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E-IJD® - CORRESPONDENCE
Year : 2022  |  Volume : 67  |  Issue : 5  |  Page : 627
Pityriasis versicolor with 'Deck Chair' sign


1 Department of Dermatology, Military Hospital, Agra, Uttar Pradesh, India
2 Department of Dermatology, Motilal Nehru Medical College, Allahabad, Uttar Pradesh, India
3 Department of Dermatology, CHAF, Bengaluru, Karnataka, India
4 Department of Dermatology, Command Hospital, Bengaluru, Karnataka, India

Date of Web Publication29-Dec-2022

Correspondence Address:
Durga Madhab Tripathy
Department of Dermatology, Military Hospital, Agra, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_201_22

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How to cite this article:
Saraswat N, Kumar S, Tripathy DM, Mitra D, Kothari R. Pityriasis versicolor with 'Deck Chair' sign. Indian J Dermatol 2022;67:627

How to cite this URL:
Saraswat N, Kumar S, Tripathy DM, Mitra D, Kothari R. Pityriasis versicolor with 'Deck Chair' sign. Indian J Dermatol [serial online] 2022 [cited 2023 Feb 8];67:627. Available from: https://www.e-ijd.org/text.asp?2022/67/5/627/366108




Sir,

Deck chair sign is a specific clinical pattern characterized by selective sparing of natural skin folds resembling the spline of a deck chair.[1] Although originally described in Papulo-erythroderma of Ofuji (PEO), it is not exclusive to it and is seen in numerous other conditions.[2] We report 'deck chair sign' in a case of pityriasis versicolor (PV).

A 54-year-old Indian male reported to dermatology OPD with complaints of multiple asymptomatic progressive dark coloured patches on the abdomen of three months duration. Such lesions were not present anywhere else in the body, and there were no associated constitutional or systemic symptoms. Dermatological examination revealed multiple polysized brownish coalescing macules distributed over the anterior abdominal wall with selective sparing of the abdominal folds depicting the 'deck chair' sign [Figure 1]. On scratching with a fingernail, bran-like scales stands out from the macules. The rest of the dermatological and systemic examinations were unremarkable. Woods lamp examination of the macules had yellow fluorescence. A 10% potassium hydroxide mount of the scales shows a characteristic 'spaghetti and meatball' appearance confirming the diagnosis of pityriasis versicolor [Figure 2]. The patient was managed with systemic and topical antifungals to which he had an excellent response with near-total remission.
Figure 1: Multiple polysized brownish coalescing macules distributed over the anterior abdominal wall with selective sparing of the abdominal folds depicting the “deck chair” sign

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Figure 2: 10% Potassium hydroxide mount of the scales shows a characteristic “spaghetti and meatball” appearance confirming the diagnosis of pityriasis versicolor (Indicated by black arrows)

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Pityriasis versicolor is a superficial fungal infection caused by Malassezia spp involving the stratum corneum and tends to re-occur. It is commoner in the tropics than in temperate countries, with the peak incidence in the early 20s. It conventionally presents with the hyper or hypo-pigmented lesion, but rarely an inverse (involving the flexures) or erythrasmoid variant can also occur. Clinical diagnosis of PV can be confirmed with the help of Woods lamp examination, which shows golden yellow fluorescence and 10% Potassium hydroxide (KOH) mount showing a spaghetti and meatball appearance.[3],[4]

Deck chair sign was first described in Papulo-erythroderma of Ofuji (PEO), an inflammatory dermatosis that is characterized by coalescence of widespread papules, which typically spares skin folds, ante-cubital and axillary areas.[5] However, this sign is not exclusive to this disease, and several other inflammatory and infective conditions have demonstrated this sign. To date, this sign is seen in lepromatous leprosy, generalized malignant acanthosis nigricans, angioimmunoblastic T cell lymphoma, parthenium dermatitis, Waldenstrom's macroglobulinemia and lichen aureus.[4] Multiple proposed hypotheses have been suggested, which include accentuated topical steroid action in folds seen in inflammatory dermatoses described as the 'occlusive dressing effect' and folds being warm areas are spared by the lepra bacilli in Hansen's disease.[5] We propose unidentified innate immunological factors in sweat might have a potential antifungal effect on Malassezia, preventing the involvement of folds. In the index case, the deck chair sign was evident, and to the best of our knowledge, it is the first reported case of this sign in pityriasis versicolor.

Acknowledgements

The patient in the manuscript has given written informed consent to the publication of case details and photographs.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
van Rhijn BD, van Ruth S, Balak DM. Deck-chair sign: Unreserved. Clin Exp Dermatol 2021;46:560-1.  Back to cited text no. 1
    
2.
Bettoli V, Pizzigoni S, Borghi A, Virgili A. Ofuji papulo-erythroderma: A reappraisal of the deck-chair sign. Dermatology 2004;209:1-4.  Back to cited text no. 2
    
3.
Ghosh SK, Dey SK, Saha I, Barbhuiya JN, Ghosh A, Roy AK. Pityriasis versicolor: A clinicomycological and epidemiological study from a tertiary care hospital. Indian J Dermatol 2008;53:182-5.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Amin SS, Qamar H, Adil M, Mohtashim M, Mushtaq S, Agrawal D. Generalized Parthenium dermatitis with deck-chair sign. G Ital Dermatol Venereol 2020;155:368-70.  Back to cited text no. 4
    
5.
Shenoy MM, Bendigeri MA, Kamath PR, Vishal B. Diffuse leprosy with “deck-chair” sign. Indian Dermatol Online J 2015;6:204-6.  Back to cited text no. 5
[PUBMED]  [Full text]  


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