Challenging Diagnosis: Prurigo Pigmentosa in a Morbidly Obese Male Patient after a Starvation Diet - A Case Report

Abstract

Prurigo pigmentosa (PP) is a skin inflammatory disorder that primarily impacts adolescents and young adults, and its cause is unknown. This case report presents a 35-year-old morbidly obese Arab male patient who developed a pruritic rash on his chest, back, neck, and face after following a starvation diet (75-125 calories/day). The rash appeared as macular spots and rapidly spread in a reticular-like pattern. The patient had a history of a similar rash 11 years ago when following a similar diet, which improved after modifying the diet. Despite recommendations to stop the diet, the patient barely agreed to modify his diet into a Very Low-Calorie Diet (VLCD) under physician supervision. Eventually, the itch disappeared a few days after diet modification only and the rash gradually faded and subsided after 8 weeks from the last day of the starvation diet.