Erythema Dyschromicum Perstans Research Articles

Ashy dermatosis, or "Tyndall-effect" dermatosis

A 59-year-old man with ashy dermatosis is presented; the classification and diagnosis of this disease is discussed. Ashy dermatosis presents two main clinical aspects: the ashy-color maculae, and the involvement mainly in darker-skinned patients often from Latin America and Asia. The blue-grey color can be explained by the Tyndall effect because of the melanin found in the dermis. Bluish dermal melanocytoses are also more common in these same racial and ethnic groups. Perhaps the particular size and distribution of melanosomes in these groups predisposes them to development of ashy dermatosis.

Erythema dyschromicum perstans in children: a report of 14 cases

Erythema dyschromicum perstans (EDP) or ashy dermatosis is a peculiar, slowly progressive, macular hyperpigmentation, which leaves a permanent discoloration. It is an acquired dermatosis that occurs most frequently in Central and South America. EDP usually appears in adults, but some isolated cases and small series have been reported in prepubertal children. A retrospective review of cases of EDP in 10-year-old children or younger, attended in a pediatric hospital between 1990 and 2003. We present 14 cases of EDC in children 10 years and younger. With an additional 25 cases reported so far in the English language literature, a total of 39 children have been described. Unlike adult patients, who are most commonly of Hispanic origin, children with EDP are usually Caucasian. Other important facts in children with EDP are the absence of consistent trigger factors and an eventual improvement or resolution of the lesions in 50% of prepubertal patients. We suggest that EDP is a distinctive clinical entity, different from lichen planus and lichen planus pigmentosus, which may be identical to the so-called idiopathic eruptive macular pigmentation.

Erythema dyschromicum perstans: Response to dapsone therapy

Erythema dyschromicum perstans (EDP) is a rare disorder characterized by asymptomatic, slowly progressive, ash-gray macular pigmentation of the skin, which usually occurs from age 5 years through adult life. Most cases reported to date are of Latin American and Indian patients. Rare cases have been reported from Turkey. No treatment of choice is presently available. Various therapies have been tried, including sun protection, chemical peels, antibiotics, corticosteroids, vitamins, isoniazid, griseofulvin, and chloroquine, without any benefit. Some authors have suggested the therapeutic efficacy of clofazimine and dapsone on EDP. We report a case of EDP that responded remarkably well to treatment with dapsone.

Optimal management of recalcitrant disorders of hyperpigmentation in dark-skinned patients.

Alterations in skin pigmentation may often have a dramatic expression in individuals with a dark skin complexion and can be a source of significant emotional distress in these individuals. Hyperpigmented disorders such as melanosis (melasma), post-inflammatory hyperpigmentation, drug-induced hyperpigmentation, and erythema dyschromicum perstans tend to have a prolonged course and, in many cases, are refractory to treatment, further contributing to the psychological impairment of the affected patients. Melanosis, is a common form of facial pigmentation attributable to sunlight and hormonal factors. A range of treatment modalities, such as depigmenting agents, topical retinoids, and chemical peels in conjunction with rigorous sun protection, can improve the melanosis but the condition usually recurs. Combination regimens, including frequent applications of superficial- and medium-depth chemical peels, appear to be particularly effective and well tolerated in dark-skinned patients with melanosis. Post-inflammatory hyperpigmentation is the result of excess pigment deposition following an inflammatory skin disorder. Topical tretinoin, hydroquinone, azelaic acid, kojic acid, and glycolic acid peels have been employed with variable degrees of success. Drug-induced pigmentation is a frequent cause of acquired hypermelanosis, its clinical expression depending on the triggering molecule and the underlying pathogenetic mechanism. Identifying and discontinuing the offending agent is the main approach in this condition, although, recent reports have demonstrated the efficacy of Q-switched lasers in accelerating the pigment removal. Erythema dischromicum perstans is a characteristic dermal pigmentation occurring mainly in dark-skinned individuals. Immunomodulating agents, such as clofazimine and dapsone have been shown to lighten this disorder, although, the exact mode of action is not clear.

Erythema dyschromicum perstans in prepubertal children.

Erythema dyschromicum perstans (EDP) is a rare disorder of pigmentation that is most common in Hispanic patients. In adults, EDP has a slow onset and is unlikely to resolve spontaneously. The etiology and clinical course in children is poorly defined. Physical examinations, chart reviews, and telephone interviews were performed for eight pediatric patients with EDP who were followed at Children's Memorial Hospital in Chicago between 1990 and 1998. All the patients available for long-term follow-up (five of the eight) experienced complete clearance without recurrence in an average of 2.5 years. In all of our patients, the onset was noted from July to December. The administration of aminopenicillins was coincident with the development of EDP in two of the patients. Review of the English-language literature reveals that 25 prepubertal children have previously been reported. Including our patients, 69% of prepubertal children with EDP experienced resolution. We concluded that the clinical course of childhood (prepubertal) EDP differs from that of adult EDP, and it is more likely to resolve within 2-3 years.

