A 50-year-old Angolan woman living in Portugal for 2 years presented to our department with a 1-year history of brownish, scaly round patches on her thighs. Her medical history included type II diabetes mellitus, arterial hypertension and dyslipidaemia for approximately 3 years, active smoking and iron deficiency anaemia due to menstrual losses. She did not have relevant family medical history or any previous skin disease. The lesions appeared 1 month after an episode of inaugural unstable angina that required the introduction of acetylsalicylic acid, ticagrelor, carvedilol and nitroglycerin to her usual medications of atorvastatin, lisinopril and metformin. The patches were asymptomatic, started on one thigh and progressed over months to both thighs and lower back, expanding also in size. Cutaneous examination revealed 15 hyperpigmented well-defined perfectly circular patches 1 to 20 cm in diameter on both thighs, buttocks and also the lower back. These lesions were dry and slightly scaly and had no erythema or induration, and some were coalesced (Fig. 1). There were no other skin, mucosal or adnexal changes. Skin biopsy showed hyperkeratosis, follicular plugging, areas of diminished or absent granular layer, hyperpigmentation of the basal layer and a sparse perivascular infiltrate of lymphocytes in the dermis (Fig. 2). Periodic acid–Schiff stain was negative for fungus. The diagnosis of pityriasis rotunda was made based on the clinical and histopathological features. Further investigation to rule out systemic diseases possibly associated with pityriasis rotunda revealed hepatitis C, and the patient was further referred to a gastroenterologist. Hepatocellular carcinoma and cirrhosis were excluded. The patient was not able to establish the source of possible viral transmission. The patient was initially treated with once daily betamethasone dipropionate (0.05%) for 1 month, with no improvement, and later with a twice daily sodium lactate containing emollient, with good results after 2 months. Pityriasis rotunda is a rare disorder with unknown pathogenesis characterised by ichthyosiform well-defined circular-shaped patches or plaques of different sizes, usually on the trunk and proximal parts of the limbs. Considered a disorder of keratinisation, pityriasis rotunda has been associated with systemic diseases, such as malignancies (mainly hepatocellular carcinoma, but also gastric and oesophagus carcinomas and haematological malignancies), infections (tuberculosis and leprosy), diabetes mellitus, hepatic cirrhosis and pulmonary or cardiac diseases, although these associations may be due to chance. In this case, the development of pityriasis rotunda could be related to the episode of unstable angina, to the hepatitis C or to the patient’s previous medical history. Most cases of pityriasis rotunda are reported in Japan, West India and South African black people, but familial cases have been observed in Mediterranean patients. Treatment with topical corticosteroids, emollients, tars, keratolytics and retinoids has variable results among studies, and treating the underlying causative systemic disease may lead to the resolution of the cutaneous lesions.

中文翻译：

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圆形糠疹

一名在葡萄牙居住 2 年的 50 岁安哥拉妇女因大腿上褐色鳞状圆形斑块 1 年就诊于我们科。她的病史包括大约 3 年的 II 型糖尿病、动脉高血压和血脂异常、主动吸烟和月经量减少导致的缺铁性贫血。她没有相关的家族病史或任何皮肤病史。病变出现在首次不稳定型心绞痛发作后 1 个月，需要在她常用的阿托伐他汀、赖诺普利和二甲双胍药物中加入乙酰水杨酸、替格瑞洛、卡维地洛和硝酸甘油。这些斑块是无症状的，从一只大腿开始，几个月后发展到大腿和下背部，尺寸也扩大了。皮肤检查发现大腿、臀部和下背部有 15 个色素沉着过度的完美圆形斑块，直径为 1 至 20 厘米。这些病灶干燥且略呈鳞状，无红斑或硬结，部分合并（图 1）。没有其他皮肤、粘膜或附件改变。皮肤活检显示角化过度、毛囊堵塞、颗粒层减少或缺失区域、基底层色素沉着过度和真皮中淋巴细胞的稀疏血管周围浸润（图 2）。过碘酸-希夫染色对真菌呈阴性。圆形糠疹的诊断是基于临床和组织病理学特征。进一步调查以排除可能与圆形糠疹相关的全身性疾病显示丙型肝炎，病人被进一步转诊给胃肠病学家。排除肝细胞癌和肝硬化。患者无法确定可能的病毒传播来源。该患者最初每天服用一次二丙酸倍他米松 (0.05%) 治疗 1 个月，没有任何改善，后来每天服用两次含有润肤剂的乳酸钠，2 个月后效果良好。圆形糠疹是一种发病机制不明的罕见疾病，其特征是鱼鳞病状明确的圆形斑块或不同大小的斑块，通常位于躯干和四肢近端。圆形糠疹被认为是一种角化障碍，与全身性疾病有关，例如恶性肿瘤（主要是肝细胞癌、以及胃癌和食道癌以及血液系统恶性肿瘤）、感染（肺结核和麻风病）、糖尿病、肝硬化和肺或心脏疾病，尽管这些关联可能是偶然的。在这种情况下，圆形糠疹的发生可能与不稳定型心绞痛发作、丙型肝炎或患者既往病史有关。大多数圆形糠疹病例在日本、西印度和南非黑人中报告，但在地中海患者中观察到家族性病例。使用局部皮质类固醇、润肤剂、焦油、角质层分离剂和类视黄醇进行治疗的研究结果各不相同，治疗潜在的全身性疾病可能会导致皮肤病变的消退。糖尿病、肝硬化和肺部或心脏疾病，尽管这些关联可能是偶然的。在这种情况下，圆形糠疹的发生可能与不稳定型心绞痛发作、丙型肝炎或患者既往病史有关。大多数圆形糠疹病例在日本、西印度和南非黑人中报告，但在地中海患者中观察到家族性病例。使用局部皮质类固醇、润肤剂、焦油、角质层分离剂和类视黄醇进行治疗的研究结果各不相同，治疗潜在的全身性疾病可能会导致皮肤病变的消退。糖尿病、肝硬化和肺部或心脏疾病，尽管这些关联可能是偶然的。在这种情况下，圆形糠疹的发生可能与不稳定型心绞痛发作、丙型肝炎或患者既往病史有关。大多数圆形糠疹病例在日本、西印度和南非黑人中报告，但在地中海患者中观察到家族性病例。使用局部皮质类固醇、润肤剂、焦油、角质层分离剂和类视黄醇进行治疗的研究结果各不相同，治疗潜在的全身性疾病可能会导致皮肤病变的消退。圆形糠疹的发生可能与不稳定型心绞痛发作、丙型肝炎或患者既往病史有关。大多数圆形糠疹病例在日本、西印度和南非黑人中报告，但在地中海患者中观察到家族性病例。使用局部皮质类固醇、润肤剂、焦油、角质层分离剂和类视黄醇进行治疗的研究结果各不相同，治疗潜在的全身性疾病可能会导致皮肤病变的消退。圆形糠疹的发生可能与不稳定型心绞痛发作、丙型肝炎或患者既往病史有关。大多数圆形糠疹病例在日本、西印度和南非黑人中报告，但在地中海患者中观察到家族性病例。使用局部皮质类固醇、润肤剂、焦油、角质层分离剂和类视黄醇进行治疗的研究结果各不相同，治疗潜在的全身性疾病可能会导致皮肤病变的消退。