Acute lichenoid and varioliform pityriasis in a pediatric patient / Vasculitis linfocítica en pitiriasis liquenoide y varioliforme aguda de un paciente pediátrico

Abstract Background: Pityriasis lichenoides et varioliformis acuta (PLEVA) is a rare dermatosis recognized as a benign condition of unknown etiopathogenesis. It is more common in pediatric patients and young adults and is characterized by multiple small or large erythematous plaques spread over the trunk and extremities. Case report: We describe the case of a 5-year-old male, previously healthy, with multiple erythematous lesions that disappeared leaving hypopigmented macules. The biopsy reported histological changes suggestive of mycosis fungoides. After a second revision of lamellae in this hospital, lymphocytic vasculitis (LV) with focal epidermal necrosis consistent with acute pityriasis lichenoides (PL) was identified. Conclusions: The existing knowledge about PLEVA lacks a consensus in specifying its classification, etiopathogenesis, diagnosis, and treatment, so this clinical condition represents a medical challenge. The diagnosis is made by clinical suspicion and confirmed by histology. The objective of this article was to report a case of PLEVA with an atypical presentation due to its histopathological findings, being the first report showing LV in children, as well as a review of the literature.

Resumen Introducción: La pitiriasis liquenoide y varioliforme aguda (PLEVA) es una dermatosis poco frecuente, de etiopatogenia desconocida y evolución autolimitada. Es más común en pacientes pediátricos y adultos jóvenes, y está caracterizada por la presencia de múltiples placas eritematoescamosas pequeñas o grandes, diseminadas en el tronco y las extremidades. Caso clínico: Se describe el caso de un escolar de 5 años, de sexo masculino, previamente sano, que presentó múltiples cuadros de lesiones eritematosas que desaparecían dejando máculas hipopigmentadas. La biopsia reportó cambios histológicos sugestivos de micosis fungoide. Se realizó una segunda revisión de laminillas, identificando vasculitis linfocítica con necrosis epidérmica focal, consistente con pitiriasis liquenoide aguda. Conclusiones: El conocimiento acerca de la PLEVA carece de un consenso que especifique su clasificación, etiopatogenia, diagnóstico y tratamiento, por lo que esta condición clínica representa un desafío médico. El diagnóstico se realiza por sospecha clínica y se confirma por histología. El objetivo de este artículo fue reportar un caso de PLEVA con presentación atípica por los hallazgos histopatológicos, siendo este el primer reporte de vasculitis linfocítica en niños, y además se realiza una revisión de la literatura.

Pitiriasis liquenoide varioliforme aguda posterior al inicio de eritropoyetina / Acute varioliform lichenoid pityriasis following the initiation of erythropoietin

Resumen La pitiriasis liquenoide varioliforme aguda (PLEVA) pertenece a un grupo de enfermedades categorizadas como pitiriasis liquenoides, junto con la enfermedad febril úlcero-necrótica de Mucha-Habermann y la pitiriasis liquenoide crónica (PLC). Se caracteriza por la aparición aguda de múltiples pápulas eritemato-violáceas con posterior necrosis, discromía residual y cicatrices varioliformes. Dentro de las teorías patogénicas propuestas se encuentra el posible papel de agentes infecciosos, trastornos linfoproliferativos, complejos inmunes e incluso, asociación a medicamentos. Se presenta un casode una mujer adulta con un cuadro típico de PLEVA con confirmación histopatológica, cuyas lesiones aparecieron posteriormente al inicio de eritropoyetina.

Abstract Pityriasis lichenoides et varioliformes acuta (PLEVA) is part of a group of diseases clustered as pityriasis lichenoides, next to febrile ulceronecrotic Mucha-Habermann disease and pityriasis lichenoides chronica. It's characterized by a sudden onset of multiple erythematous and violaceous papules which develop necrosis, leaving residual dyschromia and varioliform scars. It's been hypothesized the possible role of infectious agents, lymphoproliferative diseases, immune complexes and drugs. We present the case of a woman with a typical PLEVA with histopathological confirmation, whose lesions appeared after therapy with erythropoietin.

Pitiríase liquenoide pós-vacinação contra COVID-19: um relato de caso / Pityriasis lichenoides after COVID-19 vaccination: a case report

O artigo aborda o primeiro relato de caso que associa o desenvolvimento de pitiríase liquenoide com a vacinação contra a COVID-19. Em uma revisão literária foram encontrados escassos estudos que associam a pitiríase liquenoide como reação a outras vacinas. O mecanismo de desenvolvimento da doença ainda não é bem conhecido. Sabe-se apenas que se trata de uma reação inflamatória imunomediada. O diagnóstico da pitiríase liquenoide é clínico e é considerado um desafio, devido ao grande número de diagnósticos diferenciais e das diferentes formas de apresentação da doença. Desse modo, a maioria dos casos exige amparo na biópsia e em exames laboratoriais. As opções terapêuticas podem incluir o uso de antibióticos e imunossupressores. Destaca-se ainda a efetividade da fototerapia como tratamento de escolha da pitiríase liquenoide, podendo proporcionar uma resolução quase que completa das lesões e não causar efeitos sistêmicos que outras terapias poderiam trazer.

