minocycline and Prurigo

Prurigo pigmentosa (PP) is a rare inflammatory disease of the skin of uncertain etiology first reported in Japan. It is typified by recurrent eruptions of itching urticarial macules, papules, vesicopapules, and plaques with a reticular arrangement that quickly resolve leaving a net-like pigmentation. The disease presents specific histopathological features. Herein, 3 cases of PP in Brazilians with no Japanese ancestry are reported and a revision of all previous English-language case reports indexed on PubMed is provided. Two articles with original case reports not listed on PubMed were also included. Our patients are 2 women and 1 man at the ages of 39, 33, and 22 years, respectively. All 3 presented findings in consonance with previous cases of PP and were diagnosed based on clinicopathological correlation. They were successfully treated with oral minocycline or doxycycline. In our literature review, a total of 210 previously reported cases were included. Although PP seemed to be restricted to Japanese patients in the first years after its recognition, the geographic boundaries of the disease are continuously expanding. Korea responded for 83 previous cases and Japan for 53. The mean age was 24.4 years, with 84.3% of the cases occurring between 11 and 30 years of age. The female/male rate was 2.6 and the most affected anatomical sites were back, chest, and neck. We do believe that the rarity of case reports in western countries may represent lack of awareness about the disease by dermatologists and dermatopathologists in these regions.

Topics: Adult; Anti-Bacterial Agents; Brazil; Doxycycline; Female; Humans; Male; Minocycline; Prurigo; Young Adult

Prurigo pigmentosa is a rare inflammatory skin disease of unknown etiology presenting as a pruritic truncal eruption of reticulated and symmetric macules and papules with the predilection for young Japanese females. Although cases of PP are increasingly reported in the non-Japanese literature, dermatologists may be unfamiliar with this entity. Here we report a Caucasian American female and a Chinese American female with PP and a discussion of the literature. The treatments of choice for prurigo pigmentosa are tetracyclines such as doxycycline and minocycline, as well as dapsone. The prognosis is excellent.

Topics: Adult; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Minocycline; Prurigo; Treatment Outcome; United States

Minocycline belongs to the second generation class of cyclines. It was synthesized in 1967 and marketed in 1972. Minocycline has an antiinfectious activity with a spectrum similar to that of other cyclines, notably against Chlamydias, Treonema and Proprionibacterium acenes. The antiinflammatory activity is associated with this antiinfectious action is greater than that of first generation cyclines with specifically a modulator effect on epidermal cytokines. The pharmokinetics of minocycline is characterized by an excellent absorption, a long half-life and an important lipophilic property inducing good tissue distribution. Clinical trials of minocycline have mainly been performed in sexually transmissible diseases and in acne, a field where randomized studies are the most frequent. These trials show that the effect of minocycline is not stronger than first generation cyclines or doxycycline, but that the action is quicker than that of tetracycline at the dose of 500 mg a day. Minocycline is also efficient in nocardiasis, mycobacteriosis, leprosy, Lyme disease, pyoderma gangrenosum, autoimmune bullous dermatitis, Carteaud disease, and prurigo. However, the effect of minocycline in these different conditions has always been evaluated in open trials with a small number of patients. The usual side effects of cyclines, i.e. digestive problems, fungal infections, are less frequent than with first generation cyclines. No photosensitivity has been demonstrated although pigmentations have been described. Dizziness is a specific side effect of minocycline. Furthermore, rare but severe side effects have been reported, including hypersensitivity syndrome, autoimmune hepatitis, and lupus. Regular indications for minocycline in dermatology are acne and three sexually transmissible diseases (mycoplasm, chlamydia, treponema). Proposed dosage is 100 mg per day in sexually transmissible disease with a reduction to 50 mg per day after 15 days in acne.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Autoimmune Diseases; Cytokines; Drug Administration Schedule; Humans; Leprosy; Lyme Disease; Minocycline; Mycobacterium Infections; Nocardia Infections; Prurigo; Pyoderma Gangrenosum; Research Design; Sexually Transmitted Diseases; Skin Diseases, Vesiculobullous; Treatment Outcome

