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SHORT COMMUNICATION
Prurigo Pigmentosa in a 21-year-old Caucasian Man: A Clinicopathological Correlation
Ferdinand TOBERER, Alexander ENK, Christine FINK and Holger A. HAENSSLE
Department of Dermatology, Venerology and Allergology, University Medical Center, Ruprecht-Karls-University, Im Neuenheimer Feld 440,
DE-69120 Heidelberg, Germany. E mail: [email protected]
Accepted May 30, 2017; Epub ahead of print May 31, 2017
Prurigo pigmentosa (PP) is a rare inflammatory skin
disease first described in Japan and clinically typified
by symmetrically distributed pruritic papules, papulo-
vesicles and vesicles (1, 2). Lesions resolve over time,
leaving post-inflammatory hyperpigmentation arranged
in a reticulated pattern (2). The majority of patients di-
agnosed with PP are Asians, more frequently women (1),
but is often misdiagnosed in Western countries.
do the lesions clinically. Therefore many patients have PP
for weeks or months before a correct diagnosis is made
(3–5). As pruritus is a prominent feature in many cases,
CASE REPORT
An otherwise healthy 21-year-old Caucasian man was
referred to our clinic with symmetrically distributed
erythematous papules and plaques covering his chest
and lateral trunk. Furthermore, the patient’s back was
extensively involved. The lesions showed a reticulate
pattern with overlying focal scaling and crusting (Fig.
1). Despite occasional and moderate pruritus the skin
lesions were asymptomatic and the patient did not report
any further symptoms. The remaining integument, as well
as the mucosa and nails, were clinically unremarkable.
Histopathology of a biopsy from an erythematous, ur-
ticarial papule revealed orthokeratosis and a moderate
perivascular and interstitial infiltrate of lymphocytes and
neutrophils admixed with some eosinophils. The spongi-
otic epidermis was focally infiltrated by neutrophils.
Dyskeratotic keratinocytes were rare (Fig. S1 a, b 1 ). One
week later a follow-up biopsy was taken from a crusted
papulovesicle. Histopathology showed a significant
epidermal necrosis accompanied by many dyskeratotic
and acantholytic k