Pityriasis amiantacea associated with Staphylococcus aureus super-infection in Bedouin patients

Pityriasis amiantacea (PA) is an inflammatory disease of the scalp characterized by asbestos-like shiny scales that bind to the proximal part of the hair shaft. PA may be an isolated disorder or a reaction pattern associated with other inflammatory disorders. Previous reports did not demonstrate a clear association between PA and bacterial infections. A controlled prospective study was performed to identify the role of bacterial skin infections in patients with PA. In all patients, bacterial cultures were taken from the scalp. A group of 32 patients with various other scalp disorders served as a control group. Thirty-two patients were included in the study. There were 30 women (93.8%) and 2 men (6.2%) with a mean age of 23.1 years (SD 11.9 years). Twenty-five patients (78.1%) were of Bedouin origin and 7 were of Jewish origin (21.9%). Staphylococcus aureus was isolated in 26 patients with PA (81.3%) as compared with 1 patient (3.1%) from the control group (p =0.0001). The patients were treated by a combined regimen that included systemic and topical antibiotics and topical application of corticosteroids and coal tar. All patients responded to the treatment regimen. None of the 15 patients who were available for follow-up 1 year later developed scarring alopecia. In our study, it was observed that PA was associated with S. aureus infection, particularly in young women of Bedouin origin. According to our experience, we recommend treating patients with PA with appropriate antibiotics, topical corticosteroids and coal tar.