[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.

Pityriasis rotunda diagnosed in Canada: case presentation and review of the literature.

BACKGROUND: Pityriasis rotunda is a rare cutaneous disorder characterized by scaly, circular, well-demarcated, hypo- or hyperpigmented, fine plaques over the trunk and extremities. OBJECTIVE: We present a case of pityriasis rotunda in a 44-year-old African-Canadian woman who presented to a community dermatology practice in Toronto. RESULTS: Pityriasis rotunda has been well described in Japan, Italy, and South Africa. It is extremely rare in North America, with nine reported cases to date, the majority of which were diagnosed in the United States. CONCLUSION: Pityriasis rotunda is a rare cutaneous disorder associated with systemic disease. To the best of our knowledge, this is the second report of pityriasis rotunda diagnosed in Canada.

Differential diagnosis of round or discoid lesions.

Dermatologists are called on to diagnose a variety of skin conditions in diverse age groups. Dermatologic diagnosis, based on identification of a primary lesion, uses morphologic clues to categorize the pathologic process causing the eruption. In addition, distribution and grouping of lesions helps support a specific diagnosis. Dermatologists consciously or unconsciously use pattern recognition to arrive at their differential diagnosis based on clinical experience and their having previously viewed similarly appearing skin lesions in lectures, texts, and journals. Round and discoid patches and plaques are extremely common in the clinical practice of dermatology. This contribution reviews the dermatologic conditions that present as round or discoid lesions and presents an approach to diagnosis.

Cutaneous paraneoplasia.

Paraneoplasias are frequently the first sign of a subjacent malignant tumor. Although relatively rare, they need to be recognized by dermatologists to make an early diagnosis and improve the prognosis related especially to the neoplasia. This contribution presents the morphologic aspects and the differential diagnosis of the main paraneoplasias, which include acanthosis nigricans, tripe palms, Leser-Trélat sign, acquired ichthyosis, acquired hypertrichosis lanuginosa, pityriasis rotunda, erythema gyratum repens, palmo-plantar keratoderma, Bazex syndrome, and dermatomyositis, hoping to contribute to the familiarity of dermatologists with the identification and early diagnosis of this group.

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.

Pitiríase versicolor e seus principais diagnósticos diferenciais / Pityriasis versicolor and its differential diagnosis

Este artigo tem como finalidade esclarecer o que é pitiráse versicolor e quais são os principais diagnósticos diferenciais a se pensar.

Prevalência de pitiríase alba em pacientes com dermatite atópica na infância, de acordo com o fototipo / Prevalence of pityriasis alba in patients with atopic dermatitis in childhood according to the phototype

Fundamentos: A pitiríase alba (PA) é uma dermatose de etiologia não estabelecida, autolimitada, assintomática e de bom prognóstico. Caracteriza-se por lesões hipocrômicas, sendo um achado frequente da dermatite atópica. Objetivo: Estudar a prevalência da PA em crianças com dermatite atópica, de acordo com a cor da pele, classificada por fototipos. Metódos: Foram avaliados 62 prontuários de crianças com dermatite atópica, no período de março de 2008 a outubro de 2008. Estes pacientes foram classificados de acordo com o fototipo e avaliados quanto à presença ou não de ptiríase alba. Os dados obtidos foram submetidos à análise estatística. Resultados: Não houve prevalência da PA em relação ao sexo e a média da idade foi de 6,15 anos. A maioria dos pacientes (53,2%) apresentava lesões compatíveis com PA. Quanto ao fototipo, 62,9% eram fototipo 3, seguido por fototipo 4 (22,5%). Houve maior prevalência de PA nos fototipos 4 e 5 (82%) e a análise estatística demonstrou que esses pacientes têm seis vezes mais chance de manifestarem PA do que as crianças com fototipos 2 e 3. A associação entre o fototipo e a manifestação de PA foi estatisticamente significativa (p=0,0047). Todas as crianças avaliadas tinham xerose de leve a moderada. Conclusão: A pitiríase alba guarda importante relação com o fototipo do paciente atópico, independente da gravidade do quadro ou da presença de xerose.

Clinical and histopathological characteristics of pityriasis alba.

BACKGROUND: Pityriasis alba (PA) is a skin disorder characterized by asymptomatic, variably hypopigmented, slightly scaling patches with indistinct margins. It is sometimes difficult to clinically differentiate PA from other hypopigmented disorders such as naevus depigmentosus. AIM: To examine the clinical and histopathological characteristics of PA that are important in differentiating PA from other hypopigmenting disorders. METHODS: A clinical survey was carried out on 56 patients with PA. Histopathological features were investigated with immunostains for NKI/beteb antibody, melanoma antigen recognized by T cells (MART)-1 and S-100 protein, and by haematoxylin and eosin and Fontana-Masson stains. RESULTS: Of the 56 PA patients, 10 (18%) had a previous history of atopic dermatitis and 9 (16%) had a solitary lesion. Histopathological study revealed markedly reduced pigment in the epidermis of lesional skin, but no significant difference in melanocyte count was found between lesional and normal skin. Ultrastructurally, degenerative changes in melanocytes and a reduced number of melanosomes within keratinocytes were seen. CONCLUSION: No significant difference in the number of melanocytes between lesional and normal skin was seen. These findings should be considered when diagnosing and differentiating PA from other hypopigmentary disorders.

Micoses superficiais na infância / Superficial mycoses in childhood

Os autores descrevem as principais micoses superficiais na infância. Seus fatores predisponentes, agentes etiológicos, mecanismos de transmissão e o tratamento são discutidos.

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.

Pityriasis rotunda mimicking tinea cruris/corporis and erythrasma in an Indian patient.

Pityriasis rotunda is a rare disease characterized by perfectly round to oval, sharply defined, scaly, hypo/hyperpigmented patches of variable number and size located mainly over the trunk and proximal extremities. More than 95% of the reported cases in medical literature are from three countries/ethnic populations, namely Japan, South Africa (Bantu), and Italy (Sardinian islanders). To the best of my knowledge, no patient with the characteristic clinico-pathologic features has been reported from the Indian subcontinent. I report a 44-year-old man with eighteen pityriasis rotunda patches, persistent for nearly 20 years. The lesions in the groin and axillae closely resembled erythrasma and tinea, and he had received treatment for these conditions several times in the past. Histopathology of the skin biopsy showed thinning of the epidermis with a thinned-out granular layer and a sparse lymphomononuclear infiltrate in the dermis. A review of literature suggests that there are two subsets of the disease. The type I subset is comprised of pityriasis rotunda associated with systemic illness and is seen in Black or Oriental patients with no family history of the disease. The lesions tend to subside on treatment of the underlying illness. The type II subset patients are Caucasians as well as Blacks and Orientals with no underlying systemic illness. Familial occurrence is possible; lesions tend to be persistent and unresponsive to therapy.