Case 17.1 a 23-Year-Old Thai Female from Bangkok. Chief Complaint: Pruritic Erythematous Rash on Trunk for 2 Weeks. Present Illn

Case 17.1 Case 17.1 A 23-year-oldA 23 Thai-year female-old Thai from female Bangkok from. Bangkok. Chief complaintChief :complaint Pruritic erythematous: Pruritic erythematous rash on trunk rash for on 2 weekstrunk for. 2 weeks.

Case 17.2 Case 17.2 A 21-year-oldA 21 Thai-year female-old Thai from female Rayong from province Rayong province Chief complaintChief : complaint Recurrent: Recurrentintensely pruriticintensely erythematous pruritic erythematous Present illnessPresent: The illness patient: The developed patient developedpruritic edematous pruritic edematouspapules on papulestrunk for on 3 years.trunk for 3 years. erythematouserythematous reticulated plaquesreticulated on plaquesher back, on chest her back,and pubic chest area and pubic area for 2 weeksfor. The 2 weeks lesions. The resolved lesions in resolvedsmall area in smallleaving area a net leaving-like a net-like hyperpigmentation.Thehyperpigmentation.The patient had patient been treatedhad been as treatedeczema aswith eczema with oral anti-histamineoral anti with-histamine little improvement. with little improvement. Past historyPast history She has no Sheunderlying has no diseaseunderlying. disease. Family historyFamily history None of herNone family of member her family had member history hadof similar history skin of similarlesion. skin lesion. Skin examinationSkin examination Multiple discreteMultiple erythematous discrete erythematous, edematous,, edematous, reticulated papulesreticulated and papules Presentand illnessPresent: The illness patient: The developed patient recurrentdeveloped severely recurrent pruritic severely pruritic plaques on plaqueschest, back on chest,and pubic back area. and pubicThe lesions area. Thehealed lesions in some healed in someerythematous erythematous papules on papulesher back, on chest,her back, abdomen chest, forabdomen 3 years. for 3 years. area and leavingarea and the leavingbackground the background of reticulated of hyperpigmentationreticulated hyperpigmentation Most of lesionsMost ofresolved lesions spontaneously resolved spontaneously and leaving and reticulated leaving reticulated HistopatholHistopathology (S13-495Aogy ,( S13abdomen)-495A, abdomen) hyperpigmentation.hyperpigmentation. The lesions The were lesions precipitated were precipitated by seafood bydiet. seafood diet. There are moundThere areof parakeratosis,mound of parakeratosis, and epidermal and hyperplasiaepidermal hyperplasiain The in patientThe had patient been treatedhad been as treatedeczema asand eczema post-inflammatory and post-inflammatory association associationwith superficial with superficialand deep andperivascular deep perivascular and focal and focalhyperpigmentation hyperpigmentation with oral antiwith-histamine, oral anti -histamine,topical and topical system andic systemic lichenoid infiltrationlichenoid withinfiltration lymphocytes, with lymphocytes, melanophages melanophages admixed with admixed withcorticosteroid corticosteroid with some improvementwith some improvement but the lesions but stillthe lesionsrecur. still recur. some neutrophils.some neutrophils.

102 Interhospital Dermatology Conference 2013 Case 17.1 Case 17.1 A 23-year-oldA 23 Thai-year female-old Thai from female Bangkok from. Bangkok. Chief complaintChief :complaint Pruritic erythematous: Pruritic erythematous rash on trunk rash for on 2 weekstrunk for. 2 weeks.

