Asymptomatic Hypopigmented Macules Research Articles

Mycosis Fungoides: A Case Report

Mycosis fungoides is the most common primary cutaneous T-cell lymphoma and is recognized as one of the rare malignant skin neoplasms. Hypopigmented mycosis fungoides is a variant of mycosis fungoides, described in dark-skinned individual and Asian patients. We report a case of 32 years old Nepalese female who had presented with multiple asymptomatic hypopigmented macules over the bilateral arms, thighs, abdomen, back of trunk and buttocks. Skin biopsy revealed few atypical cells (small/medium-sized, cerebriform nuclei with halo) confined to epidermis with epidermotropism. Immunohistochemistry showed CD3, CD4, CD5 and CD8 positivity. The patient was managed with topical steroids, oral methotrexate and phototherapy, and she is on regular follow up. As the disease has an indolent clinical course, long term follow up is necessary.

Dyschromatosis Universalis Hereditaria

Dyschromatosis universalis hereditaria (DUH) is a rare pigmentary genodermatosis usually inherited in autosomal dominant fashion characterized by multiple pinpoint to pea-sized hypo- and hyper-pigmented macules arranged in reticulate pattern that develops within the first few years of life. An 11 years old boy presented with multiple gradually progressive asymptomatic hypopigmented macules on hyperpigmented background on trunk, extremities and face since 2 years of age. Family history was absent. Punch biopsies revealed increased number of melanocytes in the epidermis with basal cell vacuolar alteration and pigmentary incontinence and perivascular infiltration by lymphocytes and melanophages in the dermis. We herein present a sporadic case of dyschromatosis universalis hereditaria.

Multiple Asymptomatic Hypopigmented Macules in a Child.

Multiple Asymptomatic Hypopigmented Macules in a Child.

Leucoderma syphiliticum in a pregnant woman

A 32-year-old woman at 31 weeks’ gestation with a history of premature rupture of membranes presented with asymptomatic hypopigmented macules on her upper back and neck region of 2 months’...

Pityriasis versicolor in children: a study of 110 cases

<p class="abstract"><strong>Background:</strong> <span lang="EN-GB">Pityriasis versicolor (PV) is a cutaneous fungal infection caused by the yeast fungus <em>Malassezia</em>. Though common in adults, children can also develop PV</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-GB">110 cases of clinically and mycologically proven cases of PV in children upto 14 years were included in this study which was conducted in the Dermatology outpatient department of Karuna Medical College, Palakkad over a period of one year</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-GB">PV in children accounted for 22.63% of total cases of PV seen during the study period. Face was the commonest site involved (78%). Majority (83.64%) presented with hypopigmentation and family history was present in 26%. Most cases (67%) were seen during the months of April to September</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-GB">PV in children is not rare and it commonly presents as asymptomatic hypopigmented macules over the face</span><span lang="EN-IN">.</span></p>

Asymptomatic hypopigmented macules on the trunk and limbs of a young male

Asymptomatic hypopigmented macules on the trunk and limbs of a young male

Eruptive Tumors of the Follicular Infundibulum: An Unexpected Diagnosis of Hypopigmented Macules.

BackgroundTumor of the follicular infundibulum (TFI) is considered as a rare benign neoplasm providing two distinctive clinical patterns: the solitary and the eruptive form. The clinical presentations resemble many other dermatologic conditions and require histopathological study to make a definite diagnosis.ObjectiveTo inform physicians of a clinical presentation of TFI.Case ReportWe report on a 50-year-old man who presented with multiple asymptomatic hypopigmented macules resistant to the treatments. The histopathological study was consistent with tumors of the follicular infundibulum.ConclusionHypopigmented macules are one of the more common clinical presentations in dermatological practices. It is important to include TFI in the differential diagnosis when a patient with hypopigmented lesions does not respond to the treatment based on the clinical diagnosis.Electronic supplementary materialThe online version of this article (doi:10.1007/s13555-015-0079-0) contains supplementary material, which is available to authorized users.

