Published in the Dermatology Online Journal December 2011
I actually really feel terrible for the first patient because she had this rash off and on for 2 years and underwent multiple skin biopsies… which led to her being misdiagnosed with herpes simplex virus for which she was treated unsuccessfully with anti-viral medications (oral acyclovir, valcyclovir, and topical acyclovir) as well as topical corticosteroids with no improvement.
It wasn’t until she was successfully treated with Minocycline (100 mg daily for 3 weeks) that they put everything together and figured out that she had prurigo pigmentosa. The third picture nicely illustrates the type of residual hyperpigmentation that can occur with treatment of this rash. When they followed up with her after 3 years she was still symptom free.
The second patient in this paper was a woman of Chinese descent with a 3 year history of this rash. She was misdiagnosed with eczema and treated with both topical corticosteroids and oral corticosteroids which wasn’t of much help. She too underwent a skin biopsy with similar findings as the first patient. Eventually she was treated with Minocycline (100 mg daily for 2 weeks) with success.
When they followed up with her 10 months after treatment there was no recurrence of the rash, and only some residual hyperpigmentation.
They specifically mentioned that the first patient had normal blood glucose and no elevation of blood ketones and while the second patient wasn’t tested for these things, there “were no clinical signs or symptoms to suspect abnormalities of serum glucose or ketones.”
There was no mention was made of dieting or weight loss as potential causes in these women, and the authors never go into what they thought was the cause in these cases.
The main take away for me from this study was that treatment with minocycline seemed to have a lasting effect on the rash.
So, while this goes against the findings in the study looking at 50 Koreans which had a much larger sample size, there’s still hope that antibiotics can do the trick permanently!