Interhospital Dermatology Conference 2013 103 Past historyPast history DiscussionDiscussion She has noShe underlying has no underlyingdisease and disease does notand takedoes any not oraltake and any oral and Prurigo pigmentosaPrurigo pigmentosa (PP) is a (PP)recurrent is a inflammatoryrecurrent inflammatory topical medicationtopical medicationprior to the prioreruption to the of eruptionskin lesions. of skin lesions. dermatosis dermatosispresent with present severe with pruritus. severe It pruritus.was first It described was first indescribed in Family historyFamily history 1971 by a 1971Japanese by a dermatologistJapanese dermatologist, Masaji Nagash, Masajiima ,Nagash and mostima, and most None of herNone family of member her family had member history hadof similar history skin of similarlesion. skin lesion. patients diagnosedpatients asdiagnosed PP have asbeen PP reportedhave been in reportedJapan to indate. Japan to date. Skin examinationSkin examination PP usually presentsPP usually in presentslate teen in to late early teen twenties to early and twenties most and most Multiple reticulatedMultiple reticulatedbrownish patchesbrownish with patches some withlesions some shows lesions showsoften appearsoften in appearsspring and in springsummer and. The summer clinical. Thefeatures clinical include features include erythematouserythematous papules on papulesback, chest, on back, abdomen. chest, abdomen. symmetricalsymmetrical and intensely and pruritic intensely erythematous pruritic erythematous urticarial papules urticarial papules HistopathologyHistopathology (S13-14778A (S13, back)-14778A , back) in early lesions,in early with lesions, fully developed with fully lesionsdeveloped turn lesions to erythematous turn to erythematous There is superficialThere is superficialperivascular perivascular and lichenoid and inflammatorylichenoid inflammatory-cell papules,-cell papulovesiclespapules, papulovesicles and may confluent and may into confluent reticulated into plaquesreticulated plaques infiltration infiltof lymphocytesration of lymphocytes admixed with admixed some withmelanophages some melanophages in with in a preferentiallywith a preferentially on trunk, onback, trunk, chest, back, neck, chest, shoulder, neck, shoulder, association associationwith epidermal with epidermalhyperplasia hyperplasiaand scattered and necroticscattered necroticlumbosacral lumbosacral and abdomen and1. abdomenThe individual1. The lesioindividualns rapidly lesio changens rapidly change keratinocytes.keratinocytes. within dayswithin and can days subside and can spontaneously subside spontaneously within 1 week within leaving 1 week leaving reticulated hyperpigmentedreticulated hyperpigmented macules and macules patches. and Pruritus patches. is severePruritus is severe in early lesionin early but resolvinglesion but lesion resolving tended lesion to betended lesser. to However,be lesser. However, bullous PP isbullous rarely PPreported is rarely2-4. reported2-4. Histo pathologicHisto pathologicfindings are findings quite arevary quiteat the vary different at the different stages. In earlystages. stage, In early there stage, is superficial there is perivascularsuperficial perivascular infiltration ofinfiltration of neutrophils neutrophilsfollowed by followedscattering by of scattering neutrophils of neutrophilsin papillary indermis. papillary dermis. The neutrophilsThe neutrophilscan pass quickly can pass through quickly the through epidermis the resu epidermislting in resu lting in spongiosis, spongiosis,necrolytic keratinocytesnecrolytic keratinocytes and ballooning. and ballooning.While in fully While in fully developed lesions,developed lymphocytes lesions, lymphocytes and eosinophils and eosinophilspredominated predominated over over neutrophils neutrophilsappear both appear in dermis both whichin dermis lead whichto patchy lead lichenoidto patchy lichenoid pattern. Epidermispattern. finally Epidermis turn finallyto hyperplastic turn to hyperplastic and hyperpigmented. and hyperpigmented. There are melanophagesThere are melanophages in papillary indermis papillary resulting dermis in resulting residual in residual

hyperpigmentationhyperpigmentation in final instage final of stagedisease. of However,disease. However, Diagnosis:Diagnosis: Prurigo pigmentosa Prurigo pigmentosa histopathologichistopathologic finding in PPfinding is stillin PPvary is andstill nonvary-specific. and non The-specific. The Treatment:Treatment:DoxycyclineDoxycycline 100 mg twice 100 per mg day twice per day diagnosis ofdiagnosis PP requires of PP clinicopathological requires clinicopathological correlation correlbasedation on based on Fexofenadine Fexofenadine 60 mg twice 60 per mg day twice per day typical featurestypical of featuresPP. of PP.

