-related genes in skin biopsies, and their association with PA. Materials and Methods: A cross-sectional study was carried out. Skin biopsies of the lesion sites and healthy skin (controls) from 16 children with PA were evaluated. The tissue expression of IL-4, IL-6, IL-17A, TNFα, INFγ, IL-1ß, SOD1, and HMOX1 was analyzed by qRT-PCR, using SYBR Green and glyceraldehyde-3-phosphate dehydrogenase gene as the endogenous control. Results: There were differences in the ΔCq values of HMOX1, SOD1, IL-6, and IFNγ between tissue with lesions and healthy skin (p < 0.05). Compared with healthy skin, IL-6, IFNγ, HMOX1, and SOD1 were predominantly under-expressed in the lesion sites. However, 25% of skin biopsies with lesions showed over-expression of these four genes. Positive correlations between the expression of IL-6 and HMOX1, SOD1, and IFNγ (p < 0.05) were also observed. Conclusions: Our results suggest the presence of molecular stages of PA, defined according to the over-expression (first stage) or under-expression (second stage) of the HMOX1, SOD1, IL-6, and IFNγ genes in abnormal skin tissue. These findings may have implications for the selection of treatment for PA-related lesions.

The pathophysiology of pityriasis alba: Time-dependent histologic changes.

Although pityriasis alba is a common dermatologic condition, its pathogenesis is poorly understood, and there are many discrepancies in the literature. To assess the effect of the duration of disease on the histologic findings, a search of cases labeled "pityriasis alba" was performed on any cases submitted to our dermatopathology laboratory. Of 179 cases of pityriasis alba, five cases identified the duration of the disease, when the biopsy was taken. A biopsy for a lesion of only 1-month duration demonstrated groups of large, prominent melanocytes heaped up upon one another. Compared with biopsies from patients who had the lesions for increasingly longer periods of time, it was apparent that the melanocytes became progressively less abundant and smaller with less prominent dendritic processes. The time that the biopsy is taken may affect the histologic findings of pityriasis alba. Additionally, an abundance of melanosomes was observed between the melanocytes in all sections examined which may reflect a problem with the transfer of melanosomes into keratinocytes in this condition.

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.

Skin diseases associated with atopic dermatitis.

Atopic dermatitis is a common chronic pruritic inflammatory skin disorder, characterized by an abnormal skin barrier, immune dysfunction, and an altered skin microbiome. Atopic dermatitis may be seen in conjunction with a variety of other skin disorders due to the complex pathogenesis of atopic dermatitis, involving genetic and environmental factors that are associated with immune dysfunction, barrier defects, and altered skin microbiomes. Skin disorders associated with atopic dermatitis include diseases sharing similar genetic origins like ichthyosis vulgaris, infectious diseases such as impetigo, and eczema herpeticum, in addition to the cutaneous autoimmune diseases, alopecia areata, and vitiligo. Atopic dermatitis is also often linked to such benign conditions as pityriasis alba and keratosis pilaris. This review discusses the cutaneous comorbidities of atopic dermatitis and their relationship via their occurrence in conjunction with atopic dermatitis.

Pityriasis rotunda. A clinical study in Jordan: experience of 10 years.

BACKGROUND: Pityriasis rotunda is a rare skin disease characterized by the presence of multiple, round or oval, sharply demarcated hyperpigmented scaly patches. It has been described in Japan, South Africa, and in some other countries. The cause of pityriasis rotunda is usually idiopathic but may be associated with certain internal malignancy or systemic diseases. OBJECTIVE: The aim of this study is to describe this rare entity in Jordan in a retrospective study during the last 10 years. Jordan, as a Middle Eastern country, had no previous reports about this rare disease. In addition, the intention was to report any systemic association with the disease. Some of the cases were examined by dermoscopy. No previous reports documented dermatoscopic features of the disease. RESULTS: We could report 23 cases during the last 10 years. Eighteen cases were females and five males, in an age range of 9-38 years. There were three familial cases. The dermatoscopic findings were well demarcated, hyperpigmented with brownish patches with polygonal scales. These scales were more defined, not homogeneous in color, and separated from each other by paler stria. CONCLUSIONS: The cases of the study seem to indicate the rarity of the disease in Jordan. Our case fits neatly into the benign form of the disease with lack of association with any underlying diseases.

[Pityriasis amiantacea and folliculitis decalvans : An unusual manifestation associated with antitumor necrosis factor-α therapy]. / Pityriasis amiantacea und Folliculitis decalvans : Eine ungewöhnliche Erscheinung, assoziiert mit Anti-Tumor-Nekrose-Faktor-α-Therapie.

We report on a 21-year-old woman with a 3-year history of crusts and erosions on her scalp that had appeared after starting treatment with adalimumab due to Crohn's disease. By clinicopathological correlation pityriasis amiantacea with underlying folliculitis decalvans was diagnosed. Topical and systemic antibiotic treatment showed rapid response. The occurrence of pityriasis amiantacea in folliculitis decalvans associated with tumor necrosis factor (TNF)-α inhibitor therapy is remarkable and highlights the ambivalent role of TNF-α in diseases with immunological dysfunctions in combination with infections.

Vemurafenib-induced pityriasis amiantacea: a case report.

Vemurafenib, a novel treatment for patients with BRAF-positive metastatic melanoma, is associated with a wide spectrum of cutaneous adverse events both benign and malignant. Vemurafenib-induced pityriasis amiantacea (PA), a scaling reaction of the scalp that may cause temporary or cicatricial alopecia, has not yet been reported in the literature. In the present case, PA was observed two months after the initiation of vemurafenib therapy for metastatic melanoma and managed with symptomatic treatment without the need to cease or modify the vemurafenib dosage.

Pityriasis Alba--Common Disease, Enigmatic Entity: Up-to-Date Review of the Literature.

Pityriasis alba (PA) is a skin disorder that affects children and adolescents. Although it is common worldwide, its incidence is markedly higher in darker skin phototypes. Its characteristic features include an extended, multistage course and spontaneous remissions and recurrences. Preceded by erythematous changes, patches of hypopigmented skin of up to a few centimeters in diameter appear on the upper body. Pruritus may accompany it. Even though its etiology is unknown, possible reported triggering factors include sunlight, beauty treatments, and microorganisms, among others. Calcineurin inhibitors play the most crucial role in PA pharmacotherapy. PA often coexists with atopic dermatitis and is considered one of its milder forms.