Erythema Dyschromicum Perstans Research Articles

Dermoscopy Evaluation of Erythema Dyschromicum Perstans Treated with Combination of Topical Steroid and Narrowband-Ultraviolet B: A Case Report

Dermoscopy Evaluation of Erythema Dyschromicum Perstans Treated with Combination of Topical Steroid and Narrowband-Ultraviolet B: A Case Report

Acquired dermal macular hyperpigmentation: an overview of the recent updates.

Acquired dermal macular hyperpigmentation (ADMH), previously known as macular pigmentation of uncertain etiology (MPUE), is an umbrella concept that unifies the distinct but overlapping acquired dermal pigmentary disorders like lichen planus pigmentosus, ashy dermatosis, erythema dyschromicum perstans, Riehl's melanosis and pigmented contact dermatitis. All of these disorders usually lack a clinically apparent inflammatory phase, are characterised by dermal pigmentation clinically and histologically, and have a variable protracted disease course. Recently, a proposal has been made to classify these disorders into those with and without contact sensitisation. Dermoscopy is essentially similar across the spectrum of these disorders, and is useful for diagnosis and therapeutic response monitoring. Scoring system has been validated for the same. The treatment of ADMH remains challenging, with multiple topicals, oral therapies including mycophenolate mofetil, and lasers tried. Need of the hour is randomised controlled trials to enhance the therapeutic armamentarium.

Seeing Double: Two Cases of Dermatomyositis Misidentified as Erythema Dyschromicum Perstans

Without pathognomonic skin lesions or muscle weakness, early DM may be misdiagnosed as a disorder of hyperpigmentation. A 38-year-old male presented with a one-year history of progressive hyperpigmented patches on the face and neck. Outside biopsy was thought to be consistent with EDP, with which the patient’s identical twin brother had recently been diagnosed. Later skin exam was notable for progression to erythematous and hyperpigmented slightly scaly macules and patches of the face, faint pink thin plaques on bilateral extensor forearms and bilateral retroauricular creases, and proximal nailfold capillary dilation and dropout. These findings raised concern for dermatomyositis. Repeat biopsies were suggestive of CTD. ANA was weakly positive. Extended myositis panel was negative. Re-evaluation of his twin brother’s biopsy showed similar findings. The twin’s ANA was negative, and extended myositis panel is pending. Ultimately, both were diagnosed with DM. Work-up for muscle and systemic involvement is underway. Our patient was started on MMF 500mg BID, which was increased to 1000mg BID at follow up. After little improvement on MTX, the patient’s twin brother was switched to MMF 1000mg BID. Diagnosis of DM is particularly challenging in patients lacking classic dermatologic findings or myopathy. Recognition of subtle signs of DM, histopathologic analysis, and presence of MSAs may aid in correct diagnosis.

Ashy Dermatosis: A Narrative Literature Review

Ashy dermatosis (AD) or erythema dyschromicum perstans (EDP) is a type of hyperpigmented macules characterized by asymptomatic, gray macular lesions with a symmetrical distribution. Some of the predisposing factors for ashy dermatosis are intestinal parasitic infections, a bad environment such as consumption of ammonium nitrate, X-ray contrast media and genetic factors such as the HLA-DR4 allele. The clinical manifestations of ashy dermatosis are hyperpigmented or gray macules with slow progression and pigmentation abnormalities in the inner epidermal layer. The differential diagnosis of ashy dermatosis is with lichen planus pigmentosus, idiopathic eruptive macular pigmentation, and Riehl's melanosis. Diagnosis of ashy dermatosis needs to be linked between clinical findings and histopathological examination, other supporting examinations and differentiating it from other differential diagnoses. Management for patients with ashy dermatosis is with topical or systemic agents. For now, a combination of laser and tacrolimus ointment is recommended.

Hyperpigmented Macules in an Indian boy: is it EDP or LPP ? - A Case Report

Erythema dyschromicum perstans (EDP) and Lichen planus pigmentosus (LPP) are both inflammatory disorders of pigmentation with unknown etiology and are difficult to differentiate clinically and histologicaly. There is no consensus on whether both entities are separate or belong to the same spectrum of cutaneous disorders. We present a 13 year old boy with mostly asymptomatic hyperpigmented lesions over body. The lesions were subsequently diagnosed as EDP after detailed examination and histopatholgical examination.

Pediatric ashy dermatosis: what to expect?

Pediatric ashy dermatosis: what to expect?

