Clinical Picture

It can affect any age and both sexes. It predominates in men 2:1. It is more frequent in men between 20 to 45 years of age, and it also has been observed in children and even in nursing infants. The frequency under 10 years of age varies from 1% to 11% (Br J Dermatol. 1996; 134(Suppl 46): 7-11). There is a family history in 19%. The lesion has a centripetal distribution on the thorax, back and proximal parts of the extremities. Infrequently it appears on the neck, forearms, or distal portion of extremities (Fig. 2.1). In children it can affect the face, forehead, and preauricular areas (Fig. 2.2), and in nursing infants the diaper area (Pediatr Dermatol 1991; 8:9-12).

Clinically abundant, lenticular hypochromic and brown or pink macules are present. Their size varies from 2-4 mm in diameter, or even up to 1 or 2 cm. They are covered by furfuraceous scaling, and they can be confluent forming large plaques (Figs. 2.1-2.3). Sometimes there are follicular lesions. Lesions are often chronic and asymptomatic. Occasionally there is mild pruritus. In immune-compromised hosts, it affects unusual areas like the head and genitals. If the lesions are rubbed with a curette or a fingernail, a mark is seen on the skin created by the detachment of the scales (Besnier's or scratch sign).

The folliculitis caused by Malassezia (Pityrosporum) affects young people taking glucocorticoids or systemic antibiotics (tetracycline), diabetics and AIDS patients. It can be seen just with the use of occlusive clothing. It presents as pruritic follicular papules with keratotic plugs and pustules. Systemic infection is unusual. It has been observed in newborns and in patients with IV catheters. The relationship between confluent and reticulated papillomatosis is controversial and may be due to the hyperkeratosis.

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