|Year : 2018 | Volume
| Issue : 2 | Page : 134-135
Pityriasis rotunda in a child
Treatwell Skin Centre, Jammu, Jammu and Kashmir, India
|Date of Web Publication||26-Mar-2018|
Treatwell Skin Centre, Canal Road, Jammu - 180 019, Jammu and Kashmir
Source of Support: None, Conflict of Interest: None
Pityriasis rotunda is an uncommon disorder of keratinization characterized by sharply defined hyper- or hypo-pigmented, perfectly circular, scaly patches with no inflammatory changes. The etiology of pityriasis rotunda remains unknown. Most authors believe that it is a form of acquired ichthyosis and it has been associated with a variety of conditions including tuberculosis, malnutrition, and malignancy. We report a case of pityriasis rotunda in a 7-year-old otherwise healthy female who was treated with topical retinoids and emollients with partial improvement.
Keywords: Disorder of keratinization, ichthyosis, pityriasis rotunda, scaling
|How to cite this article:|
Gupta M. Pityriasis rotunda in a child. Indian J Paediatr Dermatol 2018;19:134-5
| Introduction|| |
Pityriasis rotunda is a rare disorder of keratinization that is characterized by hyper- or hypo-pigmented, nummular, well-demarcated, scaly plaques that involve trunk and extremities. The condition was initially described in Japan by Toyama in 1906 and was termed tinea circinata. The exact incidence and geographical distribution of this disorder are unknown, but it is relatively common in the Far East where it accounts for some 0.2% of dermatological cases and has also been reported in South Africans, Bantus, and West Indians., Although most cases are sporadic, a familial occurrence among a cohort of 42 individuals in Sardinia has been reported. The etiology of pityriasis rotunda remains unknown. Most authors believe that it is a form of acquired ichthyosis and it has been associated with a variety of conditions including tuberculosis, malnutrition, and malignancy., Herein, we report a case of pityriasis rotunda in a 7-year-old otherwise healthy female.
| Case Report|| |
A 7-year-old female presented to us with a 6-month history of an asymptomatic, dry, scaly circular lesion over the left arm. The lesion started as a coin-sized lesion and had gradually increased to the present size but had remained asymptomatic throughout. She was in, generally, good health with no other known significant medical history. There was no history of any similar lesion in the sibling or any other family member. Cutaneous examination revealed a single well-defined perfectly circular patch of size 4 cm in diameter on the left arm [Figure 1]. The lesion was dry and scaly, with no erythema or induration. There was no sensory loss over the lesion and no nerve enlargement. Rest of the cutaneous examination revealed no abnormality. Routine investigations including complete blood count, liver function tests, urine analysis, and chest X-ray were all normal. Direct microscopic examination of scales prepared with 10% potassium hydroxide was negative. The patient was advised a skin biopsy which was refused by the parents owing to the asymptomatic nature of the lesion. On the basis of clinical examination, a diagnosis of pityriasis rotunda was made and the patient was treated with topical tretinoin 0.05% gel at night and paraffin-based emollients. After 3 months of treatment, there was only a partial improvement in the lesion.
| Discussion|| |
The etiology of pityriasis rotunda remains unknown. Most authors believe that it is a form of acquired ichthyosis, a delayed presentation of congenital ichthyosis, or a cutaneous manifestation of systemic disease. Researchers have reported an association with lung, liver, stomach, and other types of carcinomas in Asian patients. Several authors have also linked pityriasis rotunda to malnutrition, tuberculosis, cirrhosis, leprosy, liver diseases, pulmonary diseases, multiple myeloma, chronic myeloid leukemia, and cardiac diseases, among many others., Familial cases have also been described, in which an autosomal dominant inheritance appears to be present.
A classification has been proposed by Grimalt et al. to encompass all reported cases of pityriasis rotunda. Type I includes Black or Asian patients with fewer than 30 hyperpigmented lesions, nonfamilial incidence and an association with malignant conditions or systemic diseases in 30% of cases. Type II occurs in Caucasian patients, and the lesions are usually hypopigmented, familial, numerous (>30) and are not associated with a chronic illness.
Pityriasis rotunda most often develops between the ages of 20 and 45 years, but childhood cases have also been reported. Clinically, typical lesions of pityriasis rotunda are circular, sharply defined patches of dry skin with ichthyosiform scaling, usually 2–3 cm in diameter but sometimes much larger, up to 14 cm. The number of lesions may vary from a single lesion to hundreds. They rarely itch, slowly enlarge, and coalesce and may be hypo- or hyper-pigmented.,, Onset in childhood has been reported to have a better prognosis, with remission in later childhood in almost 50%. Lesions are commonly seen on the buttocks, thighs, abdomen, back, or upper arms. Histologically, findings are often subtle, but hyperkeratosis, thinned granular layer, pigmented basal layer, and mild perivascular lymphocytic infiltrate are commonly reported, resembling ichthyosis vulgaris.
The management of pityriasis rotunda is difficult and multiple agents have been tried, including topical glucocorticoids, antifungal agents, salicylic acid, topical retinoids, tar, lactic acid lotion, and oral Vitamin A., In patients with pityriasis rotunda that is associated with internal malignant conditions or systemic diseases, skin lesions have resolved upon successful treatment of the underlying disease.
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