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.

Presentations, Signs of Activity, and Differential Diagnosis of Vitiligo.

Vitiligo has a variety of presentations, including focal, acrofacial, segmental, and generalized forms. Thorough knowledge of these presentations is important to make the correct diagnosis. Signs of activity are important to recognize so that treatment is optimized. Clinical findings of confettilike depigmentation, trichrome and inflammatory vitiligo, and the Koebner phenomenon should alert the clinician that a patient's disease is likely to worsen. These patients may require systemic treatment to stabilize their disease. Many other skin disorders present with hypopigmentation or depigmentation and must be distinguished to determine the right diagnosis, advise the patient on prognosis, and prescribe the correct treatment.

Pityriasis amiantacea: a study of seven cases.

Pityriasis amiantacea was first described in 1832. The disease may be secondary to any skin condition that primarily affects the scalp, including seborrheic dermatitis. Its pathogenesis remains uncertain. We aim to analyze the epidemiological and clinical profiles of patients with pityriasis amiantacea to better understand treatment responses. We identified seven cases of pityriasis amiantacea and a female predominance in a sample of 63 pediatric patients with seborrheic dermatitis followed for an average of 20.4 months. We reported a mean age of 5.9 years. Five patients were female, with a mean age of 9 years. All patients were successfully treated with topic ketoconazole.

Efficacy and tolerability of a cream containing AR-GG27® (sorbityl furfural palmitate) in the treatment of mild/moderate childhood atopic dermatitis associated with pityriasis alba. A double-blind, placebo-controlled clinical trial.

AIM: Pityriasis alba (PA) is a skin disorder characterized by finely scaly, hypopigmented patches, typical of childhood, that also represents an atopic dermatitis (AD) minor sign according to Hanifin and Rajka criteria. It may be isolated or associated with AD representing, sometimes an atypical manifestation of AD during the long-term follow-up of the disease. Aim of the study was to evaluate of the efficacy and tolerability of AR-GG27® (sorbityl furfural palmitate) cream in the treatment of childhood mild or moderate AD associated with PA. METHODS: The trial is a single center, double-blind, randomized, placebo-controlled study. The study included patients of both sexes, aged between two months and 15 years, suffering from mild and moderate AD always associated with PA. Xerosis was present in all patients. The treatment with topical steroids or topical calcineurin inhibitors (TIMs) had to be suspended for at least 15 days. Any systemic therapy and phototherapy or sun exposure were withdrawn at least 30 days before. Emollients were stopped at least seven days before. During the trial, no other local or systemic treatments were allowed, as well as sun exposure. Patients affected by AD with viral, bacterial or fungal overinfection or patients with diabetes mellitus, severe systemic diseases or intolerance to one or more components of the product were excluded. The primary endpoint was the evaluation of the average change in the Investigator Global Assessment (IGA) after 15 and 30 days of treatment. The second endpoint was the evaluation of severity of three different clinical signs: erythema, excoriation desquamation, using a subjective five-point scale. Changes in pruritus severity was also considered during the entire period of treatment, through the use of a Visual Analogue Scale (VAS). A P<0.05, two tailed was considered as statistically significant. RESULTS: After 15 and 30 days there was a statistically significant difference in the group treated with AR-GG27®, compared to the placebo (respectively, P=0.0007 and P=0.005). After 15 days of treatment, itching was clearly reduced in AR-GG27® treated group compared with the placebo, both in the study population (P=0.01) and in patients where the symptom was present from the beginning (P=0.05). CONCLUSION: AR-GG27® showed a beneficial action associated with high compliance and tolerability in dermatological skin conditions characterized by inflammation and tissue oxidative stress in children, as PA with mild and moderate AD.

[Etiology of acquired hypochromic patches in dermatological area in Mali]. / Etiologies Des Hypochromies Acquises En Milieu Dermatologique.

