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

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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: Theillness 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. 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: Theillness 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. 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
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