The exact causesThe exact of PPcauses and ofits PPpathogenesis and its pathogenesis are unclear. are unclear. Presenter:Presen Sirima ter:Sawatwarakul, Sirima Sawatwarakul, M.D. M.D. However, severalHowever, factors several have factors been havesuggested been suggestedinclude ketosis include5 ketosis5 Consultant:Consultant: Punyapat Sirithanabadeekul, Punyapat Sirithanabadeekul, M.D. M.D. causing fromcausing diet, fastingfrom diet, (anorexia fasting nervosa)(anorexia6, nervosa)diabetes 6mellitus, diabetes4 mellitus4

and soft-drinkand ketosis soft-drink7, pregn ketosisancy7,8 ,pregn menstruation,ancy8, menstruation, atopic diathesis atopic9, diathesis9,

104 Interhospital Dermatology Conference 2013 Past historyPast history DiscussionDiscussion She has noShe underlying has no underlyingdisease and disease does notand takedoes any not oraltake and any oral and Prurigo pigmentosaPrurigo pigmentosa (PP) is a (PP)recurrent is a inflammatoryrecurrent inflammatory topical medicationtopical medicationprior to the prioreruption to the of eruptionskin lesions. of skin lesions. dermatosis dermatosispresent with present severe with pruritus. severe It pruritus.was first It described was first indescribed in Family historyFamily history 1971 by a 1971Japanese by a dermatologistJapanese dermatologist, Masaji Nagash, Masajiima ,Nagash and mostima, and most None of herNone family of member her family had member history hadof similar history skin of similarlesion. skin lesion. patients diagnosedpatients asdiagnosed PP have asbeen PP reportedhave been in reportedJapan to indate. Japan to date. Skin examinationSkin examination PP usually presentsPP usually in presentslate teen in to late early teen twenties to early and twenties most and most Multiple reticulatedMultiple reticulatedbrownish patchesbrownish with patches some withlesions some shows lesions showsoften appearsoften in appearsspring and in springsummer and. The summer clinical. Thefeatures clinical include features include erythematouserythematous papules on papulesback, chest, on back, abdomen. chest, abdomen. symmetricalsymmetrical and intensely and pruritic intensely erythematous pruritic erythematous urticarial papules urticarial papules HistopathologyHistopathology (S13-14778A (S13, back)-14778A , back) in early lesions,in early with lesions, fully developed with fully lesionsdeveloped turn lesions to erythematous turn to erythematous There is superficialThere is superficialperivascular perivascular and lichenoid and inflammatorylichenoid inflammatory-cell papules,-cell papulovesiclespapules, papulovesicles and may confluent and may into confluent reticulated into plaquesreticulated plaques infiltration infiltof lymphocytesration of lymphocytes admixed with admixed some withmelanophages some melanophages in with in a preferentiallywith a preferentially on trunk, onback, trunk, chest, back, neck, chest, shoulder, neck, shoulder, association associationwith epidermal with epidermalhyperplasia hyperplasiaand scattered and necroticscattered necroticlumbosacral lumbosacral and abdomen and1. abdomenThe individual1. The lesioindividualns rapidly lesio changens rapidly change keratinocytes.keratinocytes. within dayswithin and can days subside and can spontaneously subside spontaneously within 1 week within leaving 1 week leaving reticulated hyperpigmentedreticulated hyperpigmented macules and macules patches. and Pruritus patches. is severePruritus is severe in early lesionin early but resolvinglesion but lesion resolving tended lesion to betended lesser. to However,be lesser. However, bullous PP isbullous rarely PPreported is rarely2-4. reported2-4. Histo pathologicHisto pathologicfindings are findings quite arevary quiteat the vary different at the different stages. In earlystages. stage, In early there stage, is superficial there is perivascularsuperficial perivascular infiltration ofinfiltration of neutrophils neutrophilsfollowed by followedscattering by of scattering neutrophils of neutrophilsin papillary indermis. papillary dermis. The neutrophilsThe neutrophilscan pass quickly can pass through quickly the through epidermis the resu epidermislting in resu lting in spongiosis, spongiosis,necrolytic keratinocytesnecrolytic keratinocytes and ballooning. and ballooning.While in fully While in fully developed lesions,developed lymphocytes lesions, lymphocytes and eosinophils and eosinophilspredominated predominated over over neutrophils neutrophilsappear both appear in dermis both whichin dermis lead whichto patchy lead lichenoidto patchy lichenoid pattern. Epidermispattern. finally Epidermis turn finallyto hyperplastic turn to hyperplastic and hyperpigmented. and hyperpigmented. There are melanophagesThere are melanophages in papillary indermis papillary resulting dermis in resulting residual in residual hyperpigmentationhyperpigmentation in final instage final of stagedisease. of However,disease. However, Diagnosis:Diagnosis: Prurigo pigmentosa Prurigo pigmentosa histopathologichistopathologic finding in PPfinding is stillin PPvary is andstill nonvary-specific. and non The-specific. The Treatment:Treatment:DoxycyclineDoxycycline 100 mg twice 100 per mg day twice per day diagnosis ofdiagnosis PP requires of PP clinicopathological requires clinicopathological correlation correlbasedation on based on Fexofenadine Fexofenadine 60 mg twice 60 per mg day twice per day typical featurestypical of featuresPP. of PP.

Interhospital Dermatology Conference 2013 105 sweating, frictionsweating, from friction clothing, from Helicobacter clothing, Helicobacter pylori infection, pylori andinfection, Referencesand References chemical allergenschemical such allergens as para such-amino as paracompounds,-amino compounds, trichlorophenol, trichlorophenol, 1. Kim JK, 1.Chung Kim WK, JK, ChangChung SE,WK, KoChang JY, LeeSE, JH,Ko JYWon, Lee CH JH,et al.Won Prurigo CH et al. Prurigo nickel10 andnickel chrome10 and11. Somechrome authors11. Some suggested authors thatsuggested autoimmune that autoimmune pigmentosa: clinicopathologicalpigmentosa: clinicopathological study and analysis study andof 50 analysis cases inof Korea.50 cases J in Korea. J Dermatol 2012;39:891Dermatol- 7.2012;39:891 -7. also play alsorole playin P P.role However, in PP. recentHowever, studies recent reported studies thereported the 2. De Francesco2. DeV, QuinkensteinFrancesco V, E,Quinkenstein Mariuzzi L, E,Frattasio Mariuzzi A, L, Pillon Frattasio B , Patrone A, Pillon P. B , Patrone P. relationshiprelationship between PP between and diet PPmodification and diet modification with recurrence with ofrecurrence PP of PPBullous prurigoBullous pigmentosa. prurigo Eur pigmentosa. J Dermatol Eur 200 J 6;16:184Dermatol- 6.200 6;16:184-6. after restartingafter dietary restarting modification. dietary modification. 