Pityriasis versicolor: causes, symptoms, diagnosis, treatment

Red pityriasis (synonyms: Devergie disease, pointed red lichen) is a heterogeneous disease consisting of both hereditary forms transmitted autosomally dominantly and from sporadic, acquired forms clinically close to follicular psoriasis. Of the five clinical types of the WAD Griffiths (1980) isolated, the atypical juvenile is hereditary. Acquired and hereditary forms of the disease are clinically and histologically similar. Clinical manifestations of the hereditary type of the disease occur in childhood, more often with lesions of the linden, where the reddish-yellow color of erythema with ecdysis appears. Develops keratosis of the palms and soles. Then there are follicular papules with perifollicular erythema, which, merging, form large foci. In adults, often there is a development of eyestroderma with islets of unchanged skin. Mucous membranes of the oral cavity and eyes can be affected with the development of conjunctivitis, corneal dystrophy, and ectropion. Characterized by the appearance of horny cones at the rear of the fingers of the hands (Bene's symptom), changes in nail plates. The development of the disease can contribute to allergic dermatitis, especially the palms and soles.

The causes and pathogenesis of red pityriasis hair follicles are unknown, in some cases hereditary predisposition is noted. In recent years, an opinion has been expressed about two types of red hair follicles, one of which begins soon after birth, in childhood or adolescence (children's type), and the other occurs in adulthood (adult type). It is believed that the child type of the disease is hereditary, and the adult is acquired.

Of the existing theories of the pathogenesis of red pityriasis, the concept of deficiency or insufficient assimilation of vitamin A, a decrease in the level of retinol-binding protein, has gained the most recognition. In addition, in the development of red aberrative hair follicles, factors such as endocrine disorders, nervous disorders, intoxications, etc. Play a role.

Symptoms of red pityriaside hair follicles

At the beginning of the disease there are isolated follicular pointed knots of pink-red, bright red or dark red color, otreviously flaky, with a small horn spine in the center. Later on, as the papules increase or their fusion, plaques of a yellowish-red color with an orange tinge are formed, which are more or less infiltrated, covered with whitish scales and covered with sharply pronounced cutaneous furrows (lichenification). Stroking the affected areas gives a feeling of grater. The preferred location of the rash is the extensor surfaces of the extremities, especially the dorsal surface of the fingers, where pathognomonic changes appear for this dermatosis in the form of the described Behnier follicular horny cones, although rashes can also occur in other parts of the skin. Another pathognomonic symptom is the islets of healthy skin with irregular outlines with horny spinules located on them, striking the general background of yellowish-red infiltrated skin. Eruptions are usually symmetrical. On the scalp there is a large stratification of densely seated dry otrebridae scales (asbestos scales). Skin of face pink-red, with mucovidnym peeling. On the palms and soles there is a focal or diffuse keratoderma - the skin is hyperimilated, thickened, covered with scales and cracks. A universal lesion of the skin can be developed according to the type of erythroderma. The defeat of the nail plates on the hands and feet is one of the characteristic signs of dermatosis. In this case, longitudinal or transverse striation, turbidity of the nail plates and pronounced hyperkeratosis are noted.

Disease often begins in childhood or adolescence (children's type), but relatively often the cases of a later onset (adult type). Patients usually experience a slight itch and complain about the tightness of the skin. Sometimes the red hair follicle in its course is very similar to psoriasis, and then they speak of a psoriasis-like form, or a psoriasis-like variant of the flow of red, otarian hair follicles.

Histopathology. There are hyperkeratosis with follicular plugs, small parakeratosis and granulosis, vacuolar degeneration of the basal cell. In the upper part of the dermis, there is a perivascular infiltration, consisting mainly of polymorphonuclear leukocytes and lymphocytes, located around the vessels and near the hair.

Pathomorphology. They note uneven acanthosis, hyperkeratosis with foci of parakeratosis, horny cork in the mouths of the hair follicles and epidermal depressions, on the sides of which parakeratosis is often expressed. The granular layer is expanded, of uneven thickness, and consists of 1-4 rows of cells. Granular epithelial cells are often vacuolated. In the upper part of the dermis there are edema, vasodilation, perivascular infiltrates. M. Larregue et al. (1983) note. That follicular keratosis and perivacular infiltrates are not always pronounced. Histochemical study revealed an increase in the activity of hydrolytic enzymes and a positive reaction to phospholipids in the oral layer. An electron microscopic study revealed a moderate increase in the activity of azyl epithelial cells, an expansion of intercellular spaces, a decrease in the number of tonofilament and desmosomes. The granular layer is enlarged, according to L. Kanerva et al. (1983), has up to 9 rows. Keratogialine granules are largely unchanged, but there are areas of their disaggregation. The number of lamellar granules is increased, especially in intercellular spaces. Between the granular and horny layers there are 1-2 rows of nukeratatotic cells - the transition zone. According to O. Braun-Falco et al. (1983), consisting of 3 series. Microvasculature vessels are characterized by increased activity of endotheliocytes and pericytes containing a large number of organelles. Basal layer consists mainly of amorphous substance. Deposits of the same substance are noted under the basement membrane of the epidermis, which may be associated with exudative processes. Horny scales contain many lipid drops, which distinguishes this disease from other keratoses.

Histogenesis. In addition to diffuse parakeratosis, follicular hyperkeratosis is expressed. In the process of keratinization occurring in the epidermis and hair follicles, many enzymes participate. At the same time, the formation in the hair follicles of a qualitatively different from the keratin of the epidermis - trichogialin also requires the participation of enzymes specific for this type of keratinization. With Devergie's disease, there is probably an enzymatic defect common to both types of keratinization. It is assumed that an important role in the pathogenesis of Devergie's disease is played by vitamin A deficiency or a violation of its metabolism, in particular, a defect in the synthesis of the reionol-binding protein. It was found that the concentration of this protein in the blood of patients is close to normal.

In the differential diagnosis of Devergie's disease and nebulous ichthyosiform erythroderma, clinical features and the type of inheritance are of great importance. A later onset of Devergie's disease, the characteristic color of erythema, islets of unchanged skin on its background, pronounced follicular keratosis, usually help in diagnosis. Due to the vagueness of the histological pattern in these two diseases, an electron microscopic and biochemical study of the skin, especially on n-alkanes, is necessary. It is more difficult to differentiate Devergie's disease from psoriatic erythroderma. However, pronounced follicular hyperkeratosis and granulosis in Leverzhy's disease, massive hyperkeratosis and parakeratosis with more pronounced acanthosis in psoriasis can be distinguishing features of these two diseases.

Treatment of red pityriasis hair follicles

Vitamin A is used in high doses (300,000-400,000 mg per day), neogigason (0.5-1 mg / kg of patient weight), PUVA and Re-PUVA therapy, methotrexate, glucocorticosteroids. External - keratolytic drugs and local corticosteroids.

[1], [2], [3], [4], [5], [6]