Published on 19/03/2015 by admin
Filed under Dermatology
Last modified 22/04/2025
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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
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.
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.
Urinalysis for ketones
Mitsuhashi Y, Suzuki N, Kawaguchi M, Kondo S. J Dermatol 2005; 32: 767–8.
Kubota Y, Koga T, Nakayama J. Eur J Dermatol 1998; 8: 439–41.
Oh YJ, Lee MH. J Eur Acad Dermatol Venereol 2012; 26: 1149-53.
Out of 10 cases, six patients were positive for urinary ketone tests. Of those, five cases were related to dieting or fasting. Two patients underwent retests after treatment, which were negative in both cases.
Nakada T, Sueki H, Iijima M. Clin Exp Dermatol 1998; 23: 25–7.
A young woman with anorexia nervosa developed prurigo pigmentosa. After she gained weight, the lesions resolved completely.
In all these reports, prurigo pigmentosa was associated with ketosis. Disease activity sometimes correlated with the amount of urinary ketones. In some cases, lesions resolved simply as a result of treating the causative condition.
Böer A, Misago N, Wolter M, Kiryu H, Wang XD, Ackerman AB. Am J Dermatopathol 2003; 25: 117–29.
Out of 25 cases, 16 responded well to minocycline (100–200 mg daily) and seven responded well to dapsone (25 mg daily).
Shin JW, Lee SY, Lee JS, Whang KU, Park YL, Lee HK. Int J Dermatol 2012; 51: 152–7.
Dapsone and minocycline were used alone or in combination in 37 out of 49 patients. Rapid resolution of lesions and pruritus was achieved in all cases.
A patient with diabetes mellitus developed a severe vesicular form of prurigo pigmentosa. Minocycline was very effective. In addition, the eruption subsided when the urinary glucose and ketone levels were controlled.
Nagashima M. J Dermatol 1978; 5: 61–7.
This is the first report of prurigo pigmentosa. The author suggests that friction from clothing can trigger this condition. Dapsone was used in some cases and was highly effective.
Ohnishi T, Kisa H, Ogata E, Watanabe S. Acta Derm Venereol 2000; 80: 447–8.
Eighteen cases of prurigo pigmentosa were associated with diabetic ketoacidosis. Treatment of ketoacidosis improved the eruption in eight cases, treatment with topical corticosteroid improved the rash in one case, and progress was unknown in one case.
Minocycline and dapsone are used alone or in combination, and are usually very effective. The effects are mostly observed within a few days or a week after treatment, with a reduction in pruritic and papular lesions. Minocycline might be the first-choice therapy, because it produces fewer adverse reactions.
Baykal C, Buyukbabani N, Akinturk S, Saglik E. Int J Dermatol 2006; 45: 1164–8.
Out of six cases of prurigo pigmentosa, three responded well to doxycycline 100 mg daily and another three responded well to tetracycline 500 mg daily.
Yazawa N, Ihn H, Yamane K, Etoh T, Tamaki K. Dermatology 2001; 202: 67–9.
Two cases of prurigo pigmentosa responded well to 300 mg daily roxithromycin, and another two cases responded well to 400 mg daily of clarithromycin. In all cases, the effect appeared quickly and the pruritus and papules disappeared within a week.
Gürses L, Gürbüz O, Demirçay Z, Kotiloglu E. Int J Dermatol 1999; 38: 924–5.
Of two cases, one responded well to doxycycline 200 mg daily, and the other resolved spontaneously.
Gür-Toy G, Güngör E, Artüz F, Aksoy F, Alli N. Int J Dermatol 2002; 41: 288–91.
Roxithromycin 300 mg daily was effective in two cases of prurigo pigmentosa, and clarithromycin 400 mg daily was effective in another two.
Doxycycline, a member of the tetracycline antibiotics group, and macrolide antibiotics such as roxithromycin and clarithromycin are reported effective for prurigo pigmentosa. These therapies are recommended for use in patients who respond poorly or have contraindications to dapsone or minocycline.
Requena Caballero C, Nagore E, Sanmartín O, Botella-Estrada R, Serra C, Guillén C. J Eur Acad Dermatol Venereol 2005; 19: 474–6.
This patient was initially diagnosed as having a vesiculobullous form of Darier disease and treatment with isotretinoin 40 mg/day was started, with a good response in 10 days. The lesion relapsed 5 months later, and treatment with minocycline 100 mg/day cleared it within 7 days.
Akoglu G, Boztepe G, Karaduman A. Dermatology 2006; 213: 331–3.
An 18-year-old woman was successfully treated with isotretinoin 20 mg daily (0.3 mg/kg/day). Pruritus and erythematous macules resolved in less than 1 month after therapy began.
Jang MS, Baek JW, Kang DY, Kang JS, Kim ST, Suh KS. Eur J Dermatol 2011; 21: 634–5.
A 13-week pregnant female with prurigo pigmentosa was treated with narrowband UVB. Pruritus decreased significantly after the first irradiation, and erythema cleared after fifth session.
Most patients with prurigo pigmentosa respond well to first- or second-line therapies or undergo spontaneous remission, but these alternatives might be useful in exceptional cases.
Treatment of Skin Disease Comprehensive Therapeutic Strategies 4e
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Minocycline
Dapsone
Treatment for ketosis or any other causative factors
Doxycycline
Roxithromycin
Clarithromycin
Isotretinoin
Narrowband UVB phototherapy