Topics: Anti-Bacterial Agents; Humans; Minocycline; Papilloma; Prurigo; Skin Neoplasms

Topics: Humans; Hyperpigmentation; Italy; Minocycline; Prurigo

Topics: Humans; Hyperpigmentation; Italy; Male; Minocycline; Prurigo

Pruritus pigmentosa is a skin disease mainly characterized by pruritus, inflammatory rash and reticular and macular pigmentation. The disease more commonly affects young women and may persist for several years. In this article, we report a case of a 20-year-old female patient who presented with erythema and blisters on the neck and trunk with pruritus for 20 days. Dermatological examination revealed a reticular distribution of erythema on the chest and abdomen and some areas of erythema covered with crusts. Additionally, blisters and bullae with clear fluid and negative Nikolsky's sign were noted. On the neck and back, erythema was also in a reticular distribution, and erythema secondary to erosion and/or crusts was present. In addition, histopathological analysis of the lesions showed hyperkeratosis and intraepidermal multilocular vesiculation and confirmed increased migration of inflammatory cells into the epidermis and infiltration of inflammatory cells, including lymphocytes, histiocytes and eosinophils, in the superficial dermis. The expression levels of IgG, IgM, IgA and C3 were all negative. This patient was diagnosed with prurigo pigmentosa, and the condition improved after treatment with minocycline.

Topics: Adult; Female; Humans; Minocycline; Neck; Prurigo; Young Adult

Topics: Anti-Bacterial Agents; Humans; Hyperpigmentation; Minocycline; Prurigo

Topics: Adult; Anti-Bacterial Agents; Asian People; Diet Therapy; Diet, Carbohydrate-Restricted; Exanthema; Female; Humans; Minocycline; Pigmentation Disorders; Prurigo; Treatment Outcome

Topics: Administration, Oral; Administration, Topical; Anti-Bacterial Agents; Diagnosis, Differential; Diet, Ketogenic; Drug Therapy, Combination; Erythema; Erythromycin; Exanthema; Female; Humans; Hyperpigmentation; Minocycline; Prurigo; Skin Cream; Treatment Outcome; Young Adult

Topics: Administration, Oral; Adolescent; Biopsy, Needle; Diagnosis, Differential; Female; Humans; Hyperpigmentation; Immunohistochemistry; Minocycline; Prognosis; Prurigo; Pruritus; Severity of Illness Index; Treatment Outcome

Topics: Adolescent; Biopsy; Diagnosis, Differential; Exanthema; Exocytosis; Female; Humans; Hyperpigmentation; Lymphocytes; Minocycline; Prurigo; Skin; Skin Diseases, Papulosquamous

Prurigo pigmentosa (PP) is a rare inflammatory dermatosis originally reported in Japan. Since then, most reports have originated from Asia, and to a lesser extent from Europe. Although the pathogenesis remains unclear, it is now established that PP is linked to ketoacidotic states. Four patients diagnosed with PP were identified from the dermatopathology database at the American University of Beirut Medical Center between January 2009 and December 2013. Clinicopathologic findings in the 4 patients were similar to those previously reported in the literature. The patients were all female with a mean age of 23.5 years. They all presented with itchy erythematous reticulated papulovesicles/plaques leaving variable reticulated brownish patches. Two patients had, in addition, annular lesions arranged en cocarde and pustules, respectively. In 3 patients, the rash was associated with fasting or dieting. The rash had a predilection to the trunk and proximal part of the upper extremities. One patient had intergluteal area involvement. Two biopsy specimens revealed psoriasiform hyperplasia and neutrophilic exocytosis mimicking psoriasis or an impetiginized spongiotic dermatitis. One biopsy specimen exhibited a mild superficial perivascular lymphocytic infiltrate with ballooning and reticular degeneration, a picture mimicking a viral exanthema. Another biopsy specimen exhibited a picture similar to chronic spongiotic dermatitis. Although mostly described in Japan, PP has been described much less frequently in the Middle East region likely due to mis/underdiagnosis. Therefore, increased awareness is necessary especially because fasting is a common religious practice among Arab countries. Further investigations are necessary to better understand the etiopathogenesis of this rare entity.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Doxycycline; Female; Humans; Lebanon; Minocycline; Prurigo; Saudi Arabia; Young Adult

