0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Observation |

Parthenium Dermatitis With Deck-Chair Sign FREE

Sathish Pai, MD1; Shricharith Shetty, MD1; Raghavendra Rao, MD1
[+] Author Affiliations
1Department of Dermatology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
JAMA Dermatol. 2015;151(8):906-907. doi:10.1001/jamadermatol.2015.0494.
Text Size: A A A
Published online

Deck-chair sign is a clinical pattern observed in patients with erythroderma characterized by a selective sparing of skin folds like axillary, inguinal, submammary, and flexures, classically described with papuloerythroderma of Ofuji (PEO).1 Herein we describe a case of parthenium dermatitis in which deck-chair sign was noted.

REPORT OF A CASE

A 75-year-old man from India, a farmer by occupation, presented to the dermatology department for evaluation of generalized itchy red skin eruptions present for 1 month. He had 5-year history of recurrent episodes of pruritic nonexudative erythematous papules on the face, neck, and hands, symptoms worsening in the summer months. He also had a history of regular contact with parthenium during his work. Patient did not have a personal or family history of atopy. There were no constitutional or systemic symptoms. Physical examination revealed widely spread erythematous papules, many of which were coalescing to form plaques. Well-demarcated sparing of abdominal folds, preaxillary folds, and genital areas was noted, producing deck-chair sign (Figure). Findings of systemic examination were unremarkable.

Place holder to copy figure label and caption
Figure.
A Case of Parthenium Dermatitis

A, Widespread erythematous papules and plaques on the chest and abdomen. B, Sparing of the abdominal and preaxillar skin folds, producing the deck-chair sign.

Graphic Jump Location

Patch testing with 15% parthenium showed a 2+ positive reaction to parthenium. He was treated with topical and systemic steroids on a tapering dose along with sunscreens and emollients. Oral methylprednisolone was prescribed, 32 mg/d, which was tapered by 4 mg every week. The prescription was later switched to azathioprine, 50 mg/d. Strict photoprotective measures were advised along with regular use of sunscreens.

DISCUSSION

Parthenium hysterophorus can produce a spectrum of clinical patterns. The dermatitis usually presents as itchy, erythematous, papules and plaques on exposed areas of the body like the face, including upper eyelids, side of neck, the “V” of the upper chest, flexures of the forearms, and cubital and popliteal fossae. Parthenium dermatitis commonly begins as an airborne contact dermatitis pattern. Other patterns include chronic actinic dermatitislike, seborrheic dermatitis, prurigo nodularislike, photosensitive lichenoid eruption, and hands-and-feet dermatitis patterns.2 Repeated exacerbations are common due to continued exposure and seasonal variation. In untreated cases, it may gradually spread and eventually progress to erythroderma over variable periods of time. Patch testing helps to determine the cause of the contact dermatitis.

In this patient, we noted characteristic sparing of major skin folds of the abdomen and axillary regions, producing the deck-chair sign. This is a classic sign for PEO, which was first reported by Ofuji et al1 in 1984 to describe 4 cases of papuloerythroderma with flat-topped papules that became generalized erythrodermic plaques with characteristic sparing of skin folds and flexures. Although deck-chair sign is considered pathognomic of PEO, it has also been observed in angioimmunoblastic lymphoma, cutaneous Waldenstrom macroglobulinemia, and acanthosis nigricans.35 In a study of 90 patients with erythroderma, Pal and Haroon6 observed deck-chair sign in 5.5% of the cases. This shows that the deck-chair sign is typical but not pathognomonic of PEO, and it can be seen in a heterogeneous group of cutaneous disorders, including parthenium dermatitis.

ARTICLE INFORMATION

Corresponding Author: Shricharith Shetty, MD, Department of Dermatology, OPD No. 21, Kasturba Medical College Hospital, Manipal, Karnataka, India 576104 (drshricharith@gmail.com).

Published Online: April 29, 2015. doi:10.1001/jamadermatol.2015.0494.

Conflict of Interest Disclosures: None reported.

REFERENCES

Ofuji  S, Furukawa  F, Miyachi  Y, Ohno  S.  Papuloerythroderma. Dermatologica. 1984;169(3):125-130.
PubMed   |  Link to Article
Lakshmi  C, Srinivas  C.  Parthenium the terminator: an update. Indian Dermatol Online J. 2012;3(2):89-100.
PubMed   |  Link to Article
Ferran  M, Gallardo  F, Baena  V, Ferrer  A, Florensa  L, Pujol  RM.  The ‘deck chair sign’ in specific cutaneous involvement by angioimmunoblastic T cell lymphoma. Dermatology. 2006;213(1):50-52.
PubMed   |  Link to Article
Autier  J, Buffet  M, Pinquier  L,  et al.  Cutaneous Waldenstrom’s macroglobulinemia with “deck-chair” sign treated with cyclophosphamide. J Am Acad Dermatol. 2005;52(2)(suppl 1):45-47.
PubMed   |  Link to Article
Murao  K, Sadamoto  Y, Kubo  Y, Arase  S.  Generalized malignant acanthosis nigricans with “deck-chair sign”. Int J Dermatol. 2013;52(3):377-378.
PubMed   |  Link to Article
Pal  S, Haroon  TS.  Erythroderma: a clinico-etiologic study of 90 cases. Int J Dermatol. 1998;37(2):104-107.
PubMed   |  Link to Article

Figures

Place holder to copy figure label and caption
Figure.
A Case of Parthenium Dermatitis

A, Widespread erythematous papules and plaques on the chest and abdomen. B, Sparing of the abdominal and preaxillar skin folds, producing the deck-chair sign.

Graphic Jump Location

Tables

References

Ofuji  S, Furukawa  F, Miyachi  Y, Ohno  S.  Papuloerythroderma. Dermatologica. 1984;169(3):125-130.
PubMed   |  Link to Article
Lakshmi  C, Srinivas  C.  Parthenium the terminator: an update. Indian Dermatol Online J. 2012;3(2):89-100.
PubMed   |  Link to Article
Ferran  M, Gallardo  F, Baena  V, Ferrer  A, Florensa  L, Pujol  RM.  The ‘deck chair sign’ in specific cutaneous involvement by angioimmunoblastic T cell lymphoma. Dermatology. 2006;213(1):50-52.
PubMed   |  Link to Article
Autier  J, Buffet  M, Pinquier  L,  et al.  Cutaneous Waldenstrom’s macroglobulinemia with “deck-chair” sign treated with cyclophosphamide. J Am Acad Dermatol. 2005;52(2)(suppl 1):45-47.
PubMed   |  Link to Article
Murao  K, Sadamoto  Y, Kubo  Y, Arase  S.  Generalized malignant acanthosis nigricans with “deck-chair sign”. Int J Dermatol. 2013;52(3):377-378.
PubMed   |  Link to Article
Pal  S, Haroon  TS.  Erythroderma: a clinico-etiologic study of 90 cases. Int J Dermatol. 1998;37(2):104-107.
PubMed   |  Link to Article

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

608 Views
0 Citations
×

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs