Prurigo Pigmentosa After Bariatric Surgery

Abstract

Prurigo pigmentosa (PP) is a rare idiopathic inflammatory dermatosis that typically presents as pruritic erythematous papulovesicles in a reticular pattern predominantly on the trunk of young women. [1][2][3] The lesions then resolve with residual hyperpigmentation. The pathogenesis of PP is not completely clear. However, it has mainly been associated with ketotic states such as those seen in dieting, fasting, diabetes mellitus, and softdrink ketosis. [1][2][3] Herein we report the first case to our knowledge of PP occurring after bariatric surgery, which provides further evidence of a possible role of ketosis in PP pathogenesis.

Facial Prurigo Pigmentosa After Bariatric Surgery

“…PP is most commonly seen in the third decade of life, with a female-to-male ratio as high as 6:1, and has been previously described in more than 300 cases, largely affecting the Japanese and East-Asian populations [15][16][17][18]. However, increasing reports of PP have been observed in the Western countries, and, more recently, in the Middle East, which might be reflecting the increased awareness about the condition [9][10][11]15].…”

“…The pathogenesis of PP is not fully understood; however, several factors have been associated with the condition such as diabetes mellitus, fasting/diet, pregnancy, atopy, and being in a ketotic state [4][5][6][7][8]. A few recent studies have shown a growing association between PP and bariatric surgery, which may be due to the metabolic disturbances seen as a result of such procedure [9][10][11]. Increased physician awareness about post-bariatric PP is much needed, especially with the growing popularity of bariatric and weight reduction procedures.…”

Pruritic papulovesicular dermatosis with reticular hyperpigmentation

“…As regards disease-related PP, treatment of the associated disease led to clinical improvement in patients with Helicobacter pylori infection or adult-onset Still's disease but failed to do so in a patient with Sjögren syndrome [7]. Remarkably, PP often appears to be related to dietary changes leading to ketosis, including severe weight loss, anorexia nervosa, or strict ketogenic diets without carbohydrates [10][11][12]. In almost all diet-related cases, PP improved after resuming a balanced diet.…”

“…Tetracyclines, such as minocycline or doxycycline, are usually given as first-line therapy, with the majority of patients showing a response [5,7,10]. Successful treatment has also been reported for dapsone (25-100 mg/day) and low-dose isotretinoin (20 mg/kg/day) [5,7].…”

Prurigo Pigmentosa: Case Report

“…1 Bu nötrofil aracılı inflamasyonu ise ketozisin indüklediği öne sürülmüştür. 4 Ancak PP, nonketotik hastalarda da görülebilmektedir. Henüz saptanmayan başka faktörlerin de nötrofil aracılı inflamasyonu indükle-diği muhtemeldir.…”