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We report a case of a pityriasis rosea-like eruption in a 12-year-old boy several days following BCG vaccination. It is suggested that the BCG vaccination be included in the etiology of pityriasis rosea-like eruptions.
Skin biopsy specimens from five patients with pityriasis lichenoides et varioliformis acuta and from six patients with pityriasis lichenoides chronica were studied by direct immunofluorescence and by an immunoperoxidase technique using a panel of monoclonal antibodies. The dermal inflammatory infiltrate was composed of T cells, macrophages, and a small proportion of CD1a+ cells, mostly perivascular. CD8+ cells (cytotoxic/suppressor phenotype) predominated in the epidermis according to the degree of epidermal necroses, whereas CD4+ cells (helper/inducer phenotype) were superior in number among dermal T cells. A few B cells and Leu7+ cells were detected in only a small proportion of lesions. The results obtained confirm that the two conditions are variants of a single disease process and suggest that cell-mediated immune mechanisms may be important in the pathogenesis of the epidermal and vascular damage. Endothelial cells (HLA-DR+ and HLA-DQ+) and CD1a+ cells (epidermal and possibly dermal) could be primarily involved, acting as antigen-presenting cells.
Pityriasis rosea is a frequently occurring skin disease of unknown aetiology. Ten clinical forms of this disease are known, with predominance of the macular type. We observed a healthy 24-year-old patient with the very rare vesicular variant of pityriasis rosea, which has to be differentiated from vesicular virus and drug-induced eruptions.
We report the course of benign familial pemphigus (Hailey-Hailey disease) in a 45-year-old woman. While this condition was in remission the patient started to suffer from pityriasis rosea. A biopsy of this coexisting dermatosis revealed the typical features of Hailey-Hailey disease (suprabasal acantholysis) and of pityriasis rosea within the same lesion.
13 patients with Pityriasis Lichenoides are studied clinical and histologically, showing a clinical polymorphism of the lesions, mainly in the papulous, vesiculous, and necrotic ones. The data about age, sex, evolution and response to the treatment in the present study are similar to those found by other authors. Constantly, we found, a variable degree of vasculitis. In almost all the cases there was a damage of the epithelium --exoserosis and exocytosis--, as well as presence in some cases, of red cells extravasated within the epidermis. In upper dermis we found in all biopsies, divers degrees of perivascular cell infiltration mainly composed of lymphocytes and histiocytes with predominance of the last ones, in five cases. In the majority of our cases, there was a strong relationship between the clinical and the histological aspects, but in some cases, mild lesions showed an acute microscopical picture. We are of the opinion that Pityriasis Lichenoides must be considered as a different entity from Parapsoriasis. In addition, we think that PL, is a clinical picture that manifests itself as a chronic or an acute form, and both types can be seen in the disease evolution. Finally, we could not find an evident influence and a positive response to the treatment in our patients with the classical therapeutics.
Pityriasis lichenoides et varioliformis acuta (PLEVA) is commonly thought of as a disease of young adults, yet we identified five cases, involving patients who were 3, 5, 6, 8, and 11 years of age, among 13,000 consecutive specimens submitted to a general dermatopathology laboratory during a 15-week period. The clinical and histologic features of PLEVA in our cases were similar to those reported for adults, except that no lesions were observed on the scalp or mucous membranes of children. A high index of suspicion and biopsy specimens of suspected lesions are often needed to differentiate PLEVA from other papular and crusted eruptions seen in the pediatric age group. These include reactions to arthropods, Gianotti-Crosti syndrome, varicella, and erythema multiforme. Histologically, papular eczema and pityriasis rosea may be misdiagnosed as PLEVA.
2 patients with long-standing and wide-spread pityriasis lichenoides chronica were treated with orally administered 8-methyoxypsoralen and UVA irradiation (PUVA therapy). After 15--21 PUVA treatments the patients were completely cleared. 3 and 4 weeks after the initial PUVA treatment, phase recurrences occurred in both patients. In 1 patient the lesions appeared clinically and histologically as pityriasis lichenoides et varioliformis acuta.
Unique cytolytic degeneration of keratinocytes adjacent to Langerhans cells was observed in five cases of pityriasis rosea (Gilbert). In the cytolytic area, the normal keratinocyte structures were absent except for free ribosomes. In addition, a similar cytolytic part of a keratinocyte was enveloped by the elongated dendrites of the Langerhans cell and was detected within its cytoplasm. The significance of these findings is discussed with respect to anticytoplasmic antibodies in the sera of patients with pityriasis rosea.
Nine biopsies from skin lesions of 5 patients with pityriasis lichenoides acuta and three biopsies from skin lesions of 3 patients with pityriasis lichenoides chronica were examined by means of the direct immunofluorescence technique. IgM deposits along the dermoepidermal junction were found in only two biopsies. In the majority of bioipsies, complement (C3) deposits were found along the dermo-epidermal junction and in the vessel walls. Immunoglobulin and C3 deposits were not found concomitantly in the vessel walls.
A pityriasis rosea-like eruption developed in two acne patients receiving isotretinoin and gradually resolved once the dosage was reduced. Histologically the lesions, which were characterized by psoriasiform hyperplasia, bore no resemblance to pityriasis rosea. We believe the eruptions were a side effect of isotretinoin therapy.
A patient with short-duration pityriasis rubra pilaris was successfully treated with high-dose, toxic vitamin A (retinol), but the disease subsequently recurred in new areas. Serum levels of vitamin A were highest four hours after treatment and returned to the base level within twelve hours. Fasting blood levels of vitamin A during treatment increased to five times the pretreatment level. Ultrastructural changes in the keratinocytes were notable vacuolation, granularity of the cytoplasm, and a decrease in tonofilament masses, all indications of the cellular effect of the vitamin A. We believe that patients with long-duration pityriasis rubra pilaris should be considered for this treatment.