Clinical and dermatoscopic correlation in facial melanosis: A cross-sectional study at a tertiary hospital

Background: Facial pigmentary disorders are a group of heterogeneous entities, sharing a common clinical feature of altered pigmentation of the face. The overlapping features among the different clinical entities of facial hyperpigmentation may be differentiated by dermatoscopy. Objective: The objective was to evaluate the different types of facial melanosis and their dermatoscopic findings. Methods: This non-interventional, cross-sectional study was conducted at our dermatology department over a period of one year. All clinically diagnosed cases of facial melanosis were included in our study and their dermatoscopic evaluation was performed. Results: We included 500 patients with facial melanosis. While 370 patients were female, 130 were males. Three hundred patients had melasma, 59 (lichen planus pigmentosus) had LPP, 40 had Riehl’s melanosis, while 35 had frictional melanosis. Other dermatoses included acanthosis nigricans, ashy dermatosis, and poikiloderma of Civatte, to name a few. The most common dermatoscopic finding in our study evident in almost all cases of facial melanosis was exaggerated pseudo-reticular hyperpigmentation. The unique observation in our study, the reticulo-globular pattern seen in melasma, was thin and in the shade of brown pigmentation, whereas in LPP and ashy dermatosis, it was comparatively thicker and grayish-brown in color. The other specific finding observed was telangiectasia due to topical steroids, more prominent and enlarged than telangiectasia due to sun exposure in melasma and poikiloderma of Civatte. Conclusion: This study highlights the clinical and dermatoscopic features of facial melanosis. Further research is required in this field of dermatoscopic evaluation of facial melanosis to define more accurate diagnostic features as a facial biopsy is mostly refused by the patients, yet meanwhile, clinical evaluation should not be neglected. Study Limitations: The limitations of our study were the lack of direct histopathological correlation and the inclusion of both therapy-naive patients and patients on therapy. Key words: Facial melanosis; Dermatoscope; Melasma

CLINICO-EPIDEMOLOGICAL STUDY OF FACIAL MELANOSIS

Introduction: Melanosis affecting face and neck occur from a myriad of conditions. The similar overlapping clinical, histological and dermoscopic features posses an intricate diagnostic problem for the clinician. Attempts to classify them have been partially successful. Methods: This was a prospective hospital based study conducted in a tertiary hospital over a period of one year involving 120 patients of facial melanosis. Relevant investigations including skin biopsy and patch testing were done wherever required. Results: Study sample ranged from nine to 60 years with maximum number of patients in 21-40 years of age. Females predominated in the study. Most common diagnosis was melasma followed by pigmented contact dermatitis, periorbital melanosis, lichen planus pigmentosus, erythema dyschromicum perstans, poikiloderma of civatte and eythromelanosis follicularis. Conclusion: There was considerable clinical, histological overlap between these clinical entities. UV exposure in melasma and lichen planus pigmentosus, exposure to allergens in pigmented contact dermatitis were the main etiological factors implicated. Key words: facial melanosis, melasma, pigmented contact dermatitis, lichen planus pigmentosus.

Successful Management of Erythema Dyschromicum Perstans Following Topical Ruxolitinib Therapy.

Erythema dyschromicum perstans (EDP) is a rare cutaneous disorder in which patients develop gray or blue-brown macules or patches on their bodies.1 This condition does not appear to have a gender or age predilection. The diagnosis of EDP is essentially clinical, with histopathology findings being nonspecific. To date, treatment for EDP varies. The use of several therapies, including dapsone, clofazimine, retinoid A, tacrolimus, and ultraviolet light have been reported but with minimal effectiveness.5 We report a case of EDP occurring in a patient following the COVID-19 vaccine that was given topical ruxolitinib with success in treatment. To our knowledge, this is the first report of the use of topical ruxolitinib in treatment of EDP with successful management. J Drugs Dermatol. 2022;22(3): doi:10.36849/JDD.7156.

Oral tranexamic acid in the treatment of hyperpigmentation disorder beyond melasma: A review.

Tranexamic acid, a synthetic derivative of the amino acid lysine, is an antifibrinolytic, procoagulant agent approved by the Food and Drug Administration for the treatment of cyclic heavy menstrual bleeding and prevention of bleeding in patients with hemophilia undergoing tooth extraction. Oral tranexamic acid has been used off-label in dermatology in the treatment of melasma and other hyperpigmentation disorders. In a recent study, oral tranexamic acid was reviewed thoroughly in treating melasma, and its effectiveness was demonstrated. Their role in treating other hyperpigmentation disorders has also been tried in several studies. To review the evidence regarding the use of tranexamic acid in treating different types of hyperpigmentation disorders other than melasma. A comprehensive literature review was searched using the electronic online database "PubMed" and "google scholar" using key words "Postinflammatory hyperpigmentation," "lichen planus pigmentosus," "ashy dermatosis," "riehl melanosis". After that, a full-text review of the studies was performed. Oral tranexamic acid has been used in different types of hyperpigmentation disorder, including postinflammatory hyperpigmentation treatment and prevention, lichen planus pigmentosus, ashy dermatosis, and Riehl melanosis in a dose range from 250 mg per day to 1500 mg per day for a period range from 2 weeks to 6 months with variable efficacy and a good safety profile. Oral tranexamic acid is a promising treatment option in a different type of hyperpigmentation disorders refractory to topical treatment. However, more evidence from blinded randomized controlled trials and case-control studies is needed to determine their efficacy in treating various hyperpigmentation disorders.

