Prurigo pigmentosa: Clinicopathological study and analysis of 50 cases in Korea

Abstract

Prurigo pigmentosa is a recurrent dermatosis with severe pruritus and several peculiar clinical features. Its exact etiology and pathogenesis are unclear. The aim of this study was to investigate the clinical features and chronological changes in the histopathology of prurigo pigmentosa in Korean patients and to assess the etiology of this condition. We reviewed the medical records, clinical photographs and biopsy specimens from 50 patients diagnosed with prurigo pigmentosa. Mean age at diagnosis was 23.7 years (range, 15-61 years). Prurigo pigmentosa started as urticarial papules or plaques, changing first to papulovesicles and then to reticulated brownish macules. The most frequent sites were the back and chest, especially depressed areas such as the central back and inter-mammary area. Dietary change was suspected as a cause of prurigo pigmentosa in 17 patients. Histopathologically, early-stage lesions had dermatitis herpetiformis-like features; fully-developed lesions displayed impetigo-like or acute, generalized, exanthematous, pustulosis-like features; and late lesions presented with post-inflammatory hyperpigmentation-like features. Oral minocycline, with or without dapsone, was effective in inhibiting the appearance of new lesions, but did not prevent recurrence. Prurigo pigmentosa is not rare in Korea, is apparently associated with dietary modification and preferentially involves the depressed regions of the trunk.

Prurigo pigmentosa: a clinical and histopathological study of nine Chinese cases

“…10 The distribution of skin lesions was mostly symmetrical and most frequently affected the back, as well as the lumbosacral region, nape, shoulder and chest. 1,6,8 We also report for the first time a case in which the armpit was affected. 6,8,11 This disease can be divided into four chronological stages: early, fully developed, resolving and late.…”

“…This disease usually occurs in patients in their late teens and early twenties. Females were predominantly affected by this disease, 1,6 which sometimes erupts in pregnant woman. 10 The distribution of skin lesions was mostly symmetrical and most frequently affected the back, as well as the lumbosacral region, nape, shoulder and chest.…”

“…1 However, doxycycline, minocycline and dapsone have been administered to good effect. 1,2,6,8 Minocycline appears to be more effective than doxycycline and dapsone due to its rapid resolution of PP symptoms and its lower incidence of adverse side-effects. 9 Due to the non-specific histological features of PP, clinicopathological correlation and thorough long-term follow-up are necessary to establish a diagnosis.…”

“…4 However, PP is not limited to Asian populations; it has been reported to affect Europeans, including Italians and Turks. 1,2,[5][6][7] Topically or systemically administering antihistamines or corticosteroids does not aid in the treatment of PP. 1 However, doxycycline, minocycline and dapsone have been administered to good effect.…”

Early stage prurigo pigmentosa : a case report

“…Various studies discuss the relation between prurigo pigmentosa and starvation, carbohydrate-poor diets due to their high ketogenic effect, and the ketosis observed in diabetes mellitus (4,(8)(9)(10). In a series of four cases that Hijazi et al presented in 2014, they observed that one patient developed the lesions after dieting during the month of Ramadan, and two patients developed lesions after a strict diet (7).…”