Idiopathic Papular Dermatitis in the Spectrum of Chronic Papular Eruptions (Subacute Prurigo): Reappraisal and Diagnostic Algorithm

Abstract

Background: The clinical diagnosis of papular eruptions is common but poorly characterized in the literature and the etiology is often unknown. Objective: To characterize the entity of idiopathic papular dermatitis in the spectrum of chronic papular eruptions. Methods: The cohort consisted of patients who presented at a tertiary medical center in 2005–2014 with a papular eruption of at least 4 months’ duration. Findings on histological analysis and thorough clinical investigation, performed in all cases, were collected. The patients completed a questionnaire on disease course and outcome. Results: Sixty-five patients were included. Sixteen patients showed morphological changes over time and were excluded. Investigations in the remaining 49 patients with a consistent papular morphology yielded a well-defined diagnosis in 23 (46%). Twenty-six patients (54%; 14 male) were diagnosed with idiopathic papular dermatitis. Their mean age at onset was 61.6 ± 14.4 years and the mean duration of disease 3.11 ± 2.726 years. In 60%, the rash resolved with conservative treatment during follow-up (mean 4.35 ± 2.53 years). Conclusions: Chronic papular eruptions encompass a wide range of skin diseases. In more than half of the cases, the etiopathogenesis remains unclear. On the basis of our results, we propose a diagnostic algorithm for idiopathic papular dermatitis.

Prurigo Simplex or “Itchy Red Bump” Disease: Review and Case Series

“…Original descriptions of prurigo simplex underline the occurrence of an intraepidermal sero-haemorrhagic vesicle, or crust and infiltration of lymphocytes, with a few histiocytes and eosinophils in the papillary dermis ( 1 ). Histological features common to all cases described in the current study include a mixed superficial and deep perivascular infiltrate of mononuclear cells with scattered interstitial eosinophils ( 9 , 10 , 12 – 15 ). According to Gamblicher et al ( 15 ), the inflammatory cell infiltrates observed in prurigo simplex appear to be different from those found in eczematous skin changes, e.g.…”

“…Most frequently, the skin lesions presented at doctors’ visits were papules with no vesicular element, but often with excoriations, as in 26 patients reported by Ollech ( 9 ) and 28 patients reported by Uehara & Ofuji ( 10 ). Multiple flesh-coloured to erythematous non-follicular papules with superimposed excoriations or lichenification were described in 12 patients ( 11 ).…”

“…Multiple flesh-coloured to erythematous non-follicular papules with superimposed excoriations or lichenification were described in 12 patients ( 11 ). The pruritic papules were mostly confined to the neck, behind the ears, trunk, extremities or buttocks ( 9 , 11 ).…”

“…Histopathology is diagnostic in such cases. Ollech et al ( 9 ) presented a diagnostic algorithm for the evaluation of chronic pruritic papular eruption.…”

Sleep disturbances in older adults with pruritic eruptions: Implications across inconsistent literature and a commentary on “Association of sleep disturbances with geriatric age in atopic dermatitis patients”

“…Several pruritic dermatoses, including but not limited to chronic idiopathic pruritus, idiopathic papular dermatitis, and subacute prurigo, affect the elderly population and, similarly, can impair the quality of life. [2][3][4] Unfortunately, chronic pruritus in older adults is a poorly characterized clinical entity, with significant inconsistencies and terminological heterogeneity in the extant literature. Because pruritus in this population is imprecisely defined, currently, there is a state of ambiguity in the literature.…”