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Dermatopathology: Practical & Conceptual July - September 2002
Prurigo Pigmentosa: New Observations and Comprehensive Review
Almut Böer, M.D.
Noriyuki Misago, M.D.
Manfred Wolter, M.D.
Hiromaro Kiryu, M.D.
Xiao Dong Wang, M.D.
A. Bernard Ackerman, M.D.
Differential Diagnosis Clinically
Differential Diagnosis Histopathologically
What follows are direct quotations in regard to therapy of prurigo pigmentosa.
". . . regressed within a week on dapsone 100 mg daily. The rash promptly reappeared 2 weeks after the dapsone was stopped." Cotterill
British Journal of Dermatology
". . . with sulfisomezole 2 g/d . . . the itchiness subsided and the red papules disappeared, leaving only pigmentation." Yamasaki
The Journal of Dermatology
"The . . . eruption disappeared . . . without any treatment, but the patient continues to suffer. . . eruptions. . . every season." Miyakawa
"Dapsone, 50 mg daily, was given for 4 months with very good results. Three weeks after stopping dapsone, a new eruption appeared. Treatment with potassium iodide, 500 mg/day, was tried inducing a control of the active lesions. . . . No recurrence was observed during this period but 14 days after stopping potassium iodide," Harms
"With a dose of minocycline 100200 mg daily, the pruritus, papules and erythema rapidly disappeared within a few days or up to a week. Although prurigo pigmentosa is likely to recur. . . in two of our cases. . . a long remission was obtained with minocycline." Aso
British Journal of Dermatology
"Ten days following oral minocycline, . . . , the eruption subsided. . . . It was possible that our patient responded well to dapsone and minocycline through suppression of the function of neutrophils infiltrating in the early lesion." Sakamoto
European Journal of Dermatology
"Because minocycline is not available in Turkey our first patient was treated with doxycycline. Her skin lesions resolved and did not recur . . . The skin lesions of the second patient resolved spontaneously . . . " Gürses
International Journal of Dermatology
". . . 300 mg roxythromycin daily for two weeks. Three days later the erythema disappeared, and 5 days later, the pruritus disappeared. . . . all 4 patients showed a very good response to this agent [macrolide antibiotics]. Yazawa
The remarkably beneficial effect of diamino-diphenyl-sulfone (dapsone, DDS) in prurigo pigmentosa, testified to by Sugawara
was proved to be true in at least 27 other patients. Six additional patients responded well to other sulfonamides, such as sulfimethoxazole. In an abstract of Tashiro published in 1979, minocycline was said to be effective in prurigo pigmentosa.
In articles reviewed by us, minocycline was reputed to be efficacious in 46 patients; three other patients responded to doxycycline. Harms
claimed to have observed remission of prurigo pigmentosa consequent to administration of potassium iodide,
was the first to call attention to macrolide antibiotics as being helpful in prurigo pigmentosa.
No improvement of prurigo pigmentosa derives from antihistamines or from corticosteroids administered topically or systemically. Only a few patients with prurigo pigmentosa have been purported to have recovered fully in the absence of any treatment at all, but follow up of those patients, when it was provided, was as short as two months and only as long as 15 months.
In brief, prurigo pigmentosa usually responds to dapsone, sulfonamides, and minocycline, but not to corticosteroids and antihistamines.
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