A case report and differential diagnosis of pruritic pretibial skin lesions

Abstract

Pretibial pruritic papular dermatitis (PPPD) is a clinical entity first described in 2006. The etiology is uncertain; however, gentle chronic rubbing is likely to be the reason for the skin reaction. Pretibial pruritic lesions may reflect many different systemic diseases and dermatoses. We present a 61-year-old patient with a 2-year history of pruritic pretibial xerosis, keratotic erythematous to brownish papules, and excoriations. Differential diagnosis excluded papular mucinosis, myxoedema, stasis dermatitis, lichen simplex chronicus, prurigo nodularis, lichen amyloidosis, and lichen planus. Regarding clinical-histological correlation, we confirmed a diagnosis of PPPD.

Pretibial Pruritic Papular Dermatitis: A Case Report and Emphasis on Effective Treatment with Pentoxifylline

“…Chronic scratching or rubbing of the skin leads to variable cutaneous disorders. 2 PPPD is a recently recognized entity as a distinctive response to persistent gentle rubbing of pretibial skin. 1 After the first introduction by Annessi et al in 2006, 1 4 cases of PPPD were subsequently reported in the literature.…”

“… 1 After the first introduction by Annessi et al in 2006, 1 4 cases of PPPD were subsequently reported in the literature. 2–4 The condition commonly presents as multiple, intensely pruritic, discrete, smooth-surface, flesh-colored to erythematous papules that may subsequently coalesce into plaques and result in a cobblestone appearance. 1 , 2 , 4 , 5 However, in 2019, Flores et al broadened the clinical and histological spectrum of PPPD in 38 patients, demonstrating its epidermal changes.…”

“…Histological hallmarks of PPPD are the presence of superficial perivascular and interstitial lymphohistiocytic infiltration, epidermal changes of spongiosis and parakeratosis, and numerous stellate and multinucleated fibroblasts in the dermis. 1 , 2 , 6 The histological features that indicate persistent rubbing, consisting of uneven psoriasiform epidermal hyperplasia, marked compact orthokeratosis, hypergranulosis, and coarse bundles of collagen arranged in vertical streaks, are absent in PPPD, 1 , 2 , 6 and the lack of amyloid deposits in the dermis distinguishes PPPD from LA. 1 , 13 Despite unique PPPD histopathology, its pathogenesis has yet to be fully understood.…”

“…Although the pathogenesis of PPPD has not been well elucidated, the disease was hypothesized to be one of the skin reactions secondary to persistent gentle rubbing, supported by its dermoscopic and histopathological findings. 1 , 2 To date, little attention has been paid to this disease, and there remains limited evidence on its prevalence, dermoscopic features, and effective treatment. Herein, we report a case of a 60-year-old woman with PPPD on bilateral shins who was successfully treated with topical corticosteroids and additional oral pentoxifylline.…”

Lichen Amyloidosis in an Atopic Patient Treated with Dupilumab: A New Therapeutic Option

“…It is in differential diagnosis with: keratosis pilare (KP), prurigo nodularis (PN) [8], xanthomas, perforating dermatoses (collagenoses), lichen planus, mycosis fungoides [2], papular mucinosis, myxedema, stasis dermatitis [9], lichen simplex chronicus (LSC) and pretibial pruritic papular dermatitis [6].…”