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Li S, Arvisais-Anhalt S, Vandergriff T, Le LQ. Ashy dermatosis-like hyperpigmentation in a patient taking hydroxyurea. JAAD Case Rep 2020; 6:797-800. [PMID: 32875022 PMCID: PMC7452229 DOI: 10.1016/j.jdcr.2020.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Stephen Li
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.,Medical Scientist Training Program, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Travis Vandergriff
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lu Q Le
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
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2
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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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3
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Proshutinskaya DV, Makovetskaya OS, Nefedova MA. Ashy dermatosis in a child. VESTNIK DERMATOLOGII I VENEROLOGII 2019. [DOI: 10.25208/0042-4609-2019-95-1-41-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The paper provides a description of a rare skin condition, erythema dyschromicum perstans (also called ashy dermatosis), in a child. The authors present a literature review on the issue. A particular attention is given to the etiology and pathogenesis, as well as the clinical picture and diagnostics of the disease.
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Affiliation(s)
- D. V. Proshutinskaya
- Russian Medical Academy of Continuing Professional Education, Ministry of Health of the Russian Federation
| | - O. S. Makovetskaya
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - M. A. Nefedova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
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4
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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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5
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Kumarasinghe SPW, Pandya A, Chandran V, Rodrigues M, Dlova NC, Kang HY, Ramam M, Dayrit JF, Goh BK, Parsad D. A global consensus statement on ashy dermatosis, erythema dyschromicum perstans, lichen planus pigmentosus, idiopathic eruptive macular pigmentation, and Riehl's melanosis. Int J Dermatol 2018; 58:263-272. [PMID: 30176055 DOI: 10.1111/ijd.14189] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/18/2018] [Accepted: 07/17/2018] [Indexed: 01/19/2023]
Abstract
Ashy dermatosis (AD), lichen planus pigmentosus (LPP), erythema dyschromicum perstans (EDP), and idiopathic eruptive macular pigmentation are several acquired macular hyperpigmentation disorders of uncertain etiology described in literature. Most of the published studies on these disorders are not exactly comparable, as there are no clear definitions and different regions in the world describe similar conditions under different names. A consensus on the terminology of various morphologies of acquired macular pigmentation of uncertain etiology was a long-felt need. Several meetings of pigmentary disorders experts were held to address this problem. A consensus was reached after several meetings and collation of e-mailed questionnaire responses and e-mail communications among the authors of publications on the above conditions. This was achieved by a global consensus forum on AD, LPP, and EDP, established after the 22nd International Pigment Cell Conference held in Singapore in 2014. Thirty-nine experts representing 18 countries participated in the deliberations. The main focus of the deliberations was terminology of the conditions; as such, we present here the consensus statement of the forum and briefly review the available literature on the subject. We have not attempted to discuss treatment modalities in detail.
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Affiliation(s)
| | - Amit Pandya
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Michelle Rodrigues
- Department of Dermatology, St Vincent's Hospital, Fitzroy, Vic, Australia
| | - Ncoza C Dlova
- Department of Dermatology, College of Health Sciences, Durban, South Africa
| | - Hee Young Kang
- Department of Dermatology, Ajou University, Suwon, South Korea
| | - M Ramam
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - Johannes F Dayrit
- Department of Dermatology, Research Institute for Tropical Medicine, Metro Manila, Philippines
| | | | - Davinder Parsad
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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6
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Rato M, Monteiro AF, Aranha J, Tavares E. Ashy dermatosis with involvement of mucous membranes. An Bras Dermatol 2017; 92:17-20. [PMID: 29267435 PMCID: PMC5726666 DOI: 10.1590/abd1806-4841.20176133] [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: 06/07/2016] [Accepted: 10/09/2016] [Indexed: 11/22/2022] Open
Abstract
Ashy dermatosis is a rare condition, of unknown aetiology, in which mucous membranes are typically spared. The authors report the case of a 57-year-old female with a history of asymptomatic gray-bluish macules located on the trunk and oral mucosa. There were no relief changes on examination. Skin biopsies from the oral mucosa and trunk were performed and both were compatible with ashy dermatosis. The patient started treatment with oral clofazimine but due to the absence of clinical improvement the drug was discontinued three months later. This case report illustrates an atypical case of ashy dermatosis owing to the involvement of mucous membranes, which is rarely described in the literature.
