Hypopigmented Diseases Research Articles

Diagnostic findings in Various Cutaneous Hypopigmented Disorders: A Scoping Review

Introduction: Medical conditions can cause the skin to become hypopigmented or depigmented, mainly due to decreased production of melanin. Hypomelanosis is mainly benign and rarely malignant. Depigmentation refers to a complete lack of melanin, with the most common cause being vitiligo. Differentiating between these conditions can be difficult. Diagnosis of the condition is primarily based on the patient’s detailed history, clinical signs and symptoms, accurate evaluation, and dermoscopy. Repigmentation can occur following early diagnosis and appropriate management. Aim: To highlight diagnostic findings of various cutaneous hypopigmented macular lesions and patches. Materials and Methods: PubMed and Google Scholar databases were searched using a mix of terms, including “cutaneous disorders”, “dermoscopy”, “skin biopsy”, and “hypopigmented disorders” for this scoping review, which followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines. Boolean operators “AND” and “OR” were used between the keywords. The inclusion criteria consisted of articles with full text availability, articles describing various cutaneous disorders with characteristic morphology, diagnosis, types and subtypes, conditions associated with systemic diseases, histological examination findings, and prognosis of the condition, peer-reviewed papers with a comprehensive diagnosis of cutaneous hypopigmented diseases, histological biopsies. Randomised Controlled Trials (RCTs), review articles, case reports, and articles in the English language were included in this review. Results: Based on the selection criteria, a total of 12 studies were included in the review, describing various cutaneous disorders with characteristic morphology, diagnosis, types and subtypes, conditions associated with systemic diseases, histological examination findings, and prognosis of the condition. Conclusion: Knowledge regarding various outcomes from the studies related to diagnostic findings in various cutaneous hypopigmented disorders is essential for dermatologists for awareness, appropriate examination, and adequate treatment.

Prevalance of hypopigmentary disorders in primary school children in zagazig city pilot study

Background: Hypopigmentary disorders are common group of dermatoses in pediatric age group. Some are transitory and require only one or few visits to the dermatologist, while others are chronic and recurrent. Thus require more follow-up. Aim: To determine the commonest causes of hypopigmented diseases and their prevalance among primary school children in Zagazig City. Methods: A pilot study was carried out on 40 patients of both sexes chosen by random sample. Aged from 6-11 years from one primary school children in zagazig city. The data were collected by An interview questionnaire, complete history was taken, Clinical examination. Results: The overall prevalence of hypopigmented diseases among the studied primary school children was 62.5%. The most prevalent hypopigmented diseases were pityriasis alba 56%, followed by pityriasis versicolor 24%, post-inflammatory hypopigmentaion 20%. Conclusions: Common hypopigmentary diseases constitute a significant health problem among primary school children in Zagazig city. The most prevalent hypopigmented diseases were pityriasis alba 56%, followed by pityriasis versicolor 24%, post-inflammatory hypopigmentaion 20%.

Application of dermoscopy in the diagnosis and differential diagnosis of vitiligo

Objective To evaluate the application value of polarized light dermoscopy in the diagnosis of vitiligo and differential diagnosis between vitiligo and other common hypopigmented diseases. Methods Dermoscopic images of lesions of 235 patients with confirmed vitiligo (130 with active vitiligo and 105 with stable vitiligo) were collected from the database in the Department of Dermatology, Xijing Hospital from January 2018 to July 2018, and retrospectively analyzed. Meanwhile, dermoscopic images of amelanotic nevus (151 cases) , pityriasis alba (113 cases) and idiopathic guttate hypomelanosis (54 cases) were compared with the dermoscopic images of vitiligo. Chi-square test was used for comparison of rates among groups. Results The prevalence of perifollicular pigmentation, reticular pigmentation, starburst, Tapioca sago and micro-Koebner phenomenon was significantly higher in the patients with active vitiligo than in those with stable vitiligo (χ2=36.5, 151.2, 13.0, 14.9, 8.4 respectively, all P < 0.05) . The prevalence of perifollicular pigmentation, perilesional hyperpigmentation, perifollicular telangiectasia, leukotrichia was significantly higher in patients with stable vitiligo than in those with active vitiligo (χ2=91.2, 166.0, 54.3, 41.1 respectively, all P < 0.05) . The prevalence of residual perifollicular pigmentation was significantly higher in patients with active (89.2%, 116/130) or stable vitiligo (54.3%, 57/105) than in those with amelanotic nevus (20.5%, 31/151, P < 0.05) , pityriasis alba (12.4%, 15/113, P < 0.05) or idiopathic guttate hypomelanosis (9.3%, 5/54, P < 0.05) . Conclusion Residual perifollicular pigmentation could serve as an important feature for distinguishing vitiligo from achromic nevus, pityriasis alba and idiopathic guttate hypomelanosis, and polarized light dermoscopy shows good value in the differential diagnosis between vitiligo and some hypopigmented diseases. Key words: Vitiligo; Dermoscopy; Diagnosis, differential; Hypopigmented diseases

Mycosis Fungoides: Experience in a Pediatric Hospital

BackgroundMycosis fungoides (MF), the most common primary cutaneous T-cell lymphoma, is unusual in children. ObjectivesWe aimed to describe the epidemiologic, clinical, histopathologic, and immunophenotypic characteristics of MF as well as treatments and course of disease in a pediatric case series. Material and methodsData for all patients admitted to our pediatric hospital (Hospital Dr. J. P. Garrahan) in Argentina with a clinical and histopathologic diagnosis of MF between August 1988 and July 2014 were included. ResultsA total of 14 patients were diagnosed with MF. The ratio of boys to girls was 1:1.33. The mean age at diagnosis was 11.23 years (range, 8–15 years). The mean time between onset and diagnosis was 3.5 years (range, 4 months–7 years). All patients had hypopigmented MF and 42% also presented the features of classic MF. Seven (50%) had the CD8+ immunophenotype exclusively. Seventy-eight percent were in stage IB at presentation. Phototherapy was the treatment of choice. Four patients relapsed at least once and skin lesions progressed in 3 patients. All patients improved. ConclusionsMF is unusual in children. The hypopigmented form is the most common. Diagnosis is delayed because the condition is similar to other hypopigmented diseases seen more often in childhood. Although prognosis is good, the rate of recurrence is high, so long-term follow-up is necessary.

