A case of pityriasis lichenoides: Rapid resolution with azithromycin monotherapy in 3 weeks

Oğrum, Atiye; Takçı, Zennure; Seçkin, Havva Yıldız; Cetin, E

doi:10.1111/dth.12681

Cited by 4 publications

(5 citation statements)

References 11 publications

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“…reported a 9‐year‐old girl with PLEVA who failed erythromycin treated with oral azithromycin (500 mg/day for three consecutive days every other week) in association with topical tacrolimus 0.1% ointment daily with efficacy. Ogrum et al . reported a complete and persistent remission in a 13‐year‐old boy with an overlap PL with 500 mg daily for three consecutive days every other week for three cycles.…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of treatments for pityriasis lichenoides

Bellinato

Maurelli

Gisondi

et al. 2019

Acad Dermatol Venereol

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Pityriasis lichenoides (PL) represents a spectrum of inflammatory skin diseases comprising pityriasis lichenoides et varioliformis acuta (PLEVA) and pityriasis lichenoides chronica (PLC). This study aimed to provide a summary of effective treatments for PL. A systematic review was performed according to PRISMA guidelines for studies investigating PL treatment including ≥3 subjects and published in English between 1 January 1970 and 15 April 2019. A total of 441 papers were screened, and 37 original manuscripts meeting the inclusion and exclusion criteria were found, including 12 case series, 18 reviews, four prospective studies, two comparative studies and a single randomized controlled study. In most studies, ultraviolet (UV) phototherapy (narrow‐band UVB, broadband UVB, UVA1 or PUVA) was used. Clearance rates with the different modalities are hardly comparable between different studies, ranging approximately between 70% and 100%. Narrow‐band UVB showed an efficacy similar to PUVA as such as the combination of UVA and UVB vs. PUVA. Oral erythromycin showed clearance rates ranging between 66% and 83%, whereas methotrexate up to 100% but in small and dated studies. Evidence for other treatments is scarce. There is a lack of high level of evidence studies on PL treatment. The interpretation of the results is biased by the possible auto‐resolution of the disease, the sample heterogeneity between children and adults and the short follow‐up period of the studies. Only some studies investigated how results were durable after cessation of therapy. Quality of life and the impact of treatment were never assessed. According to the results of this review, we suggest narrow‐band UVB phototherapy as first‐line treatment. Oral erythromycin with or without topical corticosteroids and low‐dose methotrexate as second‐line therapies. High‐powered studies and randomized controlled trials are needed to establish the optimal treatment for PL.

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Section: Resultsmentioning

confidence: 99%

“…reported a retrospective study on five children with PLEVA treated with BB UVB phototherapy. All patients responded with clearance of lesions, requiring an average of 26 treatments (range[22][23][24][25][26][27][28][29][30][31][32][33]. The mean total clearance dose of UVB was 4.2 J/cm 2 .…”

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confidence: 99%

A systematic review of treatments for pityriasis lichenoides

Bellinato

Maurelli

Gisondi

et al. 2019

Acad Dermatol Venereol

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“…Azithromycin in treatment of pityriasis lichenoides has been scarcely reported in literature and reports mainly described its efficacy in PLEVA [11,12]. Only 2 cases of PLC treated with azithromycin were reported [13,14]. On the other hand, phototherapy was the most studied modality in treating PLC [15], and NB-UVB was recommended as the first-line treatment in adult-onset PLC [16].…”

Section: Discussionmentioning

confidence: 99%

Role of streptococcal infection in the etiopathogenesis of pityriasis lichenoides chronica and the therapeutic efficacy of azithromycin: a randomized controlled trial

et al. 2022

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The exact aetiology of pityriasis lichenoides chronica (PLC) remains unknown. While phototherapy is the most investigated therapeutic modality, azithromycin has been used scarcely. The aim of this study is to evaluate the therapeutic efficacy of azithromycin in the treatment of PLC compared to NB-UVB and evaluating the presence of streptococcal infection as a possible etiological factor in PLC patients. The study was designed as a randomised controlled trial. Twenty-four patients with PLC were randomly allocated into either azithromycin (n = 13, standard dose every 10 days) or NB-UVB (n = 11, thrice weekly) groups. End of study (EOS) was either complete clearance of lesions or a maximum of 8 weeks. Therapeutic efficacy was defined as percent reduction in lesions and was calculated for the rash as a whole, erythematous papules alone, and hypopigmented lesions alone and graded into complete, very-good, good, poor or no response. Anti-streptolysin O titre (ASOT), anti-deoxyribonuclease B titre (anti-DNaseB) and throat culture were evaluated at day 0. No significant difference existed between both groups as regards therapeutic efficacy. At EOS, NB-UVB achieved significantly more percent reduction in the extent of hypopigmented lesions and consequently in the rash as a whole (p = 0.001, p = 0.034, respectively). The extent of the rash as a whole was significantly less in the NB-UVB at EOS (p = 0.029, respectively). The effect of NB-UVB on hypopigmented lesions appeared early at week 4 of treatment. Only two patients, one from each group, relapsed during the 3 month follow-up. Evidence of recent streptococcal infection was present in 79% of the cases, mainly in the form of elevated ASOT (94.7%). It was significantly more encountered in young children (< 13 years) (p = 0.03) and was associated with more extent of erythematous papules and consequently with more extent of the rash as a whole (p = 0.05 and p = 0.01, respectively). It did not affect outcome of therapy at EOS. Azithromycin did not show more favorable response in patients with recent streptococcal infection. Therapeutic efficacy of azithromycin is comparable to NB-UVB in treatment of PLC; however, NB-UVB is superior in management of hypopigmented lesions. It is highly suggested that PLC could be a post streptococcal immune mediated disorder.Registration number: ClinicalTrials.gov, NCT03831269.

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“…A 13‐year‐old patient with symptoms of both PLEVA and PLC, published by Ogrum et al, underwent treatment with azithromycin as first therapy (500 mg/day for 3 consecutive days every 2 weeks). The patient underwent 3 cycles and showed a rapid improvement 3 weeks after starting treatment and without exacerbation at 6‐month follow‐up …”

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confidence: 99%

“…In the reports abovementioned, it is explained that the reactions to azithromycin could be due to its anti‐inflammatory and immunomodulatory effects, by decreasing levels of cytokines and acute phase reactants. Additionally, azithromycin presents better bioavailability, longer half‐life, rapid distribution in tissue, and less adverse effects than erythromycin …”

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confidence: 99%