Received Date: March 12, 2015; Accepted Date: April 09, 2015; Published Date: April 13, 2015
Citation: Pranteda G, Abruzzese C, Tuzi M, Pranteda G, Sperandeo E et al. (2015) Transitory Acquired Flagellate Ictyosis, an Easy Treatment. J Clin Exp Dermatol Res 6:276. doi: 10.4172/2155-9554.1000276
Copyright: © 2015 Pranteda G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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We described the case of 45 years-old woman affected by a flagellate dermatitis arisen immediately after having a bath in sulfurous thermal water. Such dermopathy resolved after a common scratching of the lesions by the patient, so that the possible pathogenetic mechanism to explain the resolution of the lesions is the mechanical removal of cornified cell layer. After six months follow-up, the patient is in good conditions, without relapses of the flagellate dermatitis.
Flagellate dermatitis, Sulfurous thermal water
Flagellate dermatitis is a cutaneous disease usually related to specific drugs as bleomycin or other chemotherapies.
The term “flagellate” is linked to the particular arrangement and morphology of the lesions, suggesting cutaneous signs deriving from tortures or sadomasochistic sexual practices.
In July 2014, 45 years-old healthy woman, with a light xerotic skin, presented some linear and differently oriented pigmented macules with a flagellate shape, localized on her lower limbs, arisen after having a bath in sulfurous thermal water (Figure 1, Table 1).
|Parameter||Unit of measure||Methodical||Result|
|Temperature at the source||°C||Method APAT IRSA/CNR ed. 29/2003 n°2100||24,0|
|Concentration of hydrogen ions to the water temperature at the source||Unit of pH||Method APAT IRSA/CNR ed. 29/2003 n°2060||6,34|
|Silica||mg/L||Method APAT IRSA/CNR ed. 29/2003 n°3020||48,1|
|Hydrocarbon ions||mg/L||Method APAT IRSA/CNR ed. 29/2003 n° 2010||1,531|
|Chloride ions||mg/L||Method APAT IRSA/CNR ed. 29/2003 n°4090° A1||163|
|Sulphate ions||mg/L||Method APAT IRSA/CNR ed. 29/2003 n°4140||905|
|sodium ions||mg/L||Method APAT IRSA/CNR ed. 29/2003 n°3020||164|
|potassium ions||mg/L||Method APAT IRSA/CNR ed. 29/2003 n°3020||36,0|
|Calcium ions||mg/L||Method APAT IRSA/CNR ed. 29/2003 n°3020||721|
|Magnesium ions||mg/L||Method APAT IRSA/CNR ed. 29/2003 n°3020||159|
|Iron ions (dissolved)||mg/L||Method APAT IRSA/CNR ed. 29/2003 n°3020||2,0|
|Ammonium ions||mg/L||Method APAT IRSA/CNR ed. 29/2003 n°4030||2,60|
|Iodide ions||mg/L||Standard Methods 20th edition method 4500 - I- C||0,04|
Table 1: Main components of thermal water that causes flagellate dermatitis in our patient. Note the high concentration of sulphate ions.
The same lesions had appeared slightly also two weeks before, after having the same bath. In both events the patient, on her own initiative, superficially scratched the macules immediately after the bath, removing cornified material with the resolution of the dermatitis (Figure 2).
The patient denied any assumption of drugs, or contact with grass and stinging substances before the appearing of the dermatitis. The clinical history of the patient was negative for any cutaneous or systemic diseases and haematochymic exams we performed were all in the normal range.
When we observed the lesions appeared in the second event, we had taken a sample of cornified material, treated with potassium hydroxide solution and we noticed the presence of cornified cells. The patient referred she had never bathed in sulfurous thermal water again, and after six months follow-up, she had no relapses of the flagellate dermatitis.
The pathogenetic mechanism of typical flagellate dermatoses is not well-known, even if an increased melanogenetic process or an increased epidermic cell turnover are the main causes described in literature [2,7].
Thermal waters generally have healthy effects for skin, due to their chemical components; in fact they are used in different cutaneous diseases, like psoriasis, seborrheic dermatitis, eczematous dermatitis, Still’s disease and many others [8-12].
Sulfurous water, a particular type of thermal water, is composed by both ionic and combined sulfur.
Into the skin, sulfur interacts with cysteine rich elements and its catabolites, favouring an antinflammatory, antipruriginous and prodifferentiative action. Moreover, sulfur reacts with free oxygen radicals, producing hydrogen sulfide that has an antimicrobic and antimycotic action. Concerning to keratinocyte differentiation process, sulfur generates the thickening of malpighian layer [13-15].
We hypothesize that this latter effect of sulfur on skin is responsible for the cutaneous lesions on our patient. The flagellate shape and the single involvement of the lower limbs are more difficult to explain. Because of the quick disappearing of the dermatitis, we couldn’t perform histological examination of the lesions but only a scratching of the superficial layer that showed desquamative cornified cells by light microscopy.
We named the described dermatitis “Transitory Acquired Flagellate Ichthyosis”, because the scratching spontaneously induced by the patien, resolved the dermatitis in both cases so we suppose that an increased number of cornified cells accumulates on epidermal superficial layers.
More studies are necessary; to better identify this new nosologic entity.