This study addresses the first case report of pityriasis lichenoides development after COVID-19 vaccination. A literature review found few studies describing pityriasis lichenoides as an adverse reaction to other vaccines. Although it is an immune-mediated inflammatory response, the development mechanism of this disease remains not well known. The diagnosis of pityriasis lichenoides is clinical and is considered a challenge due to the considerable number of differential diagnoses and the different forms of presentation of the disease. Thus, most cases require confirmation by biopsy and laboratory tests. Therapeutic options may include the use of antibiotics and immunosuppressants. The effectiveness of phototherapy is also highlighted as the treatment of choice for pityriasis lichenoides, as it can promote an almost complete resolution of lesions without causing systemic effects, unlike other therapies.

A Case Study Over Pityriasis Rubra Pilaris Through Ayurvedic Management

Skin disorder are common manifestation in present era and more so frequent in elder age. The patient of skin disease is more prone to experience physical, emotional and socio-economic embarrassment in the society due to disfigured appearance. Normally 10-15% of the general practitioners encounter with skin disorder in there day to day practice. Vaipadeeka and Charma kustha is a type of Kshudra kustha occurring mainly due to the imbalance of Vata and Kapha doshas resembling the Pityriasis Rubra Pilaris in its clinical manifestation. Pityriasis rubra pilaris is rare chronic disorder that causes hyper keratotic yellowing of the skin including trunk, extremities and particularly palm and sole. The palm and sole become thickened smooth and yellow fissure are common. Systemic corticosteroid, oral retinoid, immunosuppressive such as cyclosporine are the mainstay of treatment of Pityriasis rubra pilaris. The modern treatment modalities are not devoid from grave complication mainly in long term use. Owning these reasons, there is need for treatment having good efficacy and no toxic profile. So this case study was conducted considered ptyriasis rubra pilaris as Charma kustha and Vaipadeeka. Ayurvedic management was planned accordingly. Good result was witness by Virechan and shaman.

Pitiriasis rosada como manifestación dermatológica de infección por SARS-CoV-2: a propósito de un caso / Pityriasis rosea as a cutaneous manifestation associated with SARS-CoV-2 infection: case report

Las manifestaciones cutáneas relacionadas a la infección por el coronavirus SARS-CoV-2, causante de COVID-19, se han descrito entre el 0,2% y 20,4% de las personas que cursan con esta enfermedad. Las más frecuentemente descritas son: lesiones maculopapulares (47%), lesiones acrales eritematosas con vesículas o pústulas (pseudoperniosis) (19%), urticariales (19%), lesiones vesiculosas (9%) y livedo/necrosis (6%). En particular, la pitiriasis rosada es una dermatosis autolimitada de etiología desconocida, sin embargo, se ha visto asociada a la infección por SARS-CoV-2, con algunos reportes de casos en la literatura. El mecanismo fisiopatológico de las lesiones cutáneas en COVID-19 no es claro, y se han planteado algunas teorías, entre las cuales está el papel que juega la enzima convertidora de angiotensina 2 (ACE2) utilizada por el virus para infectar las células, los infiltrados linfocíticos, los depósitos de factores del complemento en la piel, y la reactivación de virus latentes como los herpes virus humanos. Se presenta el caso de una paciente con pitiriasis rosada asociada a COVID-19 y se describen los casos reportados hasta la fecha

Pityriasis rosea-like rash after COVID-19 vaccination with Oxford-AstraZeneca: a possible trigger?

Scholars around the world have dedicated themselves to developing an effective vaccine against SARS-CoV-2. However, vaccines have produced adverse effects in some patients. We report the case of a 44-year-old man who developed a pruritic papulosquamous rash on the trunk with a characteristic pattern known as Christmas tree after receiving the first dose of the Oxford-AstraZeneca COVID-19 vaccine, similar to pityriasis rosea (PR). He had no previous symptoms of viral infection and tested negative for neutralizing antibodies (enzyme immunoassay) against COVID-19. There are few reports in the literature about the relationship between the onset of cutaneous adverse reactions and the Oxford-AstraZeneca vaccine, therefore, the dissemination of this case is of paramount importance.

