What are the other Names for this Condition? (Also known as/Synonyms)

• Asbestos Scalp
• Keratosis Follicularis Amiantacea
• Tinea Asbestina

What is Pityriasis Amiantacea? (Definition/Background Information)

• Pityriasis Amiantacea is a rare skin disorder of the hair and scalp mostly affecting children. The words describing the disorder indicate “fine scales or flakes” (or pityriasis) and “asbestos” (from French amiante)
• In this disorder, thick yellow/silvery scales resembling shiny asbestos form at the base of hair shafts and clump together tufts of hair. Mild cases of Pityriasis Amiantacea may be localized to a region, although severe cases may cover the entire scalp and lead to permanent hair loss
• Pityriasis Amiantacea is known to develop as a complication of certain skin disorders, such as psoriasis, seborrheic dermatitis, or ringworm infection; or, as a progression of certain scalp infections. In some individuals, the cause of development of Pityriasis Amiantacea is unknown
• A management of Pityriasis Amiantacea involves treating the underlying cause, as well as treating the signs and symptoms. Overall outcomes are based on the nature of the underlying condition and its severity

Who gets Pityriasis Amiantacea? (Age and Sex Distribution)

• Pityriasis Amiantacea may be observed in individuals of a wide age category. However, a large number of cases are reported in children (with onset around 12-13 years of age) and in young adults
• Both males and females are affected, although a predilection for females is reported
• Worldwide, there is no racial or ethnic preference observed. However, Pityriasis Amiantacea is typically an uncommon condition

What are the Risk Factors for Pityriasis Amiantacea? (Predisposing Factors)

Pityriasis Amiantacea may arise secondary to certain skin conditions as a complication; or, it may occur as a progression of other skin conditions. Thus, any of the following conditions may increase one’s risk for Pityriasis Amiantacea:

• Atopic dermatitis
• Lichen simplex
• Pediculosis (due to head lice)
• Psoriasis
• Seborrheic dermatitis
• Streptococcal infection
• Tinea capitis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Pityriasis Amiantacea? (Etiology)

Pityriasis Amiantacea is an inflammatory reaction that results in excessive scaling with penetrance of the hair shafts leading to tufting (clumping of hair). It may be described as a presentation pattern occurring secondary to other skin conditions.

• Underlying conditions, such as scalp psoriasis, atopic eczema, fungal infection of the scalp, or seborrheic dermatitis, among others, may cause Pityriasis Amiantacea as a complication.
• In some cases, no underlying condition is recognized; in such cases, the scalp disorder is termed idiopathic Pityriasis Amiantacea

What are the Signs and Symptoms of Pityriasis Amiantacea?

The signs and symptoms of Pityriasis Amiantacea may vary from one individual to another. It may be mild or severe too. It is observed that between 2-15% of children with Pityriasis Amiantacea may progress to psoriasis, a skin condition that involves the entire body.

The signs and symptoms may include:

• Presence of thick plates of asbestos-like scales on scalp and around each hair shaft
• This may be localized (involving some focal areas of the scalp) or widespread (involving the entire scalp)
• Hair loss or alopecia may be observed in pockets on the scalp - this may be temporary or irreversible
• The thick scaly formations are usually shiny, of yellow or silver discoloration, and binding down tufts of hair

Additional signs and symptoms of the underlying skin condition, if present, may be noted.

How is Pityriasis Amiantacea Diagnosed?

A diagnosis of Pityriasis Amiantacea may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation
• Blood tests, analysis of hair samples, and culture of the fluid being drained (for causative pathogen), as needed
• Fungal culture of the scale and hair shafts
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• KOH microscopic examination of the scale and hairs to exclude fungal infection of the scalp
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy, if required: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Tests and exams to diagnose the underlying condition, if any present, should be undertaken.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Pityriasis Amiantacea?

The possible complications due to Pityriasis Amiantacea include:

• Severe emotional stress due to cosmetic issues
• Superimposed bacterial and fungal skin infections
• Permanent hair loss
• Complications that arise from the underlying skin condition
• Recurrence of the condition
• Treatment complications

How is Pityriasis Amiantacea Treated?

The treatment measures available for Pityriasis Amiantacea mainly involves treating the underlying causative condition. The healthcare provider may recommend the following measures:

• Application of olive oil (or other vegetable/mineral oil) to soften the thick scales making them easier to remove
• Use of pine tar or salicylic acid shampoo to regularly wash the hair
• Application of topical hair and scalp agents
• Oral or systemic antibiotics or antifungals may be prescribed for infections
• In case of a fungal scalp infection, antifungal shampoos, such as ketoconazole, may be recommended
• Skin disorders, such as psoriasis or seborrheic dermatitis, may be treated using topical steroids and other medications

Regular follow up visits with the healthcare provider is important and recommended.

How can Pityriasis Amiantacea be Prevented?

Presently, it may not be able to prevent many cases of Pityriasis Amiantacea.

• However, an early diagnosis and appropriate treatment of underlying skin conditions, such as psoriasis, lichen simplex, or atopic dermatitis, may help minimize the risk for Pityriasis Amiantacea
• Maintain good personal hygiene including regular washing and shampooing of the hair to avoid fungal and bacterial infections

What is the Prognosis of Pityriasis Amiantacea? (Outcomes/Resolutions)

• The overall prognosis of Pityriasis Amiantacea depends on the severity and treatment response of the underlying cause. Chronic underlying conditions may lead to recurrence or persistence of Pityriasis Amiantacea. Also, hair loss may be permanent when associated with chronic conditions
• The prognosis of Pityriasis Amiantacea is generally good with adequate treatment, especially in those individuals with no underlying associated conditions. In such cases, the chances of recurrence are also very minimal

Additional and Relevant Useful Information for Pityriasis Amiantacea:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/