INTRODUCTION: In dark skin patients, hypopigmentation is the most disfiguring condition. Very few studies on hypochromic disorders have been conducted in specialized health centers. The present study is aimed to describe the etiologies of hypochromic patches in dermatological area, in Bamako. METHODS: We carried out a cross sectional study in the Dermatology Clinic of the "Centre National d'Appui à la lutte contre la Maladie (CNAM, Ex Institut Marchoux)". All acquired hypochromic patches (HP) were selected. HP was defined as a "skin patch lighter in pigmentation than normal surrounding skin with a diameter of at least 1 cm". The diagnosis was mainly based on clinical findings. RESULTS: The prevalence of HP was 3.42% and the main causes were seborrheic dermatitis (23.3%), pytiriasis alba (20.15%), vitiligo (18.9%), pityriasis versicolore (18.5%) and leprosy (12.6%). CONCLUSION: There are many causes of HP including leprosy, a disease though rare to date, but still prevalent in dermatological area.

Papulopustular rosacea, skin immunity and Demodex: pityriasis folliculorum as a missing link.

Papulopustular rosacea (PPR) is a common facial skin disease, characterized by erythema, telangiectasia, papules and pustules. Its physiopathology is still being discussed, but recently several molecular features of its inflammatory process have been identified: an overproduction of Toll-Like receptors 2, of a serine protease, and of abnormal forms of cathelicidin. The two factors which stimulate the Toll-like receptors to induce cathelicidin expression are skin infection and cutaneous barrier disruption: these two conditions are, at least theoretically, fulfilled by Demodex, which is present in high density in PPR and creates epithelial breaches by eating cells. So, the major pathogenic mechanisms of Demodex and its role in PPR are reviewed here in the context of these recent discoveries. In this review, the inflammatory process of PPR appears to be a consequence of the proliferation of Demodex, and strongly supports the hypothesis that: (1) in the first stage a specific (innate or acquired) immune defect against Demodex allows the proliferation of the mite; (2) in the second stage, probably when some mites penetrate into the dermis, the immune system is suddenly stimulated and gives rise to an exaggerated immune response against the Demodex, resulting in the papules and the pustules of the rosacea. In this context, it would be very interesting to study the immune molecular features of this first stage, named "pityriasis folliculorum", where the Demodex proliferate profusely with no, or a low immune reaction from the host: this entity appears to be a missing link in the understanding of rosacea.

Pityriasis amiantacea: a report of two cases in adults.

Pityriasis amiantacea is a scaly condition of the scalp that is usually seen in children. It is most often associated with an underlying primary dermatosis. We describe two adult patients who did not present with concomitant scalp or cutaneous diseases.

Pityriasis rubra pilaris and focal acantholytic dyskeratosis.

A 65-year-old man presented with a widespread erythematous maculopapular eruption. Skin biopsy showed spongiosis and focal acantholytic dyskeratosis consistent with Grover's disease. Clinically the eruption evolved to erythroderma with typical features of pityriasis rubra pilaris. On review of the histology, changes consistent with this diagnosis were also present in addition to the acantholytic dyskeratosis.

Scanning electron microscopy of scales from pityriasis amiantacea.

The scanning electron microscope has been used to examine scales taken from the scalp of 3 patients with pityriasis amiantacea alone, 3 psoriatic patients with pityriasis amiantacea and one patient with both atopic dermatitis and pityriasis amiantacea. Samples from 2 patients were additionally studied by different fixation techniques and in the frozen hydrated state, but no cementing of the scales could be observed. There was no evidence of an infective agent.

[Pityriasis rotunda]. / Pityriasis rotunda.

Pityriasis rotunda (PR) is a well-known skin disease in Japan, but it is seldom observed in Europe. Because it is often associated with an underlying, sometimes malignant disease, it is regarded by some authors as a clinical form of acquired ichthyosis. We report the case of a 20-year old male Congolese presenting with PR and ichthyosis vulgaris. This rarely described association raises the problem, discussed here, of whether PR belongs to ichthyosis vulgaris.