Post kala-azar dermal leishmaniasis: Macular variety

A 7-year-old boy presented with numerous asymptomatic whitish flat lesions of varying sizes over the whole body for last two years. Patient was diagnosed as kala-azar about 3 years previously, and was treated suboptimally. There was no other systemic complaints like fever, pain abdomen or photosensitivity. On examination, there were asymptomatic hypopigmented macules and patches over the face (Fig. 1), trunk and extremities (Fig 2). There was no evidence of any scaling, erythema, itching sensation or photosensitivity. There were no mucocutanoeus abnormalities, and lymphandenopathy, hepatosplenomegaly or any other systemic abnormalities. Slit skin smear from the lesions demonstrated the Leishmania donorexi; parasites and ELISA demonstrated the antibody in blood against the parasites. A diagnosis of post kala-azar dermal leishmaniasis was made (macular variety).

The first report of krt5 mutation underlying acantholytic dowling-degos disease with mottled hypopigmentation in an Indian family

Galli Galli disease (GGD) is the name given to a rare form of acantholytic Dowling-Degos disease. (DDD), the latter itself being a rare condition. We believe we are describing for the first time in Indian dermatologic literature a case of GGD in a family where 25 persons have DDD and have been able to document a KRT5 mutation in four members of the family. Whereas reticulate pigmentation is a hallmark of DDD there are rare reports of mottled pigmentation with multiple asymptomatic hypopigmented macules scattered diffusely along with the pigmentation. All the cases described here show a mottled pigmentation comprising hypo and hyperpigmented asymptomatic macules. After the clinical diagnosis was made by one of the authors (SV) in India, the German authors repeated histological examination and successfully demonstrated a heterozygous nonsense mutation, c.C10T (p.Gln4X), in exon 1 of the KRT5 gene, from various centers in Munich, Bonn, Dusseldorf and Friedrichschafen in Germany.

Tinea versicolor in dark‐skinned individuals

In this article, we review the salient features of tinea versicolor and describe the epidemiology, clinical presentation, and histopathology of this mycosis in dark-skinned individuals. Tinea versicolor is caused by an overgrowth of the Malassezia genus. It manifests clinically as asymptomatic hypopigmented macules, hyperpigmented macules, or a combination of the two. Under light microscopy, Malassezia presents as a dimorphic fungus - in both the hyphal and yeast form. Most clinicians have found that the majority of dark-skinned patients present solely with hypopigmented lesions. Under light microscopy, lesions on dark skin involved with tinea versicolor tend to have a thicker stratum corneum, more tonofilaments in the granulosum, and more sequestered melanosomes. Differential diagnosis includes confluent and reticulated papillomatosis, seborrheic dermatitis, pityriasis rosea, pityriasis alba, and vitiligo. Tinea versicolor can be successfully managed in most cases with topical antifungal treatments. Cases of recurrence, such as those seen in immunocompromised patients, may necessitate scheduled oral or topical therapy.

Eruptive tumors of the follicular infundibulum presenting as hypopigmented macules on the buttocks of two Black African males

We report two cases of eruptive tumors of the follicular infundibulum (TFI) with an unusual clinical presentation which has not been described previously in literature. In both cases, the appearance was strikingly similar, consisting of multiple asymptomatic hypopigmented macules on the buttocks of two Black African males, aged 38 and 55 years old. In both cases, the eruption had evolved over several months. The individual lesions were of similar size, approximately 1 cm, with irregular and ill-defined borders. Histopathological examination revealed a superficial and horizontal plate-like proliferation of keratinocytes emanating from the epidermis with multiple slender attachments. Pale keratinocytes were present within the epithelial plates. A Fontana stain showed a loss of melanin pigment from the epithelial plates. Orcein (elastic) stain highlighted an increase of the number of the elastic fibers surrounding the tumor. On the basis of these findings, a diagnosis of eruptive TFI was established for both cases. Among the various presentations of TFI, only the eruptive variant appears to be clinically distinctive, with asymptomatic hypopigmented macules usually located on the face, neck and upper trunk. Eruptive TFI should also be added to the clinical differential diagnosis of multiple hypopigmented macules on the buttocks of Black patients.