Atypical pityriasis rosea in a young colombian woman. case report

ABSTRACT Introduction: Pityriasis rosea is an acute and self-limited exanthem first described by Gilbert in 1860. Its treatment is symptomatic, and although there is no conclusive evidence, it has been associated with the reactivation of the human herpesviruses 6 and 7 (HHV-6 and HHV-7). Case presentation: A 28-year-old woman, from Bogotá, Colombia, a health worker, attended the emergency room due to the onset of symptoms that began 20 days earlier with the appearance of punctiform lesions in the left arm that later spread to the thorax, abdomen, opposite arm, and thighs. The patient reported a history of bipolar II disorder and retinal detachment. After ruling out several infectious diseases, and due to the evolution of the symptoms, pityriasis rosea was suspected. Therefore, treatment was started with deflazacort 30mg for 21 days, obtaining a favorable outcome and improvement of symptoms after 2 months. At the time of writing this case report, the patient had not consulted for recurrence. Conclusion: Primary care physicians should have sufficient training in dermatology to recognize and treat dermatological diseases since many of them are diagnosed based on clinical findings. This is an atypical case, in which the patient did not present with some of the pathognomonic signs associated with pityriasis rosea.

RESUMEN Introducción. La pitiriasis rosada es un exantema agudo y autolimitado que fue descrito formalmente por Gilbert en 1860. Su tratamiento es sintomático y, aunque faltan pruebas concluyentes, su aparición se ha asociado a la reactivación de los herpevirus humanos 7 y 6 (HHV6 y HHV7). Presentación del caso. Mujer de 28 años procedente de Bogotá, Colombia, quien se desempeñaba como trabajadora de la salud y consultó al servicio de urgencias por un cuadro clínico de 20 días de evolución que inició con la aparición de lesiones punteadas en el brazo izquierdo que se expandieron posteriormente a tórax, abdomen, brazo contralateral y muslos. La paciente informó antecedente de trastorno bipolar tipo II y desprendimiento de retina. Después de descartar varias enfermedades infecciosas, y debido a la evolución del cuadro clínico, se sospechó pitiriasis rosada, por lo que se instauró tratamiento con 30mg de deflazacort por 21 días, con el cual se logró una evolución favorable y la mejoría total de los síntomas a los 2 meses. Hasta el momento de la elaboración del presente reporte de caso la joven no había consultado por recurrencia. Conclusión. Es indispensable que los médicos de atención primaria tengan una educación adecuada en dermatología para poder reconocer y tratar la pitiriasis rosada, pues su diagnóstico es eminentemente clínico y puede tener múltiples presentaciones atípicas, como en el caso aquí reportado donde la paciente no tuvo algunos de los signos patognomónicos característicos.

A Resposta da pitiríase liquenoide varioliforme aguda à fototerapia ­ um relato de caso / The response of acute pityriasis lichenoid varioliformis to phototherapy ­ a case report

A pitiríase liquenóide e varioliforme aguda (PLEVA), é classificada dentro do grupo de dermatoses crônicas, idiopáticas, chamado de "parapsoríases". Caracteriza-se por erupção aguda ou subaguda de múltiplas e pequenas pápulas eritematosas, que podem evoluir com vesiculação e necrose hemorrágica central. A fototerapia possui altos níveis de eficácia e tolerabilidade em uma variedade de doenças inflamatórias e neoplásicas da pele caracterizadas por infiltrados epiteliais e dérmicos rico em linfócitos T . Este artigo relata o caso de uma mulher de meia idade com apresentação clínica típica e diagnóstico histopatológico de PLEVA. Por se tratar de doença que nem sempre responde a tratamentos sistêmicos, o objetivo da proposta terapêutica com fototerapia visou suprimir a doença por seu efeito anti-inflamatório e imunossupressor e prevenir a evolução para o linfoma cutâneo de células T.

Pityriasis lichenoid et varioliformis acute (PLEVA) is classified within the group of chronic, idiopathic dermatoses called "parapsoriasis". It is characterized by an acute or subacute eruption of multiple small erythematous papules, which may progress to vesiculation and central hemorrhagic necrosis. Phototherapy has high levels of efficacy and tolerability in a variety of inflammatory and neoplastic skin diseases characterized by epithelial and dermal infiltrates rich in T lymphocytes. This article reports the case of a middle-aged woman with typical clinical presentation and histopathological diagnosis of PLEVA. As it is a disease that does not always respond to systemic treatments, the objective of the therapeutic proposal with phototherapy was to suppress the disease due to its anti-inflammatory and immunosuppressive effect and prevent the evolution to cutaneous T-cell lymphoma.

