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Elbendary A, Youssef R, Abdel-Halim MRE, Abdel Halim D, El Sharkawy DA, Alfishawy M, Gad MA, Gad A, Elmasry MF. Role of streptococcal infection in the etiopathogenesis of pityriasis lichenoides chronica and the therapeutic efficacy of azithromycin: a randomized controlled trial. Arch Dermatol Res 2023; 315:521-530. [PMID: 36129521 PMCID: PMC10020249 DOI: 10.1007/s00403-022-02398-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/02/2021] [Accepted: 09/07/2022] [Indexed: 11/24/2022]
Abstract
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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Affiliation(s)
- Amira Elbendary
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Kasr Al Ainy St, Cairo, 11562, Egypt.
| | - Randa Youssef
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Kasr Al Ainy St, Cairo, 11562, Egypt
| | - Mona R E Abdel-Halim
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Kasr Al Ainy St, Cairo, 11562, Egypt
| | - Dalia Abdel Halim
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Kasr Al Ainy St, Cairo, 11562, Egypt
| | - Dina Ahmed El Sharkawy
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Kasr Al Ainy St, Cairo, 11562, Egypt
| | - Mostafa Alfishawy
- Infectious Diseases Consultants and Academic Researchers of Egypt (IDCARE), Cairo, Egypt
| | - Maha A Gad
- Clinical Pathology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Abdallah Gad
- Lowell General Hospital, Lowell, MA, USA
- Biostatistics and Cancer Epidemiology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Maha Fathy Elmasry
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Kasr Al Ainy St, Cairo, 11562, Egypt
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De La Garza H, Saliba E, Rosales Santillan M, Brem C, Vashi NA. Pityriasis Lichenoides et Varioliformis Acuta as a Complication of COVID-19 Infection. Dermatopathology (Basel) 2022; 9:244-250. [PMID: 35892481 PMCID: PMC9326675 DOI: 10.3390/dermatopathology9030028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
Pityriasis lichenoides is an acute and/or chronic skin disease associated with recurrent erythematous papules that self-resolve. While its etiology is unknown, preceding viral infection may play a role. We present an atypical case of a 40-year-old woman with pityriasis lichenoides et varioliformis acuta as a complication of a COVID-19 infection.
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Affiliation(s)
- Henriette De La Garza
- Department of Dermatology, Boston University School of Medicine, Boston, MA 02118, USA; (H.D.L.G.); (E.S.); (M.R.S.); (C.B.)
| | - Elie Saliba
- Department of Dermatology, Boston University School of Medicine, Boston, MA 02118, USA; (H.D.L.G.); (E.S.); (M.R.S.); (C.B.)
- Department of Dermatology, Brown University, Providence, RI 02903, USA
| | - Monica Rosales Santillan
- Department of Dermatology, Boston University School of Medicine, Boston, MA 02118, USA; (H.D.L.G.); (E.S.); (M.R.S.); (C.B.)
| | - Candice Brem
- Department of Dermatology, Boston University School of Medicine, Boston, MA 02118, USA; (H.D.L.G.); (E.S.); (M.R.S.); (C.B.)
| | - Neelam A. Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, MA 02118, USA; (H.D.L.G.); (E.S.); (M.R.S.); (C.B.)
