Correspondence Address:
Durga Madhab Tripathy
Department of Dermatology, Military Hospital, Agra, Uttar Pradesh
India

Full Text



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}{Figure 2}

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

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