Examine the Frequency of Diabetes Mellitus and Glucose Intolerance in Patients with Lichen Planus

Objective: The purpose of this study was to determine whether or not individuals with LP also had a high incidence of diabetic mellitus (DM) and/or glucose intolerance. Study Design: Cross-sectional study Place and Duration: This study was conducted at Abbottabad Medical Complex Hospital, Abbottabad in the duration from April, 2021 to October, 2021. Methods: Total 67 patients of both gender had lichen planus were presented in this study. After getting informed written consent detailed demographics of enrolled cases included age, sex, body mass index and duration of LP were recorded. Fasting blood sugar levels between 100 and 125 mg/dL (5.6 and 7.0 mmol/L) were considered to be indicative of impaired fasting glucose (IFG). Frequency of DM and glucose intolerance were recorded. SPSS 23.0 was used to analyze all data. Results: In this study, 36 (53.7%) were males and 31 (46.3%) were females. The mean age of the patients was 51.3±17.87 years and had mean BMI 26.08±12.63 kg/m2. Mean duration of LP was 3.9±10.29 years. There were 28 (41.8%) cases had classic lichen planus, followed by ashy dermatosis, hypertrophic, oral lichen planus, nail and actinic. We found that 17 (25.4%) patients had diabetes mellitus type II and 20 (29.9%) cases had glucose intolerance. We found a significant relationship between LP and DM in our cases with p value <0.004. Conclusion: We concluded in this study that the patients of lichen planus had higher frequency of DM type -2 and glucose intolerance. There was a close relationship between lichen planus and DM among all cases. There is need to evaluate patients early for treatment in hospitals. Keywords: Glucose Intolerance, type-2 DM, Lichen planus

Ashy dermatosis with a Wagyu beef‐like dermoscopic appearance: Report of two cases

AbstractThere have been no reports as to the link between dermoscopic observations and disease activity in ashy dermatosis. We herein report two cases of ashy dermatosis displaying on dermoscopy the so‐called Wagyu beef‐like pattern, consisting of pigmentation on skin rete ridges and brown dots. Ashy dermatosis histologic features may change according to the clinical activity of the eruption; both of our cases were deemed to be in late stages, histopathologically characterized by dermal melanin incontinence without vacuolization of the basal cell layer. The present cases suggest that the Wagyu beef‐like appearance can be seen even in late stages of activity in ashy dermatosis.

Diagnostic tools for hyperpigmentation disorders in skin of color: An updated review

AbstractHyperpigmentation disorders are highly prevalent and disproportionately affect patients with skin of color. Studies suggest that over 65% of Black or African American patients haveexperienced at least one episode of hyperpigmentation due to skin damage or irritation. Notably, melasma and postinflammatory hyperpigmentation are the two most common forms of dyschromia in patients with skin of color. Additionally, otherconditionssuch as lichen planus and erythema dyschromicum perstans can have a more severe presentation and significant morbidity in this patient population. Thus, hyperpigmentation disorders can benefit greatly from prompt and accurate diagnosis that results in more precise management. In this review, we present the most updated information regarding dermoscopy, reflectance confocal, and conventional light microscopy in the diagnosis of hyperpigmentation disorders in skin of color. In addition, we summarize the benefits and pitfalls of some of these techniques, with a special emphasis on their accuracy and potential to assess favorable treatment outcomes. We also describe recent studies that have compared these diagnostic techniques across many disorders of hyperpigmentation and the practical findings that can be applied to everyday practice. We recognize that the cost of equipment, clinician training, and device availability are all critical factors when choosing the ideal diagnostic tool and provide varied approaches to improve accuracy. Today, diagnosing and treating hyperpigmentation skin conditions has become easier through technological advances. More reliable, noninvasive techniques such as dermoscopy and reflectance confocal microscopy show promise as adjuncts to guide laser and light therapies and monitor treatment response in dermatology clinics and clinical trials.

