|Year : 1992 | Volume
| Issue : 3 | Page : 204-205
RR Mittal, SS Gill, D Prasad
R R Mittal
Source of Support: None, Conflict of Interest: None
A 50-year-old diabetic female patient had recurrent episodes of reticulate papular rash that resolved leaving a reticulate hyperpigmentation. Histopathology revealed spongiosis, mononuclear exocytosis, liquefactive degeneration of basal cells, pigmentary incontinence, and lichenoid and perivascular dermal infiltrate. Improvement was seen with dapsone. Prurigo pigmentosa is a rare disease reported mainly from Japan and this is the first report from India.
Keywords: Prurigo pigmentosa
|How to cite this article:|
Mittal R R, Gill S S, Prasad D. Prurigo pigmentosa. Indian J Dermatol Venereol Leprol 1992;58:204-5
| Introduction|| |
Prurigo pigmentosa is a pruritic inflammatory dermatosis characterized by erythematous papules arranged in a reticulated pattern that resolve leaving a reticulated, mottled hyperpigmentation. It was first reported from Japan in 1971.  Few cases have been reported from United States , and England. 
Histopathologically parakeratosis, moderate acanthosis, some spongiosis with exocytosis of mononuclears, liquefactive degeneration of basal cells and pigmentary incontinence is seen. Papillary dermal edema, dilatation of superficial dermal vessels with perivascular mononuclear cells and eosinophilic infiltration are also seen. At places mononuclear infiltration is lichenoid. , Dapsone has been reported as an effective therapy.  This is the first report in a Indian female patient.
| Case Report|| |
A 50-year-old diabetic lady presented with intensely pruritic symmetrical, erythematous papular rash in reticulate pattern on the neck, upper part of back, lumbosacral region, shoulders and extensor surfaces of both upper arms for the last 7 months. [Figure - 1] Systemic examination was normal. The disease was progressive in spite of treatment with systemic and topical steroids and systemic ketoconazole. Reticulate pigmentation of healed lesions was prominent in neck and upper back lesions. Initial diagnosis of atypical dermatitis herpetiformis (DH) was made and patient was given 150 mg dapsone per day, antihistamines and topical steroids. Eight days later, definite improvement was seen, but dapsone was withdrawn as biopsy did not confirm the diagnosis of DH. Twelve days later the patient returned with new lesions on the back, flanks, abdomen and around the umbilicus. Diagnosis of prurigo pigmentosa was made as histopathological changes were moderate acanthosis, mild spongiosis, exocytosis of mononuclear cells, liquefactive degeneration of basal cells with pigmentary incontinence. Localised lichenoid and perivascular mononuclear infiltrate was present. Dapsone was given again and it resulted in satisfactory improvement.
| Comments|| |
Prurigo pigmentosa usually affects young females. Our patient's age was 50 years and she was a diabetic. It may be chance association of diabetes mellitus and prurigo pigmentosa.
Clinical features, histology, and response to dapsone suggested the diagnosis of prurigo pigmentosa in our case. This appears to be the first report of this condition from India.
| References|| |
|1.||Nagashima M, Ohshiro A, Shimizu N. A peculiar dermatosis with gross reticular pigmentation, Jpn J Dermatol 1971; 81 :78-91. |
|2.||Dijkstra J W E, Bergfeld W F, Taylor J S, et al. Prurigo pigmentosa : a persistent lichenoid reaction to bismuth ? Int J Dermatol 1987; 26 379-81. |
|3.||Joyce A P, Horn T D, Anhalt G J. Prurigo Pigmentosa. Arch Dermatol 1989; 125: 1551-4. |
|4.||Teraki Y, ShioharaT, Nagashim M, etal. Prurigo pigmentosa: role of ICAM-1 in the localization of the eruption, BrJ Dermatol 1991; 125:360-3. |
|5.||Sugwara H, Inaba S, lijima S. Three cases of so called prurigo pigmentosa. Jpn J Dermatol 1973; 83: 111-2. |
[Figure - 1]
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