Clinical, metabolic, dermoscopic, and reflectance confocal microscopy features of prurigo pigmentosa: a retrospective case series.
- 1Department of Dermatology, Yijishan Hospital, the First Affiliated Hospital of Wannan Medical University, Wuhu, China.
Abstract
Background
Prurigo pigmentosa (PP) is a chronic, recurrent inflammatory dermatitis with nonspecific stage-dependent clinical features, leading to misdiagnosis. Noninvasive imaging may complement clinical and histopathological assessment. Metabolic abnormalities have been reported in PP, although their clinical significance remains unclear.Objectives
To characterize the clinical, metabolic, dermoscopic, and reflectance confocal microscopy (RCM) features of PP and reduce misdiagnosis.Methods
We retrospectively reviewed patients with histopathologically confirmed PP and available metabolic screening data from July 2020 to April 2026. Clinical, dermoscopic, RCM, laboratory, treatment, and follow-up data were extracted from medical records.Results
Nine women aged 17-33 years had seasonal eruptions (June-September). Seven reported dietary triggers, including caloric restriction in four and ketogenic diets in three. Disease duration ranged from 0.5 to 37 months, with initial misdiagnoses as eczema or contact dermatitis. Metabolic abnormalities included dyslipidemia (n=8), type 2 diabetes (n=3), elevated urinary ketones (n=3), hepatic steatosis (n=7), and elevated body mass index (n=7). Lesions were classified as early (n=3), fully developed (n=5), and late stage (n=1). Dermoscopy identified punctate, linear, and reticular vascular patterns with granular, patchy, or honeycomb-like brown pigmentation. RCM revealed epidermal spongiosis, basal cell degeneration, melanophage infiltration, and dermal inflammatory infiltrates.Conclusion
Nonspecific features and coexistence of lesions at different stages contribute to diagnostic difficulty. Dermoscopy and RCM may provide complementary noninvasive information for clinical and histopathological evaluation. Metabolic screening may be considered in patients with recurrent disease, dietary triggers, elevated BMI, ketonuria, or suspected lipid/glucose metabolism abnormalities.
Related
- Monitoring the Response to JAK Inhibitor Treatment in Alopecia Areata Using Reflectance Confocal Microscopy and Videotrichoscopy: A 60-Week Observational Study
- AI-Assisted Quantitative Reflectance Confocal Microscopy Reveals Modulation of Senescence-Associated Epidermal Morphometric Features by a Topical TGF-β Mimetic, XEP™-716 Miniprotein™
- Clinical and Dermoscopic Features of Subungual Hemorrhage: A Retrospective Study of 420 Cases
- Peripheral Vascular Alterations in USH2A-Retinitis Pigmentosa and Relationship with Macular Involvement: A Cross-Sectional Study
- Retinal Flattening Associated With Photoreceptor Degeneration Leads to the Formation of Staphyloma-Like Morphology in Retinitis Pigmentosa
BibTeX
@article{tan2026clinical,
title = {{Clinical, metabolic, dermoscopic, and reflectance confocal microscopy features of prurigo pigmentosa: a retrospective case series.}},
author = {Meng-Jun Tan and Xiao-Li Chang and Sai-Nan Wang and Fan Wang and Wang-Yu Zhang and Lu Xiao-Hong and Di Qiang and Yuan Tao and Cai-Feng He},
journal = {Annals of medicine},
year = {2026},
month = oct,
doi = {10.1080/07853890.2026.2751276},
url = {https://europepmc.org/article/MED/42954816},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Clinical, metabolic, dermoscopic, and reflectance confocal microscopy features of prurigo pigmentosa: a retrospective case series.
AU - Meng-Jun Tan
AU - Xiao-Li Chang
AU - Sai-Nan Wang
AU - Fan Wang
AU - Wang-Yu Zhang
AU - Lu Xiao-Hong
AU - Di Qiang
AU - Yuan Tao
AU - Cai-Feng He
PY - 2026
DA - 2026/10/29
JO - Annals of medicine
DO - 10.1080/07853890.2026.2751276
UR - https://europepmc.org/article/MED/42954816
AB - Background Prurigo pigmentosa (PP) is a chronic, recurrent inflammatory dermatitis with nonspecific stage-dependent clinical features, leading to misdiagnosis. Noninvasive imaging may complement clinical and histopathological assessment. Metabolic abnormalities have been reported in PP, although their clinical significance remains unclear.Objectives To characterize the clinical, metabolic, dermoscopic, and reflectance confocal microscopy (RCM) features of PP and reduce misdiagnosis.Methods We retrospectively reviewed patients with histopathologically confirmed PP and available metabolic screening data from July 2020 to April 2026. Clinical, dermoscopic, RCM, laboratory, treatment, and follow-up data were extracted from medical records.Results Nine women aged 17-33 years had seasonal eruptions (June-September). Seven reported dietary triggers, including caloric restriction in four and ketogenic diets in three. Disease duration ranged from 0.5 to 37 months, with initial misdiagnoses as eczema or contact dermatitis. Metabolic abnormalities included dyslipidemia (n=8), type 2 diabetes (n=3), elevated urinary ketones (n=3), hepatic steatosis (n=7), and elevated body mass index (n=7). Lesions were classified as early (n=3), fully developed (n=5), and late stage (n=1). Dermoscopy identified punctate, linear, and reticular vascular patterns with granular, patchy, or honeycomb-like brown pigmentation. RCM revealed epidermal spongiosis, basal cell degeneration, melanophage infiltration, and dermal inflammatory infiltrates.Conclusion Nonspecific features and coexistence of lesions at different stages contribute to diagnostic difficulty. Dermoscopy and RCM may provide complementary noninvasive information for clinical and histopathological evaluation. Metabolic screening may be considered in patients with recurrent disease, dietary triggers, elevated BMI, ketonuria, or suspected lipid/glucose metabolism abnormalities.
SN - 0785-3890
SN - 1365-2060
ER -