- Boston Health Care System, U.S. Department of Veterans Affairs, Boston, MA 02130, USA
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Feola H, Mancinelli MC, Perez-Klala MV, Verea MA. Pityriasis lichenoides chronica: Rapid response after a single cycle of azithromycin therapy. Dermatol Ther 2020; 33:e13303. [PMID: 32157758 DOI: 10.1111/dth.13303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/17/2020] [Accepted: 03/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Hernán Feola
- Department of Dermatology, Hospital San Juan de Dios, La Plata, Argentina
| | - Maria C Mancinelli
- Department of Dermatology, Hospital San Juan de Dios, La Plata, Argentina
| | | | - Maria A Verea
- Department of Dermatology, Hospital San Juan de Dios, La Plata, Argentina
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Bellinato F, Maurelli M, Gisondi P, Girolomoni G. A systematic review of treatments for pityriasis lichenoides. J Eur Acad Dermatol Venereol 2019; 33:2039-2049. [DOI: 10.1111/jdv.15813] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/08/2019] [Indexed: 11/27/2022]
Affiliation(s)
- F. Bellinato
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
| | - M. Maurelli
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
| | - P. Gisondi
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
| | - G. Girolomoni
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
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Ogrum A, Takci Z, Seckin HY, Cetin E. A case of pityriasis lichenoides: Rapid resolution with azithromycin monotherapy in 3 weeks. Dermatol Ther 2018; 31:e12681. [PMID: 30133949 DOI: 10.1111/dth.12681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/07/2018] [Accepted: 07/16/2018] [Indexed: 11/30/2022]
Abstract
Pityriasis lichenoides (PL) is a spectrum of inflammatory skin diseases which include PL et varioliformis acuta (PLEVA) and PL chronica (PLC) as two ends of the disease and rarely both entities can coexist on the same patient. Treatment options are based on case series-reports, and anecdotes, and include topical corticosteroids, topical immunomodulators, systemic antibiotics (tetracycline, erythromycin), and phototherapy. Herein, we report a 13-year-old boy, exhibiting mixed manifestations of PLEVA and PLC lesions concurrently, with a rapid and dramatic response to azithromycin monotherapy.
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Affiliation(s)
- Atiye Ogrum
- Department of Dermatology and Venereology, School of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Zennure Takci
- Department of Dermatology and Venereology, School of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Havva Y Seckin
- Department of Dermatology and Venereology, School of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Elif Cetin
- Department of Pathology, School of Medicine, Gaziosmanpasa University, Tokat, Turkey
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Geller L, Antonov NK, Lauren CT, Morel KD, Garzon MC. Pityriasis Lichenoides in Childhood: Review of Clinical Presentation and Treatment Options. Pediatr Dermatol 2015; 32:579-92. [PMID: 25816855 DOI: 10.1111/pde.12581] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pityriasis lichenoides (PL) is a skin condition of unclear etiology that occurs not uncommonly in childhood. It is often classified into the acute form, pityriasis lichenoides et varioliformis acuta (PLEVA), and the chronic form, pityriasis lichenoides chronica (PLC). We performed a comprehensive review of the English-language literature using the PubMed database of all cases of childhood PL reported from 1962 to 2014 and summarized the epidemiology, clinical features, treatment options, and prognosis of this condition in children. The proposed etiologies are discussed, including its association with infectious agents, medications, and immunizations and evidence for PL as a lymphoproliferative disorder. We found an average age of PL onset of 6.5 years, with a slight (61%) male predominance. We also found that PLEVA and PLC tend to occur with equal frequency and that, in many cases, there is clinical and histopathologic overlap between the two phenotypes. When systemic therapy is indicated, we propose that oral erythromycin and narrowband ultraviolet B phototherapy should be first-line treatment options for children with PL since they have been shown to be effective and well tolerated. In most cases, PL follows a benign course with no greater risk of cutaneous T-cell lymphoma, although given the rare case reports of transformation, long-term follow-up of these patients is recommended.
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Affiliation(s)
- Lauren Geller
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nina K Antonov
- College of Physicians and Surgeons, Columbia University, New York, New York
| | - Christine T Lauren
- Department of Dermatology, Columbia University, New York, New York.,Department of Pediatrics, Columbia University, New York, New York
| | - Kimberly D Morel
- Department of Dermatology, Columbia University, New York, New York.,Department of Pediatrics, Columbia University, New York, New York
| | - Maria C Garzon
- Department of Dermatology, Columbia University, New York, New York.,Department of Pediatrics, Columbia University, New York, New York
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Exantema purpúrico de larga evolución: pitiriasis liquenoide. An Pediatr (Barc) 2015; 82:e226-7. [DOI: 10.1016/j.anpedi.2014.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/30/2014] [Accepted: 06/03/2014] [Indexed: 10/25/2022] Open
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