Pityriasis rubra pilaris post-infection due COVID-19: case report / Pitiriasis rubra pilaris post-infección por COVID-19: reporte de un caso

Abstract Case description: 32-month-old boy, IgG positive for SARS-CoV-2, presented to the emergency department with dermatologic lesions. Clinical findings: Four days before admission, he presented skin eruptions with redness and pruritus on hands and feet. Generalized papular erythema was evidenced, upper extremities with diffuse erythematosquamous plaques, palmoplantar keratoderma, so he was evaluated by a dermatologist who diagnosed pityriasis rubra pilaris. Treatment and outcome: rehydrating cream, cetirizine 0.5 mg/kg/day every two days, and prednisolone 2 mg/kg/day in the morning. He was discharged after 14 days, the patient presented clinical improvement, but the erythematous lesion persisted on the trunk and extremities. In the evaluation, after three months, the patient did not show the described lesions, evidencing an improvement and clinical resolution of the dermatological problems. Clinical relevance: We report a patient with pityriasis rubra piloris associated with a post-infection by SARS-CoV-2 that had not been described before.

Resumen Descripción del caso: Niño 32 meses de vida, con IgG positivo para SARS-CoV-2, acude al servicio de emergencia por presentar lesiones dermatológicas. Hallazgos clínicos: Cuatro días antes del ingreso presentó erupciones en la piel, con enrojecimiento y prurito en manos y pies. Se evidenció eritema papular generalizado, extremidades superiores con placas eritematoescamosas difusas, queratodermia palmo-plantar por lo que es evaluado por dermatólogo quien diagnostica pitiriasis rubra pilaris. Tratamiento y resultado: Crema rehidratantes, cetirizina 0.5 mg/kg/día cada 2 días y prednisolona 2 mg/kg/día por la mañana. Fue dado de alta a los 14 días, el paciente presenta mejora clínica, pero aún persiste la lesión eritematosa en tronco y extremidades. En la evaluación a los tres meses el paciente no mostró las lesiones descritas, evidenciando una mejoría y resolución clínica de los problemas dermatológicos. Relevancia clínica: Se reporta un paciente con afectación por pitiriasis rubra piloris asociado a una post-infección por SARS-CoV-2 que no se había descrito antes.

Características clínico-epidemiológicas de los pacientes con pitiriasis versicolor en un centro de referencia de Colombia / Clinical-epidemiological characteristics of patients with tinea versicolor in a Colombian reference center

Resumen Objetivo: describir las características socio-demográficas, presentación clínica y condiciones extrínsecas que pueden favorecer el desarrollo de la pitiriasis versicolor. Material y métodos: estudio observacional descriptivo, de corte transversal y prospectivo, en el que se incluyeron pacientes con diagnóstico clínico y micológico de pitiriasis versicolor entre enero y diciembre de 2018, que asistieron al Hospital Universitario Centro Dermatológico Federico Lleras Acosta. Resultados: se incluyeron un total de 42 pacientes con diagnóstico de pitiriasis versicolor confirmado por examen directo, el 62% fueron hombres con una edad promedio de 33 años. La localización más común fue el tórax anterior (68%) y posterior (65%), en fototipos III y IV (78.5%), con una tonalidad hipocrómica. El 28% presentaron cuadros recurrentes, con síntomas hasta 7 años antes de la consulta. El signo de Besnier fue positivo en el 95% de los casos. El 64% refirió antecedente personal de hiperhidrosis y el 67% practicaba algún deporte como buceo, natación o gimnasia. Discusión: la identificación de las condiciones extrínsecas presentes esta población permite orientar medidas de prevención para evitar recurrencias de pitiriasis versicolor. Los viajes a lugares de clima cálido y la práctica de deportes son factores que favorecen el desarrollo de la micosis. En las formas clínicas atípicas se sugiere realizar siempre el examen micológico directo para confirmar el diagnóstico. El signo de Besnier es una maniobra útil para el diagnóstico clínico de la pitiriasis versicolor, particularmente cuando el acceso al examen directo es limitado.

Abstract Objective: to describe the sociodemographic aspects, clinical presentation and extrinsic conditions that may increase the risk of developing pityriasis versicolor. Materials and methods: a descriptive, cross-sectional and prospective observational study was conducted. Patients with clinical and mycological diagnosis of ptyriasis versicolor were included from january to december 2018 who attended to the Hospital Universitario Centro Dermatológico Federico Lleras Acosta. Results: a total of 42 patients were included in the study, all of them had confirmed mycological diagnosis of pityriasis versicolor. The most common location of the lesions was the anterior thorax (68%) and posterior thorax (65%), in III and IV phototypes (78.5%) with a hypochromic color. 28% had recurrent infection, with symptoms mean of 7 years before the consultation. The Besnier sign was positive in 95% of cases, 64% reported personal history of hyperhidrosis and 67% practiced some sports: diving, swimming and gymnastics. Discussion: recognizing extrinsic conditions that may increase the risk of developing pitiraisis versicolor in this population allows identifying control measures to prevent a relapse. The main factors involved in the development of pitiraisis versicolor were traveling to places with high temperatures and sport practice. In atypical clinical presentation it is mandatory to perform the mycological direct test to confirm the diagnosis. The Besnier sign is a useful method for the clinical diagnosis of pityriasis versicolor, particularly when access to direct examination is limited.