A Delphi consensus on the nomenclature and diagnosis of lichen planus pigmentosus and related entities.

Although well known in clinical practice, research in lichen planus pigmentosus and related dermal pigmentary diseases is restricted due to lack of consensus on nomenclature and disease definition. Delphi exercise to define and categorise acquired dermal pigmentary diseases. Core areas were identified including disease definition, etiopathogenesis, risk factors, clinical features, diagnostic methods, treatment modalities and outcome measures. The Delphi exercise was conducted in three rounds. Sixteen researchers representing 12 different universities across India and Australia agreed to be part of this Delphi exercise. At the end of three rounds, a consensus of >80% was reached on usage of the umbrella term 'acquired dermal macular hyperpigmentation'. It was agreed that there were minimal differences, if any, among the disorders previously defined as ashy dermatosis, erythema dyschromicum perstans, Riehl's melanosis and pigmented contact dermatitis. It was also agreed that lichen planus pigmentosus, erythema dyschromicum perstans and ashy dermatosis did not differ significantly apart from the sites of involvement, as historically described in the literature. Exposure to hair colours, sunlight and cosmetics was associated with these disorders in a significant proportion of patients. Participants agreed that both histopathology and dermatoscopy could diagnose dermal pigmentation characteristic of acquired dermal macular hyperpigmentation but could not differentiate the individual entities of ashy dermatosis, erythema dyschromicum perstans, Riehl's melanosis, lichen planus pigmentosus and pigmented contact dermatitis. A wider consensus involving representatives from East Asian, European and Latin American countries is required. Acquired dermal macular hyperpigmentation could be an appropriate conglomerate terminology for acquired dermatoses characterised by idiopathic or multifactorial non-inflammatory macular dermal hyperpigmentation.

Updates in Causes, Risk Factors, Diagnosis and Management of Lichen Planus

Bhutani et al. originally described a pigmented variety of lichen planus (LP) from India in 1974, and created the label LP pigmentosus (LPP) to better describe it. LPP is one of several variations of the LP gene. This skin lesion has also been reported in the Middle East, Latin America, Korea, and Japan, and is more common in those with darker skin. The most common differential diagnosis for LPP is erythema dyschromicum perstans (EDP). Fixed drug eruption, macular amyloidosis, urticaria pigmentosa, tar melanosis, frictional melanosis, berloque dermatitis, pigmented beautifying dermatitis (Reihl's melanosis), and pigmented beautifying dermatitis (Reihl's melanosis) are some of the other differences. Cutaneous LP usually clears up on its own after 1 to 2 years, thus care focuses on lowering pruritus and speeding up the healing process. First-line management for limited LP is superpotent interesting steroids (clobetasol 0.05%) twice daily for 2 to 4 weeks.
 This study aims to:
 1- Recognize the causes and risk factors for lichen planus
 2- Correct diagnosis of lichen planus
 3- Provide effective treatment for lichen planus

Hyperpigmentation-Ashy Dermatosis

Ashy dermatosis-like hyperpigmentation Erythema dyschromicum perstans (EDP), also known as ashy dermatosis, is a hypermelanotic condition characterised by the development of a slate-grey macula in otherwise healthy individuals. Here, we describe sudden-onset EDP in a 19-year-old male patient.His lesions had started 3 months ago and increased in the last 2 weeks. Dermatological examination revealed pigmented macules and patches of different sizes, which tended to coalesce, on the back and anterior aspect of the trunk. The lesions did not regress after local treatment with a prescribed corticosteroid cream of moderate potency. The patient was free from systemic disease, was not taking any drugs and had no relevant family history. Histopathological examination of lesional biopsy tissue from the back and anterior of the trunk revealed EDP, characterised by vacuolar degeneration of the basal layer, mild lymphohistiocytic inflammatory cell infiltration around the vessels in the upper dermis, melanophages, pigment incontinence, and low-level lymphocyte exocytosis in the epithelium. Dapsone (100 mg/day) controlled the lesions. EDP is a rare dermatosis, for which differential diagnosis and treatment may thus sometimes be inadequate.