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Affiliation(s)
- Margarida Rato
- Derpatment of Dermatology at Hospital de Santarém, EPE - Santarém, Portugal
| | | | - João Aranha
- Derpatment of Dermatology at Hospital de Santarém, EPE - Santarém, Portugal
| | - Ermelindo Tavares
- Derpatment of Dermatology at Hospital de Santarém, EPE - Santarém, Portugal
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7
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Melo CRFD, Sá MCD, Carvalho S. Erythema dyschromicum perstans in a child following an enteroviral meningitis. An Bras Dermatol 2017; 92:137-138. [PMID: 28225976 PMCID: PMC5312198 DOI: 10.1590/abd1806-4841.201745144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/05/2015] [Indexed: 11/22/2022] Open
Abstract
A healthy 6-year-old boy presented with an erythematous macular exanthema,
meningeal signs and fever, initially diagnosed with probable bacterial
meningitis and treated with antibiotic and anti-inflammatory drugs. Enteroviral
meningitis was confirmed, but the skin lesions continued to evolve and the
patient was ultimately diagnosed with erythema dyschromicum perstans. The boy
was followed during three years until the spontaneous resolution of the
dermatosis.
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Affiliation(s)
| | - Mário Correia de Sá
- Pediatric Department, Centro Hospitalar Vila Nova de Gaia/Espinho - Vila Nova de Gaia, Portugal
| | - Sónia Carvalho
- Pediatric Department, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, Portugal
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8
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Tamer F. Coexistence of erythema dyschromicum perstans and vitiligo: a case report and review of the literature. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2016; 25:77-78. [PMID: 28006880 DOI: 10.15570/actaapa.2016.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Erythema dyschromicum perstans is a rare, chronic, pigmentary disorder with unknown etiology. It clinically presents with oval to round, gray, blue, or brown macules of various sizes. The etiology remains unknown; however, cobalt allergy, radio contrast media, intestinal parasites, human immunodeficiency virus, and hypothyroidism have been proposed as causative factors. In addition, vitiligo is characterized by depigmented macules and patches that are widely andsymmetrically distributed. It has been suggested that autoimmune mechanisms play an important role in the etiopathogenesis of vitiligo. Physical and emotional stress can trigger vitiligo in genetically predisposed patients. However, coexistence of erythema dyschromicum perstans and vitiligo is extremely rare, and similar immune mechanisms have been implicated in the pathogenesis of these cutaneous pigmentary disorders.
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Affiliation(s)
- Funda Tamer
- Medical Park Hastanesi, Yenimahalle, Ankara, Turkey
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9
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Mahajan VK, Chauhan PS, Mehta KS, Sharma AL. Erythema Dyschromicum Perstans: Response to Topical Tacrolimus. Indian J Dermatol 2015; 60:525. [PMID: 26538750 PMCID: PMC4601471 DOI: 10.4103/0019-5154.164452] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Erythema dyschromicum perstans, a rare dermatosis of obscure etiopathogenesis and significant cosmetic morbidity, have no satisfactory treatment. Observations: Two patients with having characteristic asymptomatic and slowly progressive, slate-grey macular lesions with distinct red borders involving the face, neck, upper trunk and limbs were diagnosed clinicopathologically as erythema dyschromicum perstans. Both were treated successfully with topical tacrolimus 0.1% ointment. Conclusions: Overall, response to several therapeutic modalities including clofazimine and dapsone therapy is said to vary from complete failure to variable or inconsistent. Topical tarolimus provides an effective and safe alternative therapeutic option in erythema dyschromicum perstans.
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Affiliation(s)
- Vikram K Mahajan
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra, Tanda, Himachal Pradesh, India
| | - Pushpinder S Chauhan
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra, Tanda, Himachal Pradesh, India
| | - Karaninder S Mehta
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra, Tanda, Himachal Pradesh, India
| | - Anju Lath Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra, Tanda, Himachal Pradesh, India
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10
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Chang SE, Kim HW, Shin JM, Lee JH, Na JI, Roh MR, Lee JH, Lee GY, Ko JY. Clinical and histological aspect of erythema dyschromicum perstans in Korea: A review of 68 cases. J Dermatol 2015; 42:1053-7. [PMID: 26118942 DOI: 10.1111/1346-8138.13002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/16/2015] [Indexed: 11/28/2022]
Abstract
Erythema dyschromicum perstans (EDP) is a hypermelanotic disorder of the idiopathic variety characterized by blue-gray macules in healthy individuals. It has been described mainly in patients from tropical areas of Central and South America. Our aim was to evaluate EDP in Korea through the analysis of retrospective case series with EDP and to describe the clinical and histopathological features. It was a retrospective study (2002-2012) of EDP confirmed by review of clinical photographs and biopsy specimens. The files of 68 patients with EDP from six tertiary medical centers in Korea were included in this study. Of the 68 patients, 29 were male and 39 female. The age of patients ranged 3-76 years (mean, 33.9). Clinically, the majority of patients had lesions on the trunk (n = 47, 69.1%); the neck was affected in 27 cases, the upper extremities in 26, the face in 22 and the lower extremities in 16. Peripheral erythematous borders were observed in 12 patients (17.6%) and 11 patients had itching sensation at the lesion. Histopathologically, dermal melanophages and pigment incontinence were the most common findings. A follow up of more than 1 year was obtained in 51 patients. Of these, only one patient experienced complete clearance without recurrence. Our study illustrates the clinical and histopathological findings of EDP in Koreans. Our multicenter data may contribute to the understanding of EDP.
