Prurigo Pigmentosa and Confluent and Reticulated Papillomatosis a Spectrum of One Disease: A New Case Report

Background: Prurigo Pigmentosa (PP) is a rare inflammatory dermatitis first discovered in 1971. Characterized by a sudden eruption of pruritic reticulated, pink-brown papules coalescing into plaques distributed symmetrically over shoulders, neck, chest, and back. Various triggers have been identified, including the ketogenic diet. Clinicopathological presentation looks similar to confluent and reticulated papillomatosis (CARP) which is a rare dermatosis of unknown etiology characterized by hyperkeratotic pigmented papules & peripheral reticulation involving seborrheic areas. Aim: To document a new case presentation of PP caused by a low-carbohydrate restricted diet and discuss the comparison with CARP clinically, pathologically, and treatment modalities. Case report: A 15-year-old childhood male developed PP 3 weeks after self-initiating a low carbohydrate-restricted ketogenic diet for weight management. Clinically and histopathologically the lesion looks similar to CARP, treated successfully with re-introduction of high carbohydrates in his food, a short course of systemic steroids in combination with oral doxycycline capsules for the one-month duration. Conclusion: PP & CARP have been considered a spectrum of one disease, and PP is a pruritic variant from CARP caused by a low carbohydrate-restricted diet.

Effects of Qingre Huoxue Jiedu Formula on Nerve Growth Factor-Induced Psoriasis

Objective:To elucidate the mechanisms of 4 effective components from a Chinese medicine formula,namely Qingre Huoxue Jiedu Formula(QHJ heat-and toxin-clearing and blood-activating formula),in the treatment of nerve growth factor(NGF)-induced psoriasis.Methods:Keratinocyte proliferation and T cell proliferation models were developed using NGF.An NGF solution(NGF+DMEM,100 ng/mL)was added to all induced groups and treated groups and were cultured for 24 h,while a solution with NTRK1 antagonist(K252 a+DEME,300 nmol/L)was added and cultured for 1 h.The models were used to evaluate the effects of the treatment with each of the 4 components of QHJ,namely shikonin,paeonol,astilbin and ursolic acid.Cell apoptosis and proliferation were measured by flow cytometry analysis and CCK8 assay,respectively.The mRNA expression levels of Bax,Bcl-xl,and NGF receptor(NGFR)were assessed by quantitative real-time PCR(qRT-PCR)and Western blot analysis,respectively.Results:(1)All QHJ-treated groups showed significantly increased cell apoptosis and inhibition of cell proliferation compared with the NGF-induced groups(P<0.05).In addition,treatment with QHJ plus NTRK1 significantly enhanced cell apoptosis and inhibition of cell proliferation compared with cells treated with QHJ only(P<0.05),particularly in cells treated with ursolic acid.(2)QHJ-treated groups showed higher protein expression levels of Bax,Bcl-xl compared with other groups(P<0.05).Additionally,treatment with QHJ plus NTRK1 significantly increased the protein expression levels of Bax,Bcl-xl and NGFR compared with those treated with QHJ only(all P<0.05),especially in those treated with shikonin.Conclusion:The action mechanism of QHJ on psoriasis might be through enhancing cell apoptosis and inhibition of cell proliferation,and upregulating the expression level of Bax,Bcl-xl and NGFR.