3. Kim SK, 3.Kang Kim HY SK,, LeeKang ES. HY Bullous , Lee prurigoES. Bullous pigmentosa. prurigo Intpigmentosa. J Dermatol Int J Dermatol PP should PPbe shoulddifferentiated be differentiated from dermatitis from herpetiformis,dermatitis herpetiformis, 2007;46:888 -90.2007;46:888 -90. linear IgA bullouslinear IgA dermatosis, bullous dermatosis, acute lupus acute erythe lupusmatosus erythe in matosusearly in early4. Kubota Y,4. Koga Kubota T , Nakayama Y, Koga TJ. , BullousNakayama prurigo J. Bullous pigmentosa prurigo and pigmentosa diabetes. andEur diabetes. Eur J Dermatol 1998;8:439J Dermatol-41. 1998;8:439 -41. disease. Whiledisease. late lesionsWhile lateshould lesions be differentiatedshould be differentiated from confluent from confluent 5. Teraki Y, 5.Teraki Teraki E, Y,Kawashima Teraki E, M, Kawashima Nagashima M, M Nagashima , Shiohara MT ., KetosisShiohara is T. Ketosis is and reticulatedand reticulatedpapillomatosis papillomatosis of Gougerot of Gougerotand Carteaud, and Carteaud,involved in involvedthe origin in ofthe prurigo origin pigmentosa.of prurigo pigmentosa.J Am Acad J DermatolAm Acad Dermatol dyschromicumdyschromicum perstans, and perstans, pigmented and contactpigmented dermatitis. contact dermatitis. 1996;34:509-11.1996;34:509 -11. For the treatment,For the treatment,various agents various were agents reported were forreported 6.for Nakada T,6. SuekiNakada H , T,Iijima Sueki M. HPrurigo , Iijima pigmentosa M. Prurigo (Nagashima) pigmentosa (Nagashima)associated associated with anorexia withnervosa. anorexia Clin Expnervosa. Dermatol Clin Exp1998;23:25 Dermatol-7. 1998;23:25 -7. treatment oftrea PP.tment The ofmost PP. effectiveThe most are effective oral antibiotics are oral suchantibiotics as such7. asMitsuhashi 7. Y, MitsuhashiSuzuki N, Y,Kawaguchi Suzuki N, M Kawaguchi, Kondo S. M Prurigo , Kondo pigmentosa S. Prurigo on pigmentosa a on a 9, 12 9, 12 13 13 minocyclineminocycline, doxycycline, doxycycline, sulfamethoxazole,, sulfamethoxazole, dapsone, dapsone,patient with softpatient-drink with ketosis. soft- drinkJ Dermatol ketosis. 2005;32:767 J Dermatol- 8.2005;32:767 -8. 14 14 15 15 macrolides macrolides and oral retinoid and oral, chemicalretinoid ,peeling chemical combined peeling withcombined with8. Leone L, 8.Colato Leone C , GirolomoniL, Colato C G., GirolomoniPrurigo pigmentosa G. Prurigo in pigmentosa a pregnant inwoman. a pregnant woman. light emittinglight diode(LED) emitting 16diode(LED) have been16 havereported been as reported an effective as an effectiveInt J GynaecolInt and J Gynaecolobstet 2007;98:261 and obstet- 2.2007;98:261 -2. treatment treatmefor PP.nt While for PP.topical While corticosteroids, topical corticosteroids, oral steroids, oral steroids,9. Cota C, Donati9. Cota P , C,Amantea Donati A.P ,Prurigo Amantea pigmento A. Prurigosa associated pigmento sawith associated an atopic with an atopic diathesis in a 13diathesis-year-old in agirl. 13 -Pediatryear-old dermatol girl. Pediatr 2007;24:277 dermatol- 9.2007;24:277 -9. antihistamineantihistamine are ineffective are inineffective treating PP.in treating PP. 10. Atasoy M,10. Timur Atasoy H, M,Arslan Timur R, H,Ozdemir Arslan S,R, GursanOzdemir N S,, ErdemGursan T.N Prurigo, Erdem T. Prurigo Recurrence Recurrenceof lesions ofusually lesions developed usually atdeveloped the same at sites the same sitespigmentosa inpigmentosa a patient with in a nickel patient sensitivity. with nickel J Eursensitivity. Acad Dermatol J Eur Acad Venereol Dermatol Venereol of primaryof lesionsprimary within lesions 3- 9within years. 