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Abstract
Disorders of hyperpigmentation are common and challenging conditions which can arise due to a myriad of etiologic factors. Many of them can present across skin types but are more common in skin of color individuals with Fitzpatrick skin types III-VI. Facial hyperpigmentation, in particular, can have a significant impact on the quality of life of affected individuals due to its increased visibility. This article provides a comprehensive review of disorders of facial hyperpigmentation including epidemiology, pathogenesis, diagnostic considerations, and treatment approaches for these conditions.
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Affiliation(s)
- Nicole C Syder
- Department of Dermatology, Keck School of Medicine of University of Southern California, Keck School of Medicine, University of Southern California, 830 South Flower Street, Suite 100, Los Angeles, CA 90017, USA
| | - Claudia Quarshie
- Department of Dermatology, Keck School of Medicine of University of Southern California, Keck School of Medicine, University of Southern California, 830 South Flower Street, Suite 100, Los Angeles, CA 90017, USA
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine of University of Southern California, Keck School of Medicine, University of Southern California, 830 South Flower Street, Suite 100, Los Angeles, CA 90017, USA.
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Abstract
Annular lichenoid diseases encompass a diverse range of pathologies that present as circular, raised, or flat lesions that may vary in size and number. Examples include annular lichenoid dermatitis of youth, annular lichen planus, erythema dyschromicum perstans, erythema multiforme, fixed drug eruption, lichen sclerosus, neonatal lupus, porokeratosis, subacute cutaneous lupus erythematosus, and lichenoid syphilis. Clinical morphology and histopathology can differentiate these entities.
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Figueiredo R, Rodrigues MA, Machado S. Grayish progressive lesions in a child. Pediatr Int 2021; 63:1264-1265. [PMID: 34633765 DOI: 10.1111/ped.14690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/16/2021] [Accepted: 03/09/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Rafael Figueiredo
- Department of Pediatrics, Centro Materno-Infantil do Norte - Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - Susana Machado
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Ercan N. Erythema dyschromicum perstans in an infant with positive Darier sign: A case report successfully treated with tacrolimus. Dermatol Ther 2020; 33:e14175. [PMID: 32779368 DOI: 10.1111/dth.14175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Nazli Ercan
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey
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Diaz A, Gillihan R, Motaparthi K, Rees A. Combination therapy with prednisone and isotretinoin in early erythema dyschromicum perstans: A retrospective series. JAAD Case Rep 2020; 6:207-213. [PMID: 32149180 PMCID: PMC7033289 DOI: 10.1016/j.jdcr.2019.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Aisleen Diaz
- Ponce Health Sciences University School of Medicine, Ponce, Puerto Rico
| | - Ryan Gillihan
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Adam Rees
- Department of Dermatology, Kaiser Permanente, Panorama City, California
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Ashy Dermatosis and Lichen Planus Pigmentosus: The Histopathological Differences. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5829185. [PMID: 31781623 PMCID: PMC6855079 DOI: 10.1155/2019/5829185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022]
Abstract
Background Ashy dermatosis (AD) and lichen planus pigmentosus (LPP) are both acquired macular pigmentation of uncertain aetiology. Despite the controversy surrounding their entities, recent global consensus has concluded that they are 2 different diseases with distinct clinical presentations. Nevertheless, there are limited data on their histopathological comparisons. Objective To evaluate the differences in histopathological findings between AD and LPP. Methods Electronic records and photographs of patients with the diagnosis of AD or LPP from January 2008 to December 2018 were retrospectively reviewed by a dermatologist. Patients were then classified into groups with AD and LPP, based on the clinical descriptions from the recent consensus. Those with history/clinical presentations suggestive of other causes of macular pigmentation were excluded. The histopathological diagnosis of AD and LPP was then reevaluated by a blinded dermatopathologist. Results One hundred and twenty-four patients with acquired macular pigmentation were identified; 24 were excluded due to clinical history or photographs being inconsistent with AD or LPP. Of the remaining 100 patients, 71 had clinical findings consistent with LPP while 29 had AD. The prevalence of epidermal hyperkeratosis was significantly higher in LPP when compared to AD (33.8% vs. 0%, p < 0.001), as well as epidermal hypergranulosis (35.2% vs. 0%, p < 0.001), lichenoid dermatitis (49.3% vs. 7.1%, p < 0.001), perifollicular infiltration (47.9% vs.10.3%, p < 0.001), and perifollicular fibrosis (35.2% vs. 10.3%, p=0.01). In addition, the degree of pigmentary incontinence was more severe in LPP (21.1% vs. 3.5%, p=0.015). For AD, vacuolization of the epidermal basal cell layer was more common (96.4% vs. 77.5%, p=0.02). Conclusions Although most cases of AD and LPP can be diagnosed clinically, in doubtful cases, histopathological findings of lichenoid dermatitis, epidermal hyperkeratosis/hypergranulosis, and moderate to severe pigmentary incontinence can help distinguish LPP from AD.