Erythema dyschromicum perstans and vitiligo

We report an East Indian man with simultaneous lesions of erythema dyschromicum perstans and vitiligo. This report is only the second to present these two pigmentary disorders occurring in the same patient. Although the exact cause of both disorders is unknown, a pathogenetic role for cytotoxic T-cell responses has been hypothesized in each condition.

Idiopathic eruptive macular pigmentation: Report of 10 cases

Idiopathic eruptive macular pigmentation (IEMP) is a rare disease. IEMP is characterized by asymptomatic, pigmented macules involving the neck, trunk, and proximal extremities. This study describes 10 cases of idiopathic eruptive macular pigmentation seen during a 9-year period at the Asan Medical Center, Seoul, Korea. We present these characteristic consecutive cases to provide more insight into the clinical picture and course of IEMP. Skin lesions of 8 patients were multiple brown macules involving the trunk, face, neck, and extremities. In 2 patients, multiple dark brown macules and patches were noted. The age of onset varied from 1 to 20 years. Tentative diagnoses were usually ashy dermatosis (erythema dyschromicum perstans), fixed drug eruption, or mastocytosis. The history of any erythema and drug medication was absent. Darier's sign was absent. Skin biopsy specimens showed increased pigmentation of the basal layer in an otherwise normal epidermis. Pigmentary incontinence, melanophages, and mild perivascular lymphohistiocytic infiltrate in the papillary dermis were also revealed. Mast cells could not be found. The lesions gradually disappeared during a period of several months to years. The alleged rarity of IEMP may be partially caused by medical unfamiliarity with this entity, despite its clinical and histopathologic characteristic picture. Treatment of IEMP is unnecessary because spontaneous resolution of the lesions can be expected within several months to a few years. (J Am Acad Dermatol 2001;44:351-3.)

DISORDERS OF HYPERPIGMENTATION

Hyperpigmentation is a common disorder of the skin, particularly in brown-skinned patients. Melasma is a common cause of facial hyperpigmentation and can be resistant to treatment. A combination of topical creams and gels, chemical peels, and sunscreens may be necessary for significant improvement. Erythema dyschromicum perstans is a dermal pigmentation seen on the trunk and proximal extremities, most commonly presenting in dark-skinned Hispanics. Drug-induced and postinflammatory hyperpigmentation may last for many months after the offending drug or dermatitis has been eliminated. These disorders, including their management, is reviewed in this article.

Letter to the Editor Regarding the Article: “Erythema Dyschromicum Perstans in Early Childhood” by Sang‐Ju Lee and Kee‐Yang Chung

Letter to the Editor Regarding the Article: “Erythema Dyschromicum Perstans in Early Childhood” by Sang‐Ju Lee and Kee‐Yang Chung

Ashy dermatosis: Case report

Ashy dermatosis: Case report

Involvement of Cell Adhesion and Activation Molecules in the Pathogenesis of Erythema Dyschromicum Perstans (Ashy Dermatitis)

To assess the expression of several cell adhesion and lymphocyte activation molecules in erythema dyschromicum perstans lesions, and to evaluate the effect of clofazimine therapy on the expression of these molecules. A prospective study. Skin biopsy samples were obtained from patients before and after 3 months of clofazimine therapy, and the expression of cell adhesion and activation molecules was assessed by an immunohistochemical technique. This study was performed in a clinical referral center and an immunology research laboratory. We studied 6 patients with erythema dyschromicum perstans. A diagnosis was made on the basis of clinical and histological criteria. Two patients discontinued participation in the study: one because of adverse effects and the other for unknown reasons. Patients were treated with clofazimine, 100 mg/d, for 3 months. Expression of cell adhesion and lymphocyte activation molecules in skin biopsy specimens before and after clofazimine therapy. Before clofazimine therapy, we detected a noticeable expression of intercellular adhesion molecule 1 and major histocompatibility complex class II molecules (HLA-DR) in the keratinocyte basal cell layer. In addition, CD36, a thrombospondin receptor that is not expressed by normal skin, was detected in the strata spinosum and granulosum. The dermal cell infiltrate expressed the activation molecule AIM/CD69 and the cytotoxic cell marker CD94. After clofazimine therapy, the expression of intercellular adhesion molecule 1 and HLA-DR disappeared, as well as the mononuclear cell infiltrate. Our results suggest that some cell adhesion and activation molecules are involved in the pathogenesis of erythema dyschromicum perstans. Clofazimine appears to have an important effect on the inflammatory phenomenon of erythema dyschromicum perstans.