Pityriasis versicolor, aspects épidémio-cliniques, facteurs associés et qualité de vie à Parakou (Bénin) en 2020

Le pityriasis versicolor (PV) est une pathologie cutanée fréquemment rencontrée en consultation dermatologique, surtout dans les pays à climat tropical. Une étude épidémio-clinique, s'intéressant aussi aux comorbidités associées et au retentissement de la maladie a été réalisée. Elle a concerné 118 patients venus consulter dans le service de Dermatologie-Vénérologie au Centre Hospitalier Universitaire Départemental Borgou-Alibori, Bénin. La population la plus touchée était les sujets jeunes avec une fréquence plus élevée chez les 20-30 ans (38,98%). L'âge moyen était de 27,03 ans avec une sex ratio à 1,40. Les antécédents familiaux de pityriasis versicolor ont été retrouvés chez 10 patients soit 8,47%. Comme facteurs favorisants, 57,62% utilisaient les laits corporels dépigmentants. La forme classique (20,37%) était majoritairement représentée. L'acné a été notée chez 19 patients (16,10%). La sérologie VIH était revenue positive chez 4 patients (5,55%) et le diabète a été diagnostiqué chez 3 patients (7,5%). Une altération de la qualité de vie des sujets (35,59%) a été retrouvée.

Pityriasis versicolor (PV) is a cutaneous pathology frequently encountered in dermatological consultations, especially in countries with a tropical climate. An epidemio-clinical study, also questioning the associated comorbidities and the repercussions of the disease, was carried out on 118 patients who came to the Dermatology-Venerology Department at the Borgou-Alibori Departmental University Hospital, Benin. The most affected population was young subjects with a higher frequency in the 20-30 years old (38.98%). The mean age was 27.03 years with a sex ratio of 1.40. Family history was found in 10 patients (8.47%). As contributing factors, 57.62% used depigmenting body milks. The classic form (20.37%) was predominantly represented. Acne was noted in 19 patients (16.10%). HIV serology was positive in 4 patients (5.55%) and diabetes was dignosed in 3 patients (7.5%). A slight alteration in the quality of life of the subjects (35.59%) was found.

Pitiriasis rubra pilaris en niños:informe de 2 casos / Pityriasis Rubra Pilaris in children: 2 case reports

RESUMEN Antecedentes: La pitiriasis rubra pilaris es una enfermedad infrecuente pápulo-escamosa crónica en la que existe un trastorno de la queratinización de la epidermis, caracterizada por pápulas foliculares hiperqueratósicas con tendencia a formar placas de coloración asalmonada, descamativas, con islas de piel sana asociadas a queratodermia palmo plantar. Presenta una distribución bimodal en la primera y sexta década de la vida, afectando a ambos sexos por igual. Su etiopatogenia es desconocida, se ha postulado una respuesta inmune anormal ante diferentes estímulos antigénicos, así como alteración del metabolismo de la vitamina A. Se ha clasificado en 6 tipos en base a su presentación, edad de inicio, curso y pronóstico, tratándose en forma tópica o sistémica. Casos clínicos: Se presentan dos casos en pacientes de 10 y 2 años de edad, con manifestaciones clínicas correspondientes al tipo juvenil circunscrito, que es el más frecuente en edad pediátrica y juvenil clásico respectivamente, con histopatología compatible y excelente respuesta al tratamiento tópico. Conclusiones: Aunque la pitiriasis rubra pilaris es una patología rara, deberá ser sospechada si el cuadro clínico es sugestivo, y si es compatible su histopatología. Debe considerarse que el tratamientotópico puede ser suficiente para lograr la resolución del cuadro.

ABSTRACT Background: Pityriasis rubra pilaris is an infrequent chronic papulosquamous disease in which there is a disorder of keratinization of the epidermis, characterized by hyperkeratotic follicular papules with a tendency to form salmon-colored, scaly plaques, with islands of healthy skin associated with palmoplantar keratoderma. It presents a bimodal distribution in the first and sixth decades of life, affecting both sexes equally. Its etiopathogenesis is unknown, an abnormal immune response has been postulated to different antigenic stimuli, as well as alteration of the metabolism of vitamin A. It has been classified into 6 types based on its presentation, age of onset, course and prognosis, being treated appropriately topical or systemic. Clinical cases: Two cases of 10 and 2 years of age are presented, with clinical manifestations corresponding to the circumscribed juvenile type, which is the most frequent in pediatric and classic juvenile age respectively, with compatible histopathology and excellent response to topical treatment. Conclusions: Although pityriasis rubra pilaris is a rare pathology, it should be suspected if the clinical picture is suggestive and its histopathology is compatible. It should be considered that topical treatment may be sufficient to achieve resolution of the condition.