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Takeda K, Fujimura T, Tsuchiyama K, Lyu C, Aiba S. Pembrolizumab resolves adult ashy dermatosis developing in patients with squamous cell carcinoma of the lung. J Dermatol 2019; 46:271-273. [PMID: 30663147 DOI: 10.1111/1346-8138.14775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/09/2018] [Indexed: 11/29/2022]
Abstract
Ashy dermatosis is a rare cutaneous disorder of unknown etiology. We describe a case of adult ashy dermatosis developing in a patient with squamous cell carcinoma of the lung, which was resolved by the administration of pembrolizumab in parallel with multiple vitiligo. Interestingly, immunohistochemical staining revealed that lesional skin of the ashy dermatosis contained cytotoxic T cells and programmed death ligand 1 expressing cells. To our knowledge, this is the first case of adult ashy dermatosis resolved by pembrolizumab.
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Affiliation(s)
- Kana Takeda
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taku Fujimura
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenichiro Tsuchiyama
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chunbing Lyu
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Setsuya Aiba
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Wu A, Vaidya S. Literature Review of Treatment Outcomes for Lichen Planus Pigmentosus, Erythema Dyschromicum Perstans, and Ashy Dermatosis. J Cutan Med Surg 2018; 22:643-645. [PMID: 30322299 DOI: 10.1177/1203475418782132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Albert Wu
- 1 Department of Dermatology, The Queen Elizabeth Hospital, Woodville, South Australia
| | - Sachin Vaidya
- 1 Department of Dermatology, The Queen Elizabeth Hospital, Woodville, South Australia
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Leung N, Oliveira M, Selim MA, McKinley-Grant L, Lesesky E. Erythema dyschromicum perstans: A case report and systematic review of histologic presentation and treatment. Int J Womens Dermatol 2018; 4:216-222. [PMID: 30627620 PMCID: PMC6322153 DOI: 10.1016/j.ijwd.2018.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/28/2018] [Accepted: 08/08/2018] [Indexed: 01/19/2023] Open
Abstract
Objective Erythema dyschromicum perstans (EDP) can be difficult to diagnose and treat; therefore, we reviewed the literature to assess whether histology can be used to differentiate lichen planus pigmentosus (LPP) from EDP and determine which treatments are the most effective for EDP. We also present a case of a patient who was treated successfully with narrow-band ultraviolet B (NB-UVB). Methods A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted up to July 2017 using four databases. Results Histologic analyses from the literature reveal a significant percentage of melanophages, lymphocytic infiltrates, and basal vacuolar degeneration in EDP, and a significant histologic overlap with LPP. The review of the literature on treatment outcomes showed that NB-UVB and tacrolimus were effective with minimal side effects. Clofazimine was effective, but demonstrated significant-to-intolerable side effects. Griseofulvin, isotretinoin, and dapsone provided unsatisfactory results as lesions recurred after discontinuation. Lasers were largely ineffective and may cause postinflammatory hyperpigmentation and fibrosis. Conclusion A diagnosis of EDP should not be based on histologic findings alone. Clinical history, morphology, and distribution should be used to differentiate EDP and LPP. NB-UVB and tacrolimus are promising treatments for EDP with minimal side effects. This is the first report to our knowledge of sustained resolution of EDP after treatment with NB-UVB at long-term follow-up of 4 years. Larger studies are needed to confirm these findings.