Involvement of cell adhesion and activation molecules in the pathogenesis of erythema dyschromicum perstans (ashy dermatitis). The effect of clofazimine therapy

Objectives : To assess the expression of several cell adhesion and lymphocyte activation molecules in erythema dyschromicum perstans lesions, and to evaluate the effect of clofazimine therapy on the expression of these molecules. Design and Methods : A prospective study. Skin biopsy samples were obtained from patients before and after 3 months of clofazimine therapy, and the expression of cell adhesion and activation molecules was assessed by an immunohistochemical technique. Setting : This study was performed in a clinical referral center and an immunology research laboratory. Patients : We studied 6 patients with erythema dyschromicum perstans. A diagnosis was made on the basis of clinical and histological criteria. Two patients discontinued participation in the study : one because of adverse effects and the other for unknown reasons. Interventions : Patients were treated with clofazimine, 100 mg/d, for 3 months. Main Outcome Measures : Expression of cell adhesion and lymphocyte activation molecules in skin biopsy specimens before and after clofazimine therapy. Results : Before clofazimine therapy, we detected a noticeable expression of intercellular adhesion molecule 1 and major histocompatibility complex class II molecules (HLA-DR) in the keratinocyte basal cell layer. In addition, CD36, a thrombospondin receptor that is not expressed by normal skin, was detected in the strata spinosum and granulosum. The dermal cell infiltrate expressed the activation molecule AIM/CD69 and the cytotoxic cell marker CD94. After clofazimine therapy, the expression of intercellular adhesion molecule 1 and HLA-DR disappeared, as well as the mononuclear cell infiltrate. Conclusions : Our results suggest that some cell adhesion and activation molecules are involved in the pathogenesis of erythema dyschromicum perstans. Clofazimine appears to have an important effect on the inflammatory phenomenon of erythema dyschromicum perstans.

Pigmentary Problems in the Tropics

Pigmentary problems are one of the most frequent causes of dermatologic consultation in the tropics. This article deals with diseases seen mostly in tropical countries (ashy dermatosis, lichen planus pigmentosus, frictional dermatitis, pityriasis versicolor, and pinta) and in which a combination of racial, ecologic, nutritional, and social factors all contribute. Other common dermatoses seen worldwide, such as vitiligo and melasma, sometimes acquire dramatic expressions in tropical countries, and their management is usually difficult even for the most experienced dermatologists.

Ashy dermatosis associated with cobalt allergy

Ashy dermatosis associated with cobalt allergy

Erythema dyschromicum perstans and lichen planus: Are they related?

A 53-year-old woman initially had lichen planus primarily on her extremities. Approximately 1 year later, lesions consistent with erythema dyschromicum perstans were observed. Both diseases cleared with griseofulvin therapy but returned after discontinuation of the drug. Retreatment with griseofulvin again resulted in clearing.

Erythema dyschromicum perstans: Immunopathologic studies

Immunopathologic studies of a patient with clinical and histologic evidence of erythema dyschromicum perstans revealed la antigen expression on epidermal keratinocytes, pronounced OKT4 and OKT6 staining of epidermal dendritic cells, and dermal infiltration of T lymphocytes of both helper-inducer (OKT4) and suppressor-cytotoxic (OKT8) phenotypes—a pattern commonly associated with lichen planus. These findings, taken in conjunction with positive IgG staining on colloid bodies, suggest the possibility that erythema dyschromicum perstans and lichen planus have similar disease processes.

Clinical trial with clofazimine for treating erythema dyschromicum perstans. Evaluation of cell-mediated immunity.

Eight patients were studied to determine the possible use of clofazimine for treating erythema dyschromicum perstans (EDP). The T-helper/T-suppressor cytotoxic ratio (CD-4/CD-8) and the in vitro lymphoproliferative response on stimulation with phytohemaglutin (PHA) and concanavalin A (Con A) were determined in peripheral blood before and after treatment. Of the eight patients studied, seven had excellent to good responses, whereas only one had a marginal response. The immunologic evaluation before and after treatment showed a significant change in the CD-4/CD-8 ratio, a decrease of the response to PHA, and no change in the response to Con A. The results obtained show that clofazimine is useful for treating this nosologic entity because of its cosmetic effect, and also because it induces changes in cell-mediated response, which could be very important therapeutically.

Simultaneously Active Lesions of Vitiligo and Erythema Dyschromicum Perstans

Recently, a patient presented to us with skin that had areas of normal pigmentation, hyperpigmentation, and depigmentation. Workup eventually showed him to have simultaneously active lesions of a depigmenting disorder, vitiligo, and a hyperpigmenting disorder, erythema dyschromicum perstans.

Erythema Dyschromicum Perstans Following Human Immunodeficiency Virus Seroconversion in a Child With Hemophilia B

To the Editor.— Since its description by Ramirez in 1957 under the name ashy dermatosis, erythema dyschromicum perstans (EDP) remains a discussed clinical entity of unknown cause. 1-4 A relationship between EDP and lichen planus 5 (LP) has been suggested, allowing some authors to propose the term lichen planus pigmentosus . 6 We report a further case of EDP following human immunodeficiency virus (HIV) seroconversion. Report of a Case.— A 6-year-old boy was referred to our institution in January 1987, for the evaluation of a cutaneous pigmentary disturbance first noted in January 1984. The skin lesions were preceded by transient, nonpruritic, erythematous macules with generalized lymphadenopathies and splenomegaly. The patient suffered from hemophilia B, with an HIV seroconversion demonstrated in June 1983 by the enzyme-linked immunosorbent assay (ELISA) and confirmed by Western blotting, whereas ELISA performed on serum stored since September 1982 was negative. On examination, there was a brownish,

Erythema dyschromicum perstans following human immunodeficiency virus seroconversion in a child with hemophilia B

Erythema dyschromicum perstans following human immunodeficiency virus seroconversion in a child with hemophilia B