Clinical, pathologic, and ultrastructural studies of progressive macular hypomelanosis

Progressive macular hypomelanosis (PMH), a condition of uncertain etiology, is characterized by asymptomatic hypopigmented macules, predominantly located on the trunk. To date, the study of this disease has been sporadic and there are still no clinical diagnostic criteria. The aim of this study was to investigate the histopathologic and ultrastructural characteristics of PMH, and propose the clinical diagnostic criteria of PMH. The Wood's lamp and Confocal Laser Scanning Microscopy were used to observe the lesions' features. Skin biopsies were used for hematoxylin and eosin staining, melanin staining, antibodies staining of S-100 protein, tyrosinase-related protein-1(TRP-1) and tyrosinase (T311), and also for ultra-structural study. Melanocytes were isolated and cultured from the lesions. Under Wood's lamp examination, the lesions of PMH showed punctiform red fluorescence. Confocal Laser Scanning Microscopy observation of the lesion showed that its "pigmented ring" around the dermal papillae was intact, but its melanin content was decreased compared with the surrounding normal skin. Ferrous sulfate staining showed that melanin content in the lesion of PMH was significantly decreased compared with the normal skin (P < 0.05). S-100 staining showed that the number of positive cells in the basal layer had no statistical significance (P > 0.05) between the lesion areas (8.25 ± 0.96) and the surrounding normal skin (8.75 ± 1.71). TRP-1 staining showed no significant difference between lesion areas (4.25 ± 0.96) and the surrounding normal skin (4.50 ± 1.29) (P > 0.05), and T311 staining also showed no difference between lesion areas (4.01 ± 0.87) and the surrounding normal skin (4.30 ± 1.05) (P > 0.05). Ultra-structural studies revealed a large reduction in the number of mature melanosome from PMH lesions. There were many membrane-bound groups in PMH lesions with normal appearance the margin, which contained a number of smaller type II-IV melanosomes, which were distributed in clusters. No degradation of melanosomes was present in the lysosomal compartments of PMH lesions. When melanocytes from the PMH lesions were cultured in vitro, the morphology of those melanocytes showed no difference compared with normal melanocytes. As a result of the above findings, we discussed and summarized the PMH's clinical diagnostic criteria.

Progressive macular hypomelanosis in Singapore: a clinico‐pathological study

Progressive macular hypomelanosis (PMH), a condition of uncertain etiology, is characterized by asymptomatic hypopigmented macules predominantly located on the trunk. To date, there are no reports from South-East Asia concerning this condition. We sought to record the clinical features of PMH in Asian patients, identify etiologic factors, and study the structural and ultrastructural features of melanocytes in this disorder. Patients who presented to the National Skin Center with acquired, hypopigmented macules on the trunk, without a history of inflammation or infection, were recruited. Erythrocyte sedimentation rate (ESR), complete blood count, fasting blood glucose, liver function tests, skin scrapings for fungi, and skin biopsy specimens (from lesional and normal skin) were obtained. Biopsies were stained with hematoxylin and eosin (H&E), Fontana Masson, an immunohistochemical panel for identification of melanocyte differentiation antibodies (HMB 45, Melan A, and S100) and CD 68. Electron microscopy (EM) was also performed. The patients were evaluated every 3 months. During a 9 month period, eight patients (all Chinese) presented with hypopigmented, ill-defined, confluent macules involving the lower aspect of the trunk. There were four men and four women, and the mean age was 25.9 years (range 19-45 years). Skin scrapings were negative for fungi and laboratory tests were normal. Microscopic evaluation of skin biopsy specimens showed reduced pigmentation of lesional as compared with normal appearing skin, but H&E-stained sections revealed only minimal histologic differences between lesional and normal skin. EM demonstrated a statistically significant (P = 0.047, Wilcoxon Signed Rank Test, Wilcoxon 95% CI 0.02-0.62) higher ratio of stage IV and late stage III (dark) melanosomes in normal vs. lesional skin. PMH may occur among young adults in Singapore. Its etiology is uncertain. The melanin content of lesional skin appears to be less than that in normal sites. EM shows a higher ratio of immature melanosomes in lesional vs. normal skin.