Prurigo pigmentosa is a recurrent dermatosis with severe pruritus and several peculiar clinical features. Its exact etiology and pathogenesis are unclear. The aim of this study was to investigate the clinical features and chronological changes in the histopathology of prurigo pigmentosa in Korean patients and to assess the etiology of this condition. We reviewed the medical records, clinical photographs and biopsy specimens from 50 patients diagnosed with prurigo pigmentosa. Mean age at diagnosis was 23.7 years (range, 15-61 years). Prurigo pigmentosa started as urticarial papules or plaques, changing first to papulovesicles and then to reticulated brownish macules. The most frequent sites were the back and chest, especially depressed areas such as the central back and inter-mammary area. Dietary change was suspected as a cause of prurigo pigmentosa in 17 patients. Histopathologically, early-stage lesions had dermatitis herpetiformis-like features; fully-developed lesions displayed impetigo-like or acute, generalized, exanthematous, pustulosis-like features; and late lesions presented with post-inflammatory hyperpigmentation-like features. Oral minocycline, with or without dapsone, was effective in inhibiting the appearance of new lesions, but did not prevent recurrence. Prurigo pigmentosa is not rare in Korea, is apparently associated with dietary modification and preferentially involves the depressed regions of the trunk.

Topics: Adolescent; Adult; Dapsone; Diet; Female; Humans; Male; Middle Aged; Minocycline; Pigmentation Disorders; Prurigo; Republic of Korea; Young Adult

Topics: Administration, Topical; Anti-Bacterial Agents; Biopsy; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Minocycline; Pigmentation Disorders; Prurigo; Thoracic Wall; Young Adult

Prurigo pigmentosa (PP) is an unusual pruriginous dermatosis of unknown aetiology and is often misdiagnosed. We report two people (a 16-year-old Chinese boy and a 21-year-old Chinese woman), who presented with clinicopathological features consistent with PP. Both patients were successfully treated with minocycline. Better knowledge of this disease will lead to early recognition and appropriate treatment.

Topics: Adolescent; Anti-Bacterial Agents; Diagnosis, Differential; Female; Humans; Male; Minocycline; Prurigo; Treatment Outcome; Young Adult

Topics: Adult; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Minocycline; Prurigo; Skin Diseases, Vesiculobullous

A 22-year-old Chinese woman presented with a 5-year history of an intensely pruritic eruption on her posterior neck, mid back and sacrum leaving reticulate pigmentation. The diagnosis of prurigo pigmentosa was made on the basis of the clinico-histological features and a response to minocycline. Although prurigo pigmentosa is uncommon, it has characteristic clinical and histological features. Early diagnosis and appropriate treatment result in a rapid response and prevents a progression of pigmentation.

Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Back; Diagnosis, Differential; Female; Humans; Minocycline; Neck; Prurigo; Pruritus

Prurigo pigmentosa is a rare inflammatory dermatosis of unknown etiology characterized by recurrent, pruritic erythematous papules and gross reticulate hyperpigmentation. It is seen most commonly among young adult Japanese females. Only 20 cases have been described outside Japan.. We report two female, Turkish patients aged 20 and 26 years who had a pruritic rash with the characteristic clinical appearance and supportive histopathology of prurigo pigmentosa.. They were successfully treated with minocycline and doxycycline.. Prurigo pigmentosa is a relatively new clinical entity, and we believe that a more widespread knowledge of this disease will lessen its misdiagnosis. We find it noteworthy to point out that there may be a predisposition to prurigo pigmentosa amongst the Turkish and Sicilian populations.

