Pityriasis Rotunda
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Pityriasis rotunda (PR) is an idiopathic, chronic dermatosis that features characteristic discrete, round, scaly, pigmented patches. [1, 2, 3, 4, 5, 6, 7, 8, 9, 10] Pityriasis rotunda may be associated with systemic diseases (eg, hepatocellular carcinoma) in certain racially predisposed groups.
The pathophysiology of pityriasis rotunda is unknown. It may be a variant of ichthyosis vulgaris.
United States
Pityriasis rotunda is very uncommon in America. A review of English-language literature revealed only 6 case reports from America, which described 7 patients. [1, 11, 12, 13, 14, 15]
International
Pityriasis rotunda is a well-known condition in South Africa, Japan, and Italy. Pityriasis rotunda was seen in 65 (1.01%) of 6388 South African medical inpatients. Japanese investigators reported 181 cases of pityriasis rotunda in 1960. Forty-two cases, all from the Italian island of Sardinia, were reviewed in 1997. [16] In 1989, one review of the English-language literature discussed 89 previously reported pityriasis rotunda patients. Cases of pityriasis rotunda have been reported in Israel, England, Egypt, Portugal, Tanzania, and India. [2, 17, 18, 19, 20, 21, 22]
Most cases of pityriasis rotunda from South Africa, and all 6 cases from America, have occurred in blacks.
In the 1960 review of 181 cases in the French-language literature (performed by Japanese investigators), 175 patients were from Japan, 4 were from Korea, and 2 were from Manchuria. [23]
Cases have been reported among West Indians living in England. [19]
Other than the cluster of 42 patients (some familial) reported from the Italian island of Sardinia, pityriasis rotunda appears to be very uncommon among whites. [16, 24]
No sex predilection has been demonstrated in several large series. One series had 77 males and 63 females; another had 73 males and 101 females. The report of Sardinian patients had 22 males and 20 females. [16]
Lesions are often first noted in adulthood, usually when aged 20-45 years, but a patient as old as 76 years has been reported. In the review of 42 cases from Sardinia, the average age of onset was estimated to be 3-7 years.
The prognosis for pityriasis rotunda is excellent. Pityriasis rotunda lesions sometimes resolve with treatment of the associated systemic disorder. Lesions of pityriasis rotunda are not associated with mortality, and most are asymptomatic. Pityriasis rotunda can occur with serious underlying systemic diseases, such as hepatocellular carcinoma. [25, 26]
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Finch JJ, Olson CL. Hyperpigmented patches on the trunk of a Nigerian woman. Pityriasis rotunda (PR). Arch Dermatol. 2008 Nov. 144(11):1509-14. [Medline].
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Porges DY, Scott RA. Pityriasis rotunda with HTLV-1 associated tropical spastic paraparesis. NY. 1992. 184A.
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Kahana M, Levy A, Ronnen M, Schewach-Millet M, Stempler D. Pityriasis rotunda in a white patient. Report of the second case and review of the literature. J Am Acad Dermatol. 1986 Aug. 15(2 Pt 2):362-5. [Medline].
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Swift PJ, Saxe N. Pityriasis rotunda in South Africa–a skin disease caused by undernutrition. Clin Exp Dermatol. 1985 Sep. 10(5):407-12. [Medline].
Lodi A, Betti R, Chiarelli G, Carducci M, Crosti C. Familial pityriasis rotunda. Int J Dermatol. 1990 Sep. 29(7):483-5. [Medline].
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Etoh T, Nakagawa H, Ishibashi Y. Pityriasis rotunda associated with multiple myeloma. J Am Acad Dermatol. 1991 Feb. 24(2 Pt 1):303-4. [Medline].
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Jaggi Rao, MD, FRCPC Clinical Professor of Medicine, Division of Dermatology and Cutaneous Sciences, Director of Dermatology Residency Program, University of Alberta Faculty of Medicine and Dentistry
Jaggi Rao, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, Canadian Medical Association, Pacific Dermatologic Association, Royal College of Physicians and Surgeons of Canada, Canadian Medical Protective Association, Canadian Dermatology Association
Disclosure: Nothing to disclose.
Andrei I Metelitsa, MD, FRCPC Assistant Clinical Professor, Section of Dermatology, University of Calgary Faculty of Medicine, Canada
Andrei I Metelitsa, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, Canadian Medical Protective Association, Canadian Dermatology Association
Disclosure: Nothing to disclose.
Andrew Lin, MD, FRCPC Associate Professor, Department of Internal Medicine, Division of Dermatology, University of Alberta
Andrew Lin, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.
Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society
Disclosure: Nothing to disclose.
Jeffrey Meffert, MD † Former Associate Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, Texas Dermatological Society
Disclosure: Nothing to disclose.
Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.
James W Patterson, MD Professor of Pathology and Dermatology, Director of Dermatopathology, University of Virginia Medical Center
James W Patterson, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Dermatopathology, Royal Society of Medicine, Society for Investigative Dermatology, United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.
Pityriasis Rotunda
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