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.

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.

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.

[Not Available]. / Pitiríase rotunda: uma apresentação incomum.

Pityriasis rotunda disorder of keratinization clinically described as persistent, large, sharply defined circular patches of ichthyosiform scaling with no inflammatory changes. Patients with pityriasis rotunda may be classified into one of two groups, which are based on ethnicity, number of lesions, family history, and association with systemic diseases. A 45-year-old woman presented with asymptomatic, sharply-demarcated, round, scaly, hyperpigmented lesions on her leg that had been present for several years. Our patient did not have systemic disease or malignancy and so does not fit into groups already described.

Tissue immunostaining for factor XIIIa in dermal dendrocytes of pityriasis alba skin lesions.

BACKGROUND: Pityriasis alba affects 1% of the world population and about 9.9% of the children in Brazil. However, its etiology remains uncertain. OBJECTIVE: The objective of the present study was to evaluate the immunoexpression of factor XIIIa in dermal dendrocytes of skin lesions of pityriasis alba. METHOD: Twenty patients with pityriasis alba and 20 patients with atopic dermatitis underwent biopsy. The dermal dendrocytes marked by factor XIIIa were counted by means of immunohistochemical analysis. RESULTS: The mean amount of dermal dendrocytes found in the patients with pityriasis alba was 2, whereas in the patients with atopic dermatitis it was 4, with a statistically significant difference between them. A cutoff point of 3 cells/square inch was established to differentiate pityriasis alba from atopic dermatitis, with 80% sensibility and 90% specificity. CONCLUSION: We believe that pityriasis alba and atopic dermatitis should be considered different clinical forms within the spectrum of atopic disease, in which sun radiation plays an important role by modulating the progression of the disease.

Tissue immunostaining for factor XIIIa in dermal dendrocytes of pityriasis alba skin lesions

BACKGROUND: Pityriasis alba affects 1% of the world population and about 9.9% of the children in Brazil. However, its etiology remains uncertain. OBJECTIVE: The objective of the present study was to evaluate the immunoexpression of factor XIIIa in dermal dendrocytes of skin lesions of pityriasis alba. METHOD: Twenty patients with pityriasis alba and 20 patients with atopic dermatitis underwent biopsy. The dermal dendrocytes marked by factor XIIIa were counted by means of immunohistochemical analysis. RESULTS: The mean amount of dermal dendrocytes found in the patients with pityriasis alba was 2, whereas in the patients with atopic dermatitis it was 4, with a statistically significant difference between them. A cutoff point of 3 cells/square inch was established to differentiate pityriasis alba from atopic dermatitis, with 80% sensibility and 90% specificity. CONCLUSION: We believe that pityriasis alba and atopic dermatitis should be considered different clinical forms within the spectrum of atopic disease, in which sun radiation plays an important role by modulating the progression of the disease. .

Pityriasis amiantacea: clinical-dermatoscopic features and microscopy of hair tufts.

Pityriasis Amiantacea, also known as pseudotinea amiantacea, is a clinical syndrome which affects the scalp, having a reaction pattern reported to occur in several inflammatory dermatoses. The authors seek to establish the correlation between its clinical, dermoscopic and light microscopy features through the analysis of scale- encrusted hair tufts submitted to histological processing.

Pityriasis amiantacea: clinical-dermatoscopic features and microscopy of hair tufts / Pitiríase amiantácea: aspectos clínicos e dermatoscópicos e microscopia dos tufos capilares

Pityriasis Amiantacea, also known as pseudotinea amiantacea, is a clinical syndrome which affects the scalp, having a reaction pattern reported to occur in several inflammatory dermatoses. The authors seek to establish the correlation between its clinical, dermoscopic and light microscopy features through the analysis of scale- encrusted hair tufts submitted to histological processing.

A pitiríase amiantácea, também chamada de pseudotínea amiantácea, é compreendida como uma síndrome clínica que acomete o couro cabeludo. Representa um padrão de reação a diversas dermatoses inflamatórias. Os autores procuram estabelecer a correlação entre características clínicas, dermatoscópicas e de microscopia ótica, através da análise do tufo de cabelos agregados pelas escamocrostas, submetido a processamento histológico.