3 -Both9 years. minocycline Both minocycline and and2009;23:228 -30.2009;23:228 -30. doxycycline doxycyclinecannot prevent cannot the prevent recurrence the ofrecur PP1rence. of PP1. 11. Kim MH, 11.Choi Kim YW, MH, Choi Choi HY YW,, Myung Choi KB.HY ,Prurigo Myung pigmentosaKB. Prurigo from pigmentosa contact from contact allergy to chromeallergy in detergent.to chrome Contactin detergent. dermatitis Contact 2001;44:289 dermatitis- 92.2001;44:289 -92. In our patients,In our we patients, presented we 2presented cases of 2 PPcases who ofhave PP who have 12. Chiam LY,12. Goh Chiam BK, Lim LY, KS Goh , NgBK, SK. Lim Prurigo KS , Ng pigmentosa: SK. Prurigo a pigmentosa: report of two a casesreport of two cases classic characteristicclassic characteristic of PP. The of firstPP. caseThe firstdemonstrated case demonstrated early earlythat respondedthat to minocycline.responded to Clin minocycline. Exp Derm Clinatol Exp2009;34:e584 Dermatol 2009;34:e584-6. -6. disease whodisease was treatedwho was with treated doxycyline with doxycylinesince early sincestage early of stage13. of Mok YJ, 13.Lim MokKS , YJ,Tey Lim HL. KS Doxycycline , Tey HL.-- anDoxycycline emerging-- antherapy emerging for prurigotherapy for prurigo disease. Afterdisease. 6-month After follow6-month-up infollow this- upcase in hasthis showncase has that shown thatpigmentosa. J pigmentosa.Eur Acad Dermatol J Eur Acad Venereol Dermatol 2012;26:526 Venereol- 7.2012;26:526 -7. patients developedpatients developedminimal hyperpigmentation.minimal hyperpigmentation. This finding This finding14. Yazawa N,14. Ihn Yazawa H, Yamane N, Ihn K, H, Etoh Yamane T , Tamaki K, Etoh K. TThe , Tamaki successful K. The treatment successful of treatment of prurigo pigmentosaprurigo with pigmentosa macrolide with antibiotics. macrolide Dermatology antibiotics. 2001;202:67Dermatology- 9.2001;202:67 -9. suggests thatsuggests early treatmentthat early maytreatment have maybenefit have by benefitceasing bythe ceasing the 15. Akoglu G,15. Boztepe Akoglu G G,, Karaduman Boztepe G A., Karaduman Prurigo pigmentosa A. Prurigo successfully pigmentosa treated successfully treated inflammatoryinflammatory process resultingprocess inresulting reduce insequela reduce ofsequela post- of post-with low-dose withisotretinoin. low-dose Dermatology isotretinoin. 2006;213:331Dermatology 2006;213:331-3. -3. inflammatoryinflammatory hyperpigmentation. hyperpigmentation. 16. Choi JR, 16.Kim ChoiJK, WonJR, KimCH, JK,Lee WonMW, CH,Oh LeeES , MW,Chang Oh S. ES Prurigo , Chang pigmentosa S. Prurigo pigmentosa treated with treatedJessner's with peel Jess andner's irradiation peel and with irradiation an 830 -withnm lightan -830emitting-nm light-emitting diode. J Dermatoldiode. 2012;39:493 J Dermatol- 6.2012;39:493 -6.

106 Interhospital Dermatology Conference 2013 sweating, frictionsweating, from friction clothing, from Helicobacter clothing, Helicobacter pylori infection, pylori andinfection, Referencesand References chemical allergenschemical such allergens as para such-amino as paracompounds,-amino compounds, trichlorophenol, trichlorophenol, 1. Kim JK, 1.Chung Kim WK, JK, ChangChung SE,WK, KoChang JY, LeeSE, JH,Ko JYWon, Lee CH JH,et al.Won Prurigo CH et al. Prurigo nickel10 andnickel chrome10 and11. Somechrome authors11. Some suggested authors thatsuggested autoimmune that autoimmune pigmentosa: clinicopathologicalpigmentosa: clinicopathological study and analysis study andof 50 analysis cases inof Korea.50 cases J in Korea. J Dermatol 2012;39:891Dermatol- 7.2012;39:891 -7. also play alsorole playin P P.role However, in PP. recentHowever, studies recent reported studies thereported the 2. De Francesco2. DeV, QuinkensteinFrancesco V, E,Quinkenstein Mariuzzi L, E,Frattasio Mariuzzi A, L, Pillon Frattasio B , Patrone A, Pillon P. B , Patrone P. relationshiprelationship between PP between and diet PPmodification and diet modification with recurrence with ofrecurrence PP of PPBullous prurigoBullous pigmentosa. prurigo Eur pigmentosa. J Dermatol Eur 200 J 6;16:184Dermatol- 6.200 6;16:184-6. after restartingafter dietary restarting modification. dietary modification. 3. Kim SK, 3.Kang Kim HY SK,, LeeKang ES. HY Bullous , Lee prurigoES. Bullous pigmentosa. prurigo Intpigmentosa. J Dermatol Int J Dermatol PP should PPbe shoulddifferentiated be differentiated from dermatitis from herpetiformis,dermatitis herpetiformis, 2007;46:888 -90.2007;46:888 -90. linear IgA bullouslinear IgA dermatosis, bullous dermatosis, acute lupus acute erythe lupusmatosus erythe in matosusearly in early4. Kubota Y,4. Koga Kubota T , Nakayama Y, Koga TJ. , BullousNakayama prurigo J. Bullous pigmentosa prurigo and pigmentosa diabetes. andEur diabetes. Eur J Dermatol 1998;8:439J Dermatol-41. 1998;8:439 -41. disease. Whiledisease. late lesionsWhile lateshould lesions be differentiatedshould be differentiated from confluent from confluent 5. Teraki Y, 5.Teraki Teraki E, Y,Kawashima Teraki E, M, Kawashima Nagashima M, M Nagashima , Shiohara MT ., KetosisShiohara is T. Ketosis is and reticulatedand reticulatedpapillomatosis papillomatosis of Gougerot of Gougerotand Carteaud, and Carteaud,involved in involvedthe origin in ofthe prurigo origin pigmentosa.of prurigo pigmentosa.J Am Acad J DermatolAm Acad Dermatol dyschromicumdyschromicum perstans, and perstans, pigmented and contactpigmented dermatitis. contact dermatitis. 1996;34:509-11.1996;34:509 -11. For the treatment,For the treatment,various agents various were agents reported were forreported 6.for Nakada T,6. SuekiNakada H , T,Iijima Sueki M. HPrurigo , Iijima pigmentosa M. Prurigo (Nagashima) pigmentosa (Nagashima)associated associated with anorexia withnervosa. anorexia Clin Expnervosa. Dermatol Clin Exp1998;23:25 Dermatol-7. 1998;23:25 -7. treatment oftrea PP.tment The ofmost PP. effectiveThe most are effective oral antibiotics are oral suchantibiotics as such7. asMitsuhashi 7. Y, MitsuhashiSuzuki N, Y,Kawaguchi Suzuki N, M Kawaguchi, Kondo S. M Prurigo , Kondo pigmentosa S. Prurigo on pigmentosa a on a 9, 12 9, 12 13 13 minocyclineminocycline, doxycycline, doxycycline, sulfamethoxazole,, sulfamethoxazole, dapsone, dapsone,patient with softpatient-drink with ketosis. soft- drinkJ Dermatol ketosis. 2005;32:767 J Dermatol- 8.2005;32:767 -8. 14 14 15 15 macrolides macrolides and oral retinoid and oral, chemicalretinoid ,peeling chemical combined peeling withcombined with8. Leone L, 8.Colato Leone C , GirolomoniL, Colato C G., GirolomoniPrurigo pigmentosa G. Prurigo in pigmentosa a pregnant inwoman. a pregnant woman. light emittinglight diode(LED) emitting 16diode(LED) have been16 havereported been as reported an effective as an effectiveInt J GynaecolInt and J Gynaecolobstet 2007;98:261 and obstet- 2.2007;98:261 -2. treatment treatmefor PP.nt While for PP.topical While corticosteroids, topical corticosteroids, oral steroids, oral steroids,9. Cota C, Donati9. Cota P , C,Amantea Donati A.P ,Prurigo Amantea pigmento A. Prurigosa associated pigmento sawith associated an atopic with an atopic diathesis in a 13diathesis-year-old in agirl. 