Topics: Adult; Anti-Bacterial Agents; Doxycycline; Female; Humans; Hyperpigmentation; Minocycline; Prurigo

Prurigo pigmentosa is rather frequently observed in Japan. By contrast, this skin disease has so far rarely been reported in German speaking countries or elsewhere in Europe. In order to make the European dermatologists familiar with this peculiar skin disease, the epidemiological features as well as the clinical and histopathological findings are reviewed. The disease can be discriminated from prurigo simplex subacuta by the typical reticular hyperpigmentation, by the sparing of arms and legs and by the response to treatment with dapsone or minocycline. Additional differential diagnostic possibilities include lichen amyloidosus and confluent and reticulate papillomatosis of Gougerot-Carteaud. Diabetes or malnutrition may represent etiological factors. Because this unusual skin disease may also occur in Europe, dermatologists here should include prurigo pigmentosa in the differential diagnosis of acquired pigmentary disorders.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Biopsy; Dapsone; Diagnosis, Differential; Female; Humans; Hyperpigmentation; Incontinentia Pigmenti; Male; Middle Aged; Minocycline; Prurigo; Recurrence; Skin; Time Factors

We present a case of prurigo pigmentosa associated with vesicles that we call 'vesicular prurigo pigmentosa'. The subject was treated using minocycline with good results and no recurrence of the lesions over a 2-year period.

Topics: Adult; Anti-Bacterial Agents; Humans; Hyperpigmentation; Male; Minocycline; Prurigo; Skin; Skin Diseases, Vesiculobullous

Prurigo pigmentosa (PP) is a type of inflammatory dermatosis characterized by pruritic, reddish, papular lesions that normally resolve while leaving gross reticular pigmentation. In severe cases however, they may form edematous infiltrative plaques, but no formation of vesicles or bullae is generally found. We herein present the case of a 32-year-old Japanese male patient with diabetes mellitus, who developed a severe vesicular formation. Minocycline was found to be very effective. In addition, the eruption subsided when the urine glucose and ketone levels were controlled by glibenclamide. The most characteristic feature in this case was the fact that numerous vesicles and bullae were seen both in the beginning and throughout the clinical course. It therefore seems that a sudden exacerbation of diabetes mellitus was associated with a severe formation of vesicles and bullae. The findings of this case may suggest a correlation between diabetes mellitus and PP.

Topics: Adult; Anti-Bacterial Agents; Diabetes Mellitus, Type 2; Follow-Up Studies; Humans; Male; Minocycline; Pigmentation Disorders; Prurigo; Skin Diseases, Vesiculobullous

We report the first case of prurigo pigmentosa in the German literature. For over a year, a 16-year old white girl developed an immensely pruritic symmetrical reticular, papulovesicular eruption on the trunk, axillae and pubic region. Histologically a superficial perivascular spongiotic and lichenoid inflammatory pattern with prominent pigmentary incontinence in older lesions was observed. Topical corticosteroids and systemic antihistamines had no effect. Systemic corticosteroids and diaminophenylsulphone (DADPS) produced improvement but could not prevent recurrences. Healing occurred only after 4 weeks of systemic-minocycline.

Topics: Adolescent; Anti-Bacterial Agents; Basement Membrane; Complement C3; Drug Administration Schedule; Female; Humans; Minocycline; Pigmentation Disorders; Prurigo; Recurrence; Skin

Topics: Adolescent; Adult; Female; Humans; Hyperpigmentation; Male; Minocycline; Prurigo

Five patients with prurigo pigmentosa were treated with 100-200 mg minocycline daily. The eruption and pruritus rapidly resolved within a few days or up to a week. There has been no recurrence after stopping medication and we conclude that minocycline is effective for prurigo pigmentosa and safer than dapsone.

Topics: Adolescent; Adult; Female; Humans; Male; Minocycline; Prurigo; Tetracyclines