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.

Características clínico-epidemiológicas de pitiriasis alba en población de 6 a16 años en colegios nacionales del distrito de Manuel A. Mesones Muro, Lambayeque, Perú / Clinico-epidemiological fetaures of pityriasis alba in six- to sixteen- year old children in public schools in Manuel A. Mesones-Muro district Lambayeque, Perú

Objetivo: Describir las características clínico-epidemiológicas de la pitiriasis alba en la población de 6 a 16 años en los colegios nacionales del distrito de Mesones Muro, durante el periodo MarzoûJunio 2010. Material y método: Estudio descriptivo, prospectivo y transversal. Se usó una ficha de recolección de datos clínicos- epidemiológicos y una ficha de patologías asociadas y antecedentes dirigida a padres o apoderados. Se utilizó el programa Epidat v.3,1, para hallar el índice kappa que indicó la fiabilidad de concordancia entre evaluadores. Se utilizó toda la población de 6 a 16 años de colegios nacionales que pertenecen a la jurisdicción educativa del distrito. Se usó estadística descriptiva y analítica, con nivel de significancia p<0,05. Para el análisis se empleó el programa SPSS v.17,0. Resultados: De 548 estudiantes, 390(71,2%) presentaron pitiriasis alba. La edad promedio fue de 10,16±2,99 años; sexo masculino 52,6%; etapa adolescente 55,1%; localización más frecuente cara con 93,6%; lesiones múltiples en 92,3%; fototipo de piel más afectado IV con 61,8%; tiempo de enfermedad fue 5,34 ±6,85 años. Hay asociación entre pitiriasis alba con: patologías asociadas de acné; antecedentes personales de pitiriasis alba y atopía; y antecedentes familiares de pitiriasis alba y rinitis alérgica, encontrada con prueba chi2 y test exacto de Fisher con p<0,05. Conclusiones: La pitiriasis alba en Mesones Muro es un problema común. Las características epidemiológicas difieren de las encontradas en otras poblaciones, las características clínicas son similares a otras poblaciones. Se encontró asociación entre pitiriasis alba con patología asociada de acné; antecedentes personales de pitiriasis alba y atopía; mas no se encontró asociación de pitiriasis alba con sexo y edad por etapas de vida.

Objective: To describe clinical and epidemiological features of pityriasis alba in a 6- to 16- year old population of students from public schools in Mesones-Muro district, from March to June 2010. Materials and methods: This is a descriptive, prospective and crosssectional study. We collected clinical and epidemiological data, including associated diseases and clinical history in a specially designed form, which was administered to parents and/or guardians. We used the Epidat v. 3.1 software, in order to find the kappa index which indicated the reliability of agreement between raters. We surveyed the whole 6- to16- year old schoolchildren population from public schools belonging to this district educational jurisdiction. We used descriptive and analytical statistics, and significance was fixed with using a p <0.05 value. SPSSv.17.0. software was used for data analysis. Results: Out of 548 students assessed, 390 (71.2%) had pityriasis alba.Their average age was 10.16 ± 2.99 years, 52.6% were male, and 55.1% were adolescents. Facial lesions were found in 93.6%, multiple lesions in 92.3%, the skin phototype IV was most frequently affected (61.8%), and the time with the condition was 5.34 ± 6.85 years. We found an association between pityriasis alba and the following conditions: acne, a history of atopy, and a family history of pityriasis alba and allergic rhinitis, according to chi2 testing and FisherÆs exact test all with p <0.05. Conclusions: Pityriasis alba is a common problem in Mesones-Muro district. Its epidemiological characteristics differ from those found in other populations, but its clinical features are similar to those reported in other populations. There was an association between pityriasis alba with associated conditions, such as acne and a history of atopy, but there was no association between pityriasis alba and sex and life development stages.

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.