13 -Pediatryear-old dermatol girl. Pediatr 2007;24:277 dermatol- 9.2007;24:277 -9. antihistamineantihistamine are ineffective are inineffective treating PP.in treating PP. 10. Atasoy M,10. Timur Atasoy H, M,Arslan Timur R, H,Ozdemir Arslan S,R, GursanOzdemir N S,, ErdemGursan T.N Prurigo, Erdem T. Prurigo Recurrence Recurrenceof lesions ofusually lesions developed usually atdeveloped the same at sites the same sitespigmentosa inpigmentosa a patient with in a nickel patient sensitivity. with nickel J Eursensitivity. Acad Dermatol J Eur Acad Venereol Dermatol Venereol of primaryof lesionsprimary within lesions 3- 9within years. 3 -Both9 years. minocycline Both minocycline and and2009;23:228 -30.2009;23:228 -30. doxycycline doxycyclinecannot prevent cannot the prevent recurrence the ofrecur PP1rence. of PP1. 11. Kim MH, 11.Choi Kim YW, MH, Choi Choi HY YW,, Myung Choi KB.HY ,Prurigo Myung pigmentosaKB. Prurigo from pigmentosa contact from contact allergy to chromeallergy in detergent.to chrome Contactin detergent. dermatitis Contact 2001;44:289 dermatitis- 92.2001;44:289 -92. In our patients,In our we patients, presented we 2presented cases of 2 PPcases who ofhave PP who have 12. Chiam LY,12. Goh Chiam BK, Lim LY, KS Goh , NgBK, SK. Lim Prurigo KS , Ng pigmentosa: SK. Prurigo a pigmentosa: report of two a casesreport of two cases classic characteristicclassic characteristic of PP. The of firstPP. caseThe firstdemonstrated case demonstrated early earlythat respondedthat to minocycline.responded to Clin minocycline. Exp Derm Clinatol Exp2009;34:e584 Dermatol 2009;34:e584-6. -6. disease whodisease was treatedwho was with treated doxycyline with doxycylinesince early sincestage early of stage13. of Mok YJ, 13.Lim MokKS , YJ,Tey Lim HL. KS Doxycycline , Tey HL.-- anDoxycycline emerging-- antherapy emerging for prurigotherapy for prurigo disease. Afterdisease. 6-month After follow6-month-up infollow this- upcase in hasthis showncase has that shown thatpigmentosa. J pigmentosa.Eur Acad Dermatol J Eur Acad Venereol Dermatol 2012;26:526 Venereol- 7.2012;26:526 -7. patients developedpatients developedminimal hyperpigmentation.minimal hyperpigmentation. This finding This finding14. Yazawa N,14. Ihn Yazawa H, Yamane N, Ihn K, H, Etoh Yamane T , Tamaki K, Etoh K. TThe , Tamaki successful K. The treatment successful of treatment of prurigo pigmentosaprurigo with pigmentosa macrolide with antibiotics. macrolide Dermatology antibiotics. 2001;202:67Dermatology- 9.2001;202:67 -9. suggests thatsuggests early treatmentthat early maytreatment have maybenefit have by benefitceasing bythe ceasing the 15. Akoglu G,15. Boztepe Akoglu G G,, Karaduman Boztepe G A., Karaduman Prurigo pigmentosa A. Prurigo successfully pigmentosa treated successfully treated inflammatoryinflammatory process resultingprocess inresulting reduce insequela reduce ofsequela post- of post-with low-dose withisotretinoin. low-dose Dermatology isotretinoin. 2006;213:331Dermatology 2006;213:331-3. -3. inflammatoryinflammatory hyperpigmentation. hyperpigmentation. 16. Choi JR, 16.Kim ChoiJK, WonJR, KimCH, JK,Lee WonMW, CH,Oh LeeES , MW,Chang Oh S. ES Prurigo , Chang pigmentosa S. Prurigo pigmentosa treated with treatedJessner's with peel Jess andner's irradiation peel and with irradiation an 830 -withnm lightan -830emitting-nm light-emitting diode. J Dermatoldiode. 2012;39:493 J Dermatol- 6.2012;39:493 -6.

Interhospital Dermatology Conference 2013 107