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Affiliation(s)
- N Leung
- Duke University School of Medicine, Duke University, Durham, North Carolina
| | - M Oliveira
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - M A Selim
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina.,Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - L McKinley-Grant
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - E Lesesky
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
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Erythema Dyschromicum Perstans in an 8-Year-Old Indian Child. Case Rep Dermatol Med 2018; 2018:2143089. [PMID: 30112220 PMCID: PMC6077569 DOI: 10.1155/2018/2143089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/04/2018] [Indexed: 01/19/2023] Open
Abstract
We report an 8-year-old East Indian boy with erythema dyschromicum perstans. The condition has very rarely been reported in prepubertal Indian children. A perusal of the literature revealed but two cases, to which we add another one. Recognition of erythema dyschromicum perstans in prepubertal Indian children is important for proper diagnosis and to prevent unnecessary investigations.
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Abstract
Pigmented deposits can occur in the skin due to many and varied causes. Some of them are systemic conditions accompanied by involvement of internal organs. Others have serious prognostic implications, and early diagnosis can help in the correct and adequate management of the diseases. In addition, some of them are quite innocuous and the correct diagnosis avoids unnecessary treatments. In this article, we review the morphologic features of some of the most common and some of the less usual pigmented deposits in skin other than tattoos.
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Abstract
The terms 'lichenoid' and 'interface' dermatitis are often used interchangeably to describe an inflammatory pattern characterized histologically by damage to the basal keratinocytes in the epidermis. The mechanism of cell damage of such cells is now best understood as apoptosis, or programmed cell death. This inflammatory pattern of dermatoses, is also accompanied frequently by a band of lymphocytes and histiocytes in the superficial dermis, that often obscures the dermal-epidermal junction, hence the term 'lichenoid'. A discussion of the more common lichenoid/interface dermatitides encountered in the routine clinical practice encompasses the following entities: lichen planus, lupus erythematosus, dermatomyositis, erythema multiforme, graft versus host disease, fixed drug reactions, and multiple others.
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Affiliation(s)
- Alejandro A Gru
- Department of Pathology & Dermatology, University of Virginia, Charlottesville, VA, Unitee States.
| | - Andrea L Salavaggione
- Department of Radiation Oncology, The Ohio State University, Columbus, OH, United States
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Numata T, Harada K, Tsuboi R, Mitsuhashi Y. Erythema Dyschromicum Perstans: Identical to Ashy Dermatosis or Not? Case Rep Dermatol 2015; 7:146-50. [PMID: 26351421 PMCID: PMC4560306 DOI: 10.1159/000437414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Erythema dyschromicum perstans (EDP) and ashy dermatosis (AD) are pigmentary disorders of unknown etiology. EDP is usually considered to be identical to AD; however, a new clinical classification for EDP was proposed in the recent literature. Herein, we report a typical case of EDP observed in an African-American man. Interestingly, the late skin lesions in this case fit the criteria of AD as well. While there appear to be a few clinical cases that can be diagnosed as both EDP and AD based on the clinical course, the preponderance of the evidence in the published reports of EDP and AD and the clinical findings reported here strongly suggest that they are two distinct entities in terms of the extent of the inflammation, albeit on the same spectrum of pigment disorders.
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Affiliation(s)
- Takafumi Numata
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Kazutoshi Harada
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Ryoji Tsuboi
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
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