Pityriasis amiantacea L21.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Asbestos Beef; contagious follicular keratosis; Dough amiantacé; Fist dough amiantacé; impetigo scabida; keratosis follicularis amiantacea; porrigo amiantacea; Taenia amiantacea; tonina amiantacea

Definition
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Polyätiological clinical picture of the capillitium with the formation of asbestos-like, micaceous, grey-white shimmering, dry or greasy scaly deposits, which surround the head hair in different lengths. The disease is often accompanied by tuft-like hair loss.

Etiopathogenesis
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Polyätiological, e.g. occurring in seborrhoea, atopic eczema, pediculosis, impetigo, psoriasis vulgaris

Complication(s)
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If untreated asbestos-infested scalps remain untreated for a longer period of time, irreversible hair loss can occur. The hair falls out in clumps or can be easily and painlessly pulled out of the scalp.

External therapy
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  • Scaling therapy with salicylic acid-containing external agents such as 10% salicylic acid oil/ointment (Rp221) or salicylic acid oil 2/5 or 10% with triamcinolone acetonide 0.1%. The oil containing salicylic acid should be spread generously on the scalp. Then cover the entire capillitium for several hours with a foil, as final as possible, and fix it with a tubular bandage (a towelling cap or a cotton cap, also a surgical cap is sufficient). Repeat the identical procedure the following day; after 2-3 days (also possible daily) wash out the hair thoroughly. Rising scales can be combed out with a large comb without a firm pull.
  • Alternative: After this keratolytic primary treatment, an occlusive treatment with topical glucocorticoids in O/W bases, such as triamcinolone cream(e.g. Triamgalen, Rp259 ) or a glucocorticoid-containing gel such as 0.05% betamethasone gel (e.g. Diprosis gel) has proven to be effective. Afterwards, again remove scaly plaques mechanically.
  • Alternatively: local application with a tar-containing external agent (5%-10% Liquor carnbonis detergens in Lygal ointment).
  • Subsequently, the formation of psoriatic plaques should be reduced by keratolytic maintenance therapy (once/week, possibly every 2 weeks). Additionally, special anti-dandruff shampoos (e.g. de-Squam®, Almirall). An alternative would be a shampoo containing tar (e.g. Tarmed® shampoo with 4% tar added; available again on prescription since June 2015).
  • Remark: It is important to draw the patients' attention to the fact that pityriasis amiantacea is often accompanied by hair loss, which can become more noticeable in a phase of intensified local therapy.

Literature
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  1. Abdel-Hamid IA et al (2003) Pityriasis amiantacea: a clinical and etiopathologic study of 85 patients. Int J Dermatol 42: 260-264
  2. Bettencourt MS, Olsen EA (1999) Pityriasis amiantacea: a report of two cases in adults. Cutis 64: 187-189
  3. Ginarte M (2000) Case Reports. Pityriasis amiantacea as manifestation of tinea capitis due to Microsporum canis. Mycoses 43: 93-96
  4. Gschwandter WR (1973) Porrigo amiantacea (Pityriasis amiantacea). dermatologist 256: 134-139

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020