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Affiliation(s)
- Sung Eun Chang
- Department of Dermatology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Hyun Woo Kim
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Jae Min Shin
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Ji Hyun Lee
- Department of Dermatology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Jung Im Na
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi Ryung Roh
- Department of Dermatology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hee Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ga Young Lee
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
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11
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Cherobin ACFP, Oliveira FOD, Baeta IGR, Vale ECSD. Case for diagnosis. An Bras Dermatol 2012; 87:151-2. [PMID: 22481670 DOI: 10.1590/s0365-05962012000100025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 04/25/2011] [Indexed: 11/22/2022] Open
Abstract
Dyschromicum erythema perstans, or ashy dermatosis, is a rare chronic acquired skin disease characterized by gray hyperpigmented patches with erythematous borders. Its etiology is unknown and there is no specific treatment for the condition. We report a case of ashy dermatosis in a 41-year-old patient with extensive lesions on the trunk and limbs.
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12
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Cutrì FT, Ruocco E, Pettinato G, Ciancia G. Lichen planus pigmentosus-like ashy dermatosis. Dermatol Reports 2011; 3:e46. [PMID: 25386298 PMCID: PMC4211508 DOI: 10.4081/dr.2011.e46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 09/18/2011] [Accepted: 10/24/2011] [Indexed: 12/02/2022] Open
Abstract
Ashy dermatosis, also known as erythema dyschromicum perstans, is an idiopathic dermal melanosis of unknown etiology. We here describe an unusual case of 63-year-old Caucasian male with ashy dermatosis and skin lesion of lichen pigmentosus-like. No treatment was tried because the lesions were totally asymptomatic. After a control, three months later, all lesions had cleared up. This case is of interest because it proves the existence of ashy dermatosis with clinical aspect lichen planus pigmentosus-like. This is the first case in the literature of lichen planus pigmentosus-like ashy dermatosis confirming the view that ashy dermatosis is a variant of lichen planus without the typically band-like infiltrate and Max Joseph spaces.
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Affiliation(s)
| | | | - Guido Pettinato
- Department of Anatomopathology, University of Naples Federico II, Naples, Italy
| | - Giuseppe Ciancia
- Department of Anatomopathology, University of Naples Federico II, Naples, Italy
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13
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Chun JS, Hong SK, Seo JK, Lee D, Sung HS, Hwang SW. A case of unilateral ashy dermatosis. Ann Dermatol 2010; 21:432-4. [PMID: 20523842 DOI: 10.5021/ad.2009.21.4.432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 04/18/2009] [Accepted: 06/02/2009] [Indexed: 11/08/2022] Open
Abstract
Ashy dermatosis, also known as erythema dyschromicum perstans, is a peculiar, slowly progressive, idiopathic dermal melanosis. In most cases, slate gray- to lead-colored patches are symmetrically distributed over the body. Ashy dermatosis with a unilateral distribution is rare. We report a case of unilateral ashy dermatosis in a 27-year-old Korean man.
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Affiliation(s)
- Ji-Sung Chun
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
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14
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Current concepts: dermatopathology of pigmentary alteration disorders in the Hispanic population. ACTA ACUST UNITED AC 2008; 24:211-21. [PMID: 19256311 DOI: 10.1016/j.yadr.2008.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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15
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Abstract
Pigmentary disorders with hypopigmentation/depigmentation or hyperpigmentation may have special manifestations in Latin America. Most pigmentary disorders are commonly observed in all areas of Latin America, but a few are particularly seen in tropical and subtropical regions. In most pigmentary disorder ailments described, multiple factors involved in their pathogenesis are known, but etiology remains elusive. Some pigmentary disorders have peculiar clinical expressions and, in spite of being restricted to certain geographical areas, they may be observed in other world areas because of frequent traveling of affected patients. Therapy of most of these ailments is difficult or remains unknown.
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Affiliation(s)
- Rafael Falabella
- Department of Dermatology, Universidad del Valle and Hospital Universitario del Valle, Calle 5 #36-08, Cali, Colombia.
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