To assess the specificity of the histopathologic features in the diagnosis of pityriasis lichenoides et varioliformis acuta (PLEVA), we reviewed the clinical manifestations and courses of 42 patients for whom this diagnosis was suggested in the pathology report. The histologic diagnosis of PLEVA was clinically substantiated in 16 of these 42 cases. Of the 26 cases in which PLEVA was erroneously diagnosed histologically, the correct clinical diagnosis was suggested before biopsies were done in 21 instances. In the five remaining cases, both the prebiopsy clinical diagnosis and the pathologic diagnosis proved to be incorrect. Pityriasis rosea, insect bites, and eczematous dermatitis accounted for the majority of the cases that histologically mimicked PLEVA. The constellation of histologic findings described in PLEVA (presence of intraepidermal lymphocytes and erythrocytes, dermal hemorrhage, and so-called lymphocytic vasculitis) is not specific and may be seen in a variety of dermatologic disorders.
Seven patients who were disabled by pityriasis rubra pilaris were given toxic doses of oral vitamin A (1 million IU/day in six of the seven patients) for five to 14 days. Within 72 hours, the patients began to exfoliate the hyperkeratotic and keratodermatous lesions. The desquamative process was completed between ten and 14 days. The skin remained erythematous for several months before assuming a normal color. The skin of six of the seven patients was virtually cleared by the treatment, and none suffered a relapse of the pityriasis rubra pilaris. Serial skin biopsy specimens showed evidence suggestive of an accelerated turnover rate of epidermal cells during treatment. Transient abnormalities of liver function test results were noted in two patients.
Pityriasis rotunda is an uncommon cutaneous disorder consisting of asymptomatic, strikingly circular, scaly lesions on the trunk and extremities, with the histologic appearance of ichthyosis vulgaris. Previous cases have been described in Japanese, South African, and West Indian persons, usually in association with an underlying serious systemic disease. A case of pityriasis rotunda in a 32-year-old black man in whom no diagnosable disorder could be demonstrated is presented.
A pityriasis rubra pilaris-like eruption has been described in patients with dermatomyositis. These patients showed generalized follicular hyperkeratosis and diffuse thickening of the palms and soles. Histopathological findings consisted of keratotic plugging of the follicular infundibulum and features of erector pili myositis. We report on an 18-year-old woman with dermatomyositis. The diagnosis was established by characteristic enzymatic alterations, electromyographic pattern of myositis and the findings in a muscle biopsy, although the patient had no evidence of muscular weakness during a follow-up of 14 years. She developed an erythematosus and squamous eruption associated with diffuse palmoplantar keratoderma. Histopathological features consisted of a papillomatous epidermis with spicules of compact eosinophilic hyperkeratosis over the tips of papillae that were not related to hair follicles. Pityriasis rubra pilaris-like eruption seems to be a characteristic although uncommon cutaneous manifestation in dermatomyositis.
A total of 410 cases of pityriasis versicolor were studied in the Division of Dermatology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, during January to December 1987. These comprised 1% of all skin disorders, while infection caused by fungus comprised 17%. Most persons infected with pityriasis versicolor were 12-21 years old (mean age 20 years) and 47% were male and 53% were female. The common sites of infection were back, arms, face and trunk. The colors of lesions found were white (83%), brown (7%), pink (6%) and ashy (4%). Both forms of M. furfur were isolated, the ovale form in 97% and the orbiculare form in 3% of cases. The colors of the lesions did not depend on the form of the organism. Mycological and immunological studies confirmed that the two forms were different stages in the complex developmental cycle of a single species.
In a randomly collected series of 175 cases of pityriasis versicolor in residents of the central-northern part of Venezuela, 13% of the patients were infected with ovoid unicellular units of the causal fungus (Malassezia ovalis) and 87% with globous unicellular units in the scales (M. furfur). Only globous unicellular units (Pityrosporum orbiculare) were seen outside the active lesions and in these, after the successful treatment with ketoconazole. The median age of 40 'ovalis' patients was 37.5 years; the same in 40 'furfur' patients was 24.5 years. The median age at the moment of discovering the first lesions among 'ovalis' patients was 31; among 'furfur' patients this was 20 years. There were 16 male patients among the 'ovalis' and 24 among the 'furfur' groups of 40. The topographic distribution of the lesions varied according to the type of the invader. M. ovalis prevailed on the trunk below the waist-line and on the limbs, mainly on buttocks and upper legs. M. furfur prevailed on the chest, neck, face and upper limbs. The hypothesis is offered that the ovoid agent of pityriasis versicolor preferentially occupies the less sweating and sebum-producing parts of the body in older (and drier) persons than the globous type does.
Malassezia furfur is lypophilic yeast commonly associate with dermatological disorders. In the present work, we described the isolation of 47 M. furfur strains from three groups of patients: pityriasis versicolor (21 isolates), seborrhoeic dermatitis (15 isolates) and seborrhoeic dermatitis of the HIV positive patients (11 isolates). To investigate the identity of the strains at molecular level, DNA genomic of M. furfur strains were prepared and used to RAPD-PCR analyses. RAPD assay were carried out using two decamer primers and bands pattern generated were analyzed by an Unweighted Pair-Group Method (UPGMA). Dendrogram established a distinct differentiation between M. furfur isolates from pityriasis versicolor and seborrhoeic dermatitis patients with or without AIDS. We concluded that RAPD typing presented a high discriminatory power between strains studied in this work and can be applied in epidemiological investigation of skin disease causing by M. furfur.