Evaluation of Dermoscopic Features in Facial Melanosis with Wood Lamp Examination

IntroductionFacial melanosis is one of the most common reasons for which patients refer to a dermatologist in Nepal.ObjectivesThe objective of this study was to evaluate the dermoscopic findings of common facial melanoses and correlate them with findings from Wood lamp examination.MethodsThis was a cross-sectional study conducted at the Department of Dermatology and Venereology, Nepal Medical College and Teaching Hospital. We recruited a total of 204 patients from July 2020 to March 2021. The most common diagnosis was melasma (37 patients) followed by melasma with steroid-induced rosacea-like dermatitis (29 patients). After collecting clinical and demographic data, patients underwent Wood lamp and dermoscopic examination.ResultsDermoscopy of ashy dermatosis and nevus of Ota revealed blue-gray pigmentation forming a curvilinear pattern; café-au-lait macule and nevus spilus revealed a light brown reticular pattern with follicular sparing; and a reticular and hem-like pattern of pigmentation was observed in clofazimine-induced pigmentation, peribuccal pigmentation of Brocq and periorbital pigmentation. The degree of agreement between Wood lamp and dermoscopic findings was found to be statistically significant in melasma (κ = 0.701, P = 0.0001) and melasma with steroid-induced rosacea-like dermatitis (κ = 0.628, P = 0.0001). While the agreement between the two techniques was 100% for epidermal types, it decreased to 44.8% for dermal melasma and 61.5% for dermal melasma with steroid-induced rosacea-like dermatitis.ConclusionsDermoscopy is useful in assessing facial melanoses. It may be supplemented with Wood lamp examination to increase diagnostic accuracy.

Annular lichenoid diseases

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.

Erythema Dyschromicum Perstans: The Spotty Possibility – A Rare Case Report

Erythema Dyschromicum Perstans (EDP) / Ashy Dermatosis are a less common dermatological disorder with an unknown etiology. It is characterized by asymptomatic, grey, symmetric and confluent macules all over the body. Herein, we report a case of a 50 years old man who presented clinically, with diffuse, patchy pigmentation having ill-defined, erythematous borders involving bilateral arms and forearms. Histopathological examination of the lesion biopsy demonstrates vacuolar degeneration of the basal cell layer, dermal perivascular mononuclear cell infiltrate and increased epidermal melanin pigment and presence of dermal melanophages. For the present case, treatment with Clofazimine has proven to be effective.

Lichen planus pigmentosus in a 7-year-old girl.

LPP is a rare variant of LP that is infrequently encountered in children. In a retrospective analysis of 316 pediatric patients with LP, only nine (2.8%) were diagnosed with LPP (4). Similarly, in a recent retrospective study of 76 pediatric patients with LP in South India, only one (1.3%) was diagnosed with LPP (6). It is commonly seen in middle-aged patients with high skin phototypes. LPP presents as chronic, acquired, violaceous to brownish-gray, oval macules, with poorly-defined borders (7). The lesions appear more frequently in the neck and face, but they can also affect the upper and lower extremities, and torso as well. LPP rarely affects the oral mucosa, scalp, palms, soles, and nails. Flexural involvement is seen in around 20% of cases with a concurrent photo-exposed distribution (5). LPP-inversus is a variant of LPP, limited to intertriginous and flexural areas, and sparing sun-exposed areas (3, 5). A skin biopsy will confirm the diagnosis. The histopathology findings include hyperkeratosis and vacuolar degeneration of the basal layer, dermal band-like or perivascular infiltrate, and melanophages. Superficial pigmentary incontinence can be seen (7). The main differential diagnosis of LPP is erythema dyschromicum perstans (EDP) or ashy dermatosis. EDP presents as non-pruritic, blue-gray macules and patches, with or without raised erythematous borders in photo-exposed areas and trunk. Histopathology reveals lichenoid features within the peripheral active border. A perivascular infiltrate and numerous melanophages can be seen. The clinical features and histopathology of LPP and EDP can overlap, so much so as to suggest that the two conditions can be part of the spectrum of a unique entity. Other differential diagnoses include post-inflammatory hyperpigmentation, pigmented contact dermatitis, fixed drug eruption, and urticaria pigmentosa, among others (2, 7). LPP treatment is difficult, with limited results in most cases. The available topical treatments include medium to high potency corticosteroids, calcineurin inhibitors (mostly tacrolimus 0.1% ointment) and skin lightening creams containing hydroquinone and retinoids in conjunction with an anti-inflammatory treatment (3, 7, 9). Some Authors (3) recommend that in order to prevent steroid atrophy, corticosteroids should be used for a short period (2-4 weeks). Later on they could be followed by a calcineurin inhibitor over a longer period (3-6 months). In recalcitrant or widespread cases, systemic treatments with or without topical therapy can be used. They include oral corticosteroids, dapsone, and isotretinoin (7, 9, 10). The use of narrow band ultraviolet B (NB-UVB) phototherapy in LPP has been recently reported. Complete resolution of lesions was achieved after 20 exposures and no adverse effect was observed (1).