Estudo epidemiológico da pitiríase versicolor na cidade de João Pessoa, PB, de 1999 a 2008 / Epidemiological studies of pityriasis versicolor in the city of João Pessoa,PB, from 1999 to 2008

A Pitiríase versicolor(PV) é uma micose superficial causada por leveduras do gênero Malassezia. Caracteriza­-se por manchas de tonalidades diversas, arredondadas, que podem formar placas, com descamação furfurácea. 0 diagnóstico de PV é clínico, associado ao exame micológico direto e cultura. Buscou-se avaliar a epidemiologia da PV na cidade de João Pessoa, PB, correlacionando sexo, faixa etária, raça, localizações das lesões e exame direto e cultura. 0 estudo exploratório e descritivo foi realizado no Laboratório de Micologia do Departamento de Ciências Farmacêuticas/CCS da Universidade Federal da Paraíba de 1999 a 2008. Em 196 pacientes com suspeita clínica de PV, houve predomínio no gênero feminino (62,24%). A faixa etária de 21 a 30 anos de idade foi a mais acometida. Houve registro de 53,57% pardos, 46,42% brancos, sem registro de negros. A região anatômica mais envolvida foi o trance (71,36%). 0 exame direto e cultura foram realizados para confirmar o diagnóstico. A PV ocorre em todas as idades, em especial adolescentes e adultos, sendo o gênero feminino e indivfduos da cor parda os rnais afetados.

Pityriasis versicolor (PV) is a superficial mycosis caused by yeasts of the genus Malassezia. It is characterized by round patches of various shades, which can form plaques with desquamation furfuracea. The diagnosis of PV is clinical and it is associated with the direct mycological examination and culture. The exploratory and descriptive study was conducted at the Laboratory of Mycology, Department of Pharmaceutical Sciences /CCS,Universidade Federal da Paraiba from 1999 to 2008. In 196 patients with clinical suspicion of PV, there was a predominance in females (62.24%). The age group 21 to 30 years of age was the most affected. There was record of 53.57% brown, 46.42% white, with no record of blacks. The most involved anatomical region was the trunk (71.36%). The direct examination and culture were performed to confirm the diagnosis. The PV occurs in all ages, especially adolescents and adults, being the females of brown color the most affected individuals.

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.

Superficial fungal infections: clinical and epidemiological study in adolescents from marginal districts of Lima and Callao, Peru.

BACKGROUND: Since limited data on superficial fungal infections in teenagers exist in our setting, this study provides the first description of the clinical and epidemiological characteristics of these infections among teenagers in Lima and Callao, Peru. METHODOLOGY: The study involved 1,387 adolescents in five public schools from June to November 2006. Participants were examined for superficial fungal lesions. Samples of skin scrapings for microbiological investigations were obtained from suspicious lesions. RESULTS: A total of 257 subjects were identified with suspected superficial fungal infections. Microbiological assessment was positive for 166 of 257 (64.59%). The average prevalence was 12.61% with variation between different districts. Males were more affected (64%) than females (36%) (p = 0.001). Pet ownership, use of public baths, and wearing sneakers were identified as important risk factors. The majority (61.5%) of the subjects presented with itching although 38.5% were asymptomatic. Tinea pedis was observed in 62.6%, onychomycosis in 24% and pityriasis versicolor in 10.8%. Dermatophytes were isolated in 105 cases with T. rubrum being identified in 86 cases (59.7%), T. mentagrophytes in 14 (9.7%) and yeast in 39 (23.4%). Malassezia spp. was found by direct examination in 18 cases (12.5%), C. kruseii in 8 cases (5.6%), and C. albicans in 2 cases (1.4%). Mixed infections were found in 22 cases. CONCLUSIONS: Superficial fungal infection manifesting as tinea pedis, onychomycosysis and tinea versicolor is prevalent in our setting. As many infections remain asymptomatic, regular examination of this population is advocated. The associated risk factors for these infections also need to be addressed.

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.

Hypomelanotic conditions of the newborn and infant.

Depigmented nevi, pityriasis alba, and postinflammatory hypopigmentation are the most frequent hypomelanotic conditions in newborns and infants. These, and examples of less frequent hypopigmentations are briefly discussed in this article. A new classification for depigmented nevi is also proposed.