Acantholytic pityriasis rubra pilaris associated with topical use of imiquimod 5%: case report and literature review

Abstract Topical use of immune response modifiers, such as imiquimod, has increased in dermatology. Although its topical use is well tolerated, it may be associated with exacerbations of generalized cutaneous inflammatory diseases, possibly through the systemic circulation of pro-inflammatory cytokines. This report describes a case of development of pityriasis rubra pilaris, a rare erythematous-papulosquamous dermatosis, in a woman aged 60 years during treatment with imiquimod 5% cream for actinic keratosis. It evolved with erythrodermic conditions and palmoplantar keratoderma, presenting progressive clinical resolution after the introduction of methotrexate. The authors emphasize the importance of recognizing possible systemic reactions associated with the topical use of imiquimod.

Senna alata (akapulko) extract versus topical antifungals for treatment of superficial fungal skin infections: A systematic review and meta-analysis

@#<p style="text-align: justify;"><b>OBJECTIVE:</b> The study aimed to assess the efficacy and safety of Senna alata (akapulko) plant extracts compared with topical antifungals in the treatment of superficial fungal skin infections.</p><p style="text-align: justify;"><br /><b>METHODS:</b> A systematic review and meta-analysis of randomized controlled trials that studied patients with diagnosed cutaneous tinea or dermatophytosis (excluding hair and nail), tinea versicolor, or cutaneous candidiasis, via microscopy or culture, and compared the efficacy and safety of S. alata (akapulko) extract versus topical antifungals. Two authors independently screened titles and abstracts of merged search results from electronic databases (The Cochrane Skin Group Specialized Register, CENTRAL, MEDLINE, EMBASE (January 1990 to December 2011), Health Research and Development Information Network (HERDIN), and reference lists of articles), assessed eligibility, assessed the risk of bias using the domains in the Cochrane Risk Bias tool and collected data using a pretested Data extraction form (DEF). Meta-analyses were performed when feasible.</p><p style="text-align: justify;"><br /><b>RESULTS:</b> We included seven RCTs in the review. There is low certainty of evidence that S. alata 50% lotion is as efficacious as sodium thiosulfate 25% lotion (RR 0.91, 95% CI, 0.79 to 1.04; 4 RCTs, n=216; p=0.15; I2=52%) and high quality evidence that S. alata cream is as efficacious as ketoconazole (RR 0.95, 95% CI, 0.82 to 1.09; 1 RCT, n=40; p=0.44) and terbinafine cream (RR 0.93, 95% CI, 0.86 to 1.01; 1 RCT, n=150; p=0.09) in mycologic cure. For adverse effects, there is very low certainty of evidence of increased harm with S. alata 50% lotion compared to sodium thiosulfate 25% lotion (RR 1.26, 95% CI, 0.46, 3.44; 2 RCTs, n=120; p=0.65; I2=19%). Adverse effects were few and mild.</p><p style="text-align: justify;"><br /><b>CONCLUSION:</b> S. Alata 50% lotion may be as efficacious as sodium thiosulfate 25% lotion and is as efficacious as ketoconazole 2% and terbinafine 1% creams. There is insufficient evidence to compare the safety of S. alata 50% lotion with sodium thiosulfate 25% lotion.</p>

Especies de Malassezia causantes de pitiriasis versicolor en Paraguay / Malassezia species causative of pityriasis versicolor in Paraguay

Resumen Introducción: La pitiriasis versicolor es una patología frecuente en Paraguay; sin embargo, su epidemiologia es desconocida. Objetivo: Determinar la frecuencia de especies de Malassezia causantes de pitiriasis versicolor y las características epidemiológicas de la población. Materiales y Métodos: Se recolectaron muestras de pacientes con diagnóstico presuntivo de pitiriasis versicolor. El diagnóstico de laboratorio se realizó mediante examen en fresco y cultivo en agar Dixon modificado y agar cromogénico Chromagar Malassezia®, incubados a 32°C; y la identificación por las características macro y micromorfológicas, pruebas bioquímicas y fisiológicas. Resultados: Se incluyeron 102 pacientes (51% femenino), de 1 mes a 63 años de edad, predominando el grupo de 11 a 20 años (35,3%). La localización más frecuente fue el dorso (60,8%). Predominaron las formas hipocrómicas (48%). La especie más frecuente fue M. globosa (52,9%), seguida de M. furfur (24,5%), M. sympodialis (18,6%) y M. slooffiae (6,9%). Conclusiones: La epidemiología observada es similar a otros estudios sudamericanos, no hace distinción de sexo, se presenta predominantemente en la forma clínica hipocrómica y M. globosa aparece como principal responsable. Este es el primer reporte sobre las especies causantes de pitiriasis versicolor en Paraguay y las características de la población con esta patología.

