Prurigo pigmentosa

Published on 19/03/2015 by admin

Filed under Dermatology

Last modified 22/04/2025

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Prurigo pigmentosa

Yukiko Tsuji-Abe and Hiroshi Shimizu

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

image

Prurigo pigmentosa is a pruritic eruption, commencing with urticarial papules or papulovesicles on the nape, chest, and back, followed by a peculiar reticular pigmentation. The majority of reported patients are Japanese with a female preponderance, but non-Japanese patients are also described.

Management strategy

The pathogenesis of prurigo pigmentosa remains unknown. Friction from clothing in wet conditions such as sweating or swimming can trigger the disease. In some cases, ketosis caused by diabetes mellitus, sudden weight loss, or anorexia nervosa precedes prurigo pigmentosa, and treatment of these conditions can lead to lesion resolution. There are several case reports of individuals who developed this condition in association with other disorders, including contact allergic reactions to certain chemical agents, Helicobacter pylori infection, atopic diathesis, and pregnancy. Minocycline (100–200 mg daily) and dapsone (25–100 mg daily) are usually very effective for prurigo pigmentosa. The effects are mostly observed within a few days or a week after treatment, with a reduction in both itch and papular lesions. Minocycline is regarded as first-line therapy, because it produces fewer adverse reactions, and the remission time has been reported as being longer than with dapsone treatment. Topical or systemic corticosteroids or antihistamines are usually ineffective.

Specific investigations

First-line therapies

image Minocycline C
image Dapsone C
image Treatment for ketosis or any other causative factors D

Second-line therapies

image Doxycycline C
image Roxithromycin E
image Clarithromycin E

Third-line therapies

image Isotretinoin E
image Narrowband UVB phototherapy E

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Prurigo pigmentosa

Yukiko Tsuji-Abe and Hiroshi Shimizu

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

image

Prurigo pigmentosa is a pruritic eruption, commencing with urticarial papules or papulovesicles on the nape, chest, and back, followed by a peculiar reticular pigmentation. The majority of reported patients are Japanese with a female preponderance, but non-Japanese patients are also described.

Management strategy

The pathogenesis of prurigo pigmentosa remains unknown. Friction from clothing in wet conditions such as sweating or swimming can trigger the disease. In some cases, ketosis caused by diabetes mellitus, sudden weight loss, or anorexia nervosa precedes prurigo pigmentosa, and treatment of these conditions can lead to lesion resolution. There are several case reports of individuals who developed this condition in association with other disorders, including contact allergic reactions to certain chemical agents, Helicobacter pylori infection, atopic diathesis, and pregnancy. Minocycline (100–200 mg daily) and dapsone (25–100 mg daily) are usually very effective for prurigo pigmentosa. The effects are mostly observed within a few days or a week after treatment, with a reduction in both itch and papular lesions. Minocycline is regarded as first-line therapy, because it produces fewer adverse reactions, and the remission time has been reported as being longer than with dapsone treatment. Topical or systemic corticosteroids or antihistamines are usually ineffective.

Specific investigations

First-line therapies

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