Background: Pityriasis versicolor is a frequent pathology in Paraguay; however, its epidemiology is unknown. Aim: To determine the frequency of Malassezia species causing pityriasis versicolor and the epidemiological characteristics of the population. Methods: Samples from patients with a presumptive diagnosis of pityriasis versicolor were collected. Laboratory diagnosis was carried out by fresh examination and culture in modified Dixon agar and chromogenic Chromagar Malassezia®, incubated at 32° C, and identification by macro and micromorphological features, biochemical and physiological tests. Results: 102 patients were included (51% female) from 1 month to 63 years of age, the predominant age group was 11-20 years (35.3%). The most frequent location was on the back (60.8%). Hipocromic clinical forms (48%) predominated. The most frequent species was M. globosa (52.9%), followed by M. furfur (24.5%), M. sympodialis (18.6%) and M. slooffiae (6.9%). Conclusions: The observed epidemiology is similar to other South American studies, with no sex distinction, predominantly hypochromic clinical form and as primary responsible species appears M. globosa. This is the first report on species causing pityriasis versicolor in Paraguay and the characteristics of the affected population.

Dermatitis atópica: Pitiriasis alba. A propósito de un caso / Atopic Dermatitis: Pityriasis Alba. A clinical case

RESUMEN La Pitiriasis alba es una enfermedad cutánea inespecífica de etiología desconocida, caracterizada por máculas hipocrómicas, redondeadas u ovaladas poco delimitadas y cubiertas con escamas finas que ocurren usualmente en la región facial de los niños. Fue descrita por Gilbert en 1860 y Fox en 1923, pero fue O'Farrell en 1956 quien propuso el nombre de Pitiriasis alba. La condición dermatológica con la que suele asociarse es la dermatitis atópica. La presencia de Pitiriasis alba fue definida como uno de los criterios menores para el diagnóstico de Dermatitis atópica, según Hanifin y Rajka en 1980. Sin embargo, también se presenta en 20-40% de los niños atópicos, sin evidencia de Dermatitis atópica, así como en individuos no atópicos. La disfunción de la barrera epitelial causada por mutaciones del gen de la filagrina, proteína estructural epidérmica, que forma parte del factor humectante natural, se considera un factor de riesgo emergente para la Dermatitis atópica severa de comienzo precoz. Se presenta un caso de Pitiriasis albaen el que fue necesaria terapia combinada tópica y vía oral, con evolución satisfactoria en 8 semanas de tratamiento.

SUMMARY Pityriasis Alba is a non-specific skin disease of unknown etiology characterized by hypochromic macules, rounded or oval, poorly defined and covered with fine scales that usually occur in the facial region of children. It was described by Gilbert in 1860 and Fox in 1923, but it was O'Farrell in 1956 who proposed the name Pityriasis alba. The dermatological condition with which it is usually associated is Atopic dermatitis. The presence of Pityriasis alba was defined as one of the minor criteria for the diagnosis of Atopic dermatitis, according to Hanifin and Rajka in 1980. However, it also occurs in 20-40% of atopic children, without evidence of Atopic dermatitis, as well as in non-atopic individuals. Epithelial barrier dysfunction caused by mutations of the filaggrin gene, epidermal structural protein, which is part of the natural humectant factor, is considered an emerging risk factor for severe early onset Atopic dermatitis. We present a case of Pityriasis alba where combined topical and systemic therapy was necessary with satisfactory evolution in 8 weeks of treatment.

A case of febrile ulceronecrotic Mucha-Habermann disease with comorbidities

Febrile ulceronecrotic Mucha-Habermann disease is a very rare and severe variant of pityriasis lichenoides et varioliformis acuta. Adult cases are difficult to diagnose as in the early course they can mimic erythema multiforme or lymphomatoid papulosis. We report a case of a 38-year-old woman who presented with 90% body surface area involvement, fever, diarrhea, malaise and associated comorbidities. She was treated with systemic steroids and methotrexate but suffered a fatal outcome. So far, a total of 65 cases are reported in the literature.

A Study on Demographic Profile and Risk Factor Association in Pityriasis Versicolor Cases Attending at a Tertiary Care Hospital in Kolkata

Pityriasis versicolor (PV), also known as tinea versicolor, is a chronic, mild, superficial and recurrent infection of the stratum corneum, caused by different Malassezia spp and seen predominantly in young age group and primarily in hot and humid climates. The aim of this study was to analyze epidemiological parameters and risk factors association in clinically diagnosed PV cases and also the mycological evaluation of those PV cases. Methods: A total of 116 patients attending the OPD of Dermatology were included and analysed for detailed history, clinical examination, epidemiological parameters, risk factors and investigations. Skin scrapings collected were processed by direct microscopy with 10% KOH and culture in modified Dixon agar (mDA). Isolates were identified by colony morphology, gram staining, biochemical characteristics & tween assimilation test. Results: Females were more affected (56.03%) than the males (43.97%) with F: M ratio 1.27:1. PV affected most commonly (36.21%) in 11-20 years of age group. Students (32.29%) were affected in maximum. Majority of affected patients (65.52%) used oily body creams, whereas 34.48% cases shared their body towels with others. 10.34% cases were associated with seborrheic dermatitis. Seasonal occurrence mostly seen in May - August. Patients with type III (Medium) complexion (56.03%) with normal skin texture (49.14%) were mostly affected. Maximum patients (74.14%) were associated with excessive sweating. 18.96% patients were associated with Type II DM. Most of the cases presented with macular, scaly hypopigmented, bilaterally asymmetrically distributed and having well defined margin. Neck was the most affected site (28.45%) followed by back (20.69%). Conclusion: M.furfur was the most common isolate (47.06%) followed by M. globosa (24.71%) and M. sympodialis (15.29%).

Subsets of T lymphocytes in the lesional skin of pityriasis rosea

Abstract: Background: Pityriasis rosea is a common papulosquamous disorder. However, its etiology and pathogenesis remain unclear. Objective: We investigate the types of inflammatory cells infiltrating the lesional skin of pityriasis rosea and demonstrate whether T-cell-mediated immunity is involved in the pathogenesis of this condition or not. Methods: The biopsies were taken from the lesional skin of 35 cases of patients diagnosed with pityriasis rosea. The specimens were prepared in paraffin sections, then submitted to routine immunohistochemistry procedures using monoclonal antibodies directed against CD3, CD4, CD8, CD20 and CD45RO and horseradish peroxidase-labeled goat anti-human antibodies. The positive sections were determined by the ratio and staining intensity of positive inflammatory cells. Results: The mean score of positive CD3, CD4, CD8, and CD45RO staining was respectively 3.74±3.88, 5.67±4.40, 2.94±3.42 and 7.68±4.33 in these pityriasis rosea patients (P<0.001). The percentage of positive staining was 54.29% (19/35), 69.7% (23/33), 40% (14/35) and 79.41% (27/34) (P<0.05). However, the staining of CD20 was negative in all samples. The mean score of CD3 staining in patients with time for remission ≤60 days (4.90±4.21) was higher than that in patients with time for remission >60 days (2.00±2.5) (P<0.05), whereas no statistical difference in the mean score of CD4, CD8 and CD45RO staining was observed. study liMitations: The sample size and the selected monoclonal antibody are limited, so the results reflect only part of the cellular immunity in the pathogenesis of pityriasis rosea. Conclusion: Our findings support a predominantly T-cell mediated immunity in the development of pityriasis rosea.

Systematic review and meta-analysis on oral azoles for the treatment of pityriasis versicolor

@#<p style="text-align: justify;"><strong>Background:</strong> Oral azole drugs are a second-line option for the treatment of pityriasis versicolor but evidence on their efficacy and safety is unclear. Objectives. To determine the efficacy and safety of oral azoles in the treatment of patients with pityriasis Versicolor.</p><p style="text-align: justify;"><strong>Methods</strong>: We searched MEDLINE, CENTRAL, EMBASE, LILACS, and HERDIN, from inception to the period between January to February 2014. We did not restrict the search by language or publication status. We included randomized controlled trials (RCTs) that compared the efficacy of oral azoles with placebo or no treatment, with topical agents, other oral azoles or dosing regimens in the treatment of pityriasis Versicolor, and that measured any of the pre-specified outcomes (mycologic cure, clinical cure, recurrence, duration to cure, time-to-cure, and quality of life). For adverse effects, we also included non-randomized studies (NRS). We used Cochrane methods to select studies, extract data, assess the risk of bias, pool studies, and calculate for treatment effects.</p><p style="text-align: justify;"><strong>Results:</strong> We included 38 RCTs (n=2894) and 56 NRS (n=3452). Overall, there were few pooled studies and evidence was low to moderate quality. Oral azoles were more effective than placebo (mycologic cure, RR 11.34, 95% CI 4.90, 26.28; 3 RCTs, n=131; I2=0%; low quality of evidence) and as effective as topical agents (mycologic cure, RR 1.02, 95% CI 0.86, 1.21; 4 RCTs, n=232; I2=60%; moderate quality of evidence).There were few adverse effects and were mostly minor and transient.</p><p style="text-align: justify;"><strong>Conclusions:</strong> Oral azoles may be more effective than placebo, and are probably as effective as topical agents in the treatment of PV. Triazoles are probably as effective as ketoconazole. Adverse effects were few, mostly minor, and transient.</p>