Micosis fungoide. Experiencia en un hospital pediátrico

Mycosis fungoides (MF), the most common primary cutaneous T-cell lymphoma, is unusual in children. ObjectivesWe aimed to describe the epidemiologic, clinical, histopathologic, and immunophenotypic characteristics of MF as well as treatments and course of disease in a pediatric case series. Material and methodData for all patients admitted to our pediatric hospital (Hospital Dr. J. P. Garrahan) in Argentina with a clinical and histopathologic diagnosis of MF between August 1988 and July 2014 were included. ResultsA total of 14 patients were diagnosed with MF. The ratio of boys to girls was 1:1.33. The mean age at diagnosis was 11.23 years (range, 8–15 years). The mean time between onset and diagnosis was 3.5 years (range, 4 months–7 years). All patients had hypopigmented MF and 42% also presented the features of classic MF. Seven (50%) had the CD8+ immunophenotype exclusively. Seventy-eight percent were in stage IB at presentation. Phototherapy was the treatment of choice. Four patients relapsed at least once and skin lesions progressed in 3 patients. All patients improved. ConclusionsMF is unusual in children. The hypopigmented form is the most common. Diagnosis is delayed because the condition is similar to other hypopigmented diseases seen more often in childhood. Although prognosis is good, the rate of recurrence is high, so long-term follow-up is necessary.

Analysis of tuberous sclerosis initially manifested as hypomelanotic macules in 12 infants

Objective To investigate clinical characteristics of tuberous sclerosis (TSC) without nervous system abnormalities in infants. Methods Clinical manifestations of 12 infants with TSC were analyzed. Reflectance confocal microscopy (RCM) was performed in 5 of the 12 infants. Two patients underwent histopathological examination and electron microscopic examination. Results The age at first clinic visit for TSC ranged from 2 to 18 months (median, 8.6 months) among these patients. Before occurrence of nervous symptom, TSC mainly manifested as hypomelanotic macules, nodules in the subependymal layer or walls of lateral ventricles of the brain, cardiac rhabdomyoma and multiple renal cysts. RCM revealed intact dermal papillary rings with low reflectivity and obscure boundaries in 5 infants. Histopathological examination showed a local decrease in melanocytes and pigment granules in basal cells. Electron microscopic examination showed a normal number of melanin granules in the cytoplasm of melanocytes in the basal layer. Conclusions Before appearance of nervous system abnormalities, TSC mainly manifests as hypomelanotic macules in infants, and is easily confused with vitiligo in clinic. RCM examination may serve as a useful method to distinguish infant TSC from hypopigmented diseases. Key words: Tuberous sclerosis; Infant; Hypopigmentation; Vitiligo; Microscopy, confocal

Angiography with a multifunctional line scanning ophthalmoscope

A multifunctional line scanning ophthalmoscope (mLSO) was designed, constructed, and tested on human subjects. The mLSO could sequentially acquire wide-field, confocal, near-infrared reflectance, fluorescein angiography (FA), and indocyanine green angiography (ICGA) retinal images. The system also included a retinal tracker (RT) and a photodynamic therapy laser treatment port. The mLSO was tested in a pilot clinical study on human subjects with and without retinal disease. The instrument exhibited robust retinal tracking and high-contrast line scanning imaging. The FA and ICGA angiograms showed a similar appearance of hyper- and hypo-pigmented disease features and a nearly equivalent resolution of fine capillaries compared to a commercial flood-illumination fundus imager. An mLSO-based platform will enable researchers and clinicians to image human and animal eyes with a variety of modalities and deliver therapeutic beams from a single automated interface. This approach has the potential to improve patient comfort and reduce imaging session times, allowing clinicians to better diagnose, plan, and conduct patient procedures with improved outcomes.

Calcineurin inhibitors in the treatment of vitiligo

Vitiligo is an acquired hypopigmented disease characterized by the destruction of melanocytes.Many scholars consider that the pathogenesis of vitiligo is mainly associated with immune abnormalities.Topical calcineurin inhibitors have favorable efficacy in the treatment of vitiligo,and the efficacy is associated with the treatment regimen,course,application sites,duration and stage of vitiligo,etc.The combination with narrow-band ultraviolet B,308-nm excimer laser or other therapies may have synergistic effect on the efficiency of calcineurin inhibitors.Although calcineurin inhibitors are safe and effective in the treatment of vitiligo,further studies are needed to evaluate their long-term safety and stability. Key words: Vitiligo; Tacrolimus; Pimecrolimus; Therapy

In vivo confocal laser scanning microscopic features of several hypopigmented diseases

Objective To investigate the confocal laser scanning microscopic (CLSM) features of several hypopigmented diseases, including vitiligo, nevus depigmentosus, progressive macular hypomelanosis and amelanotic nevus. Methods A total of 131 patients with hypopigmented diseases were recruited in this study. CLSM was performed on depigmented lesions, adjacent normal appearing skin and lesion borders at the dermoepidermal junction level in these patients. Results CLSM showed that in progressive vitiligo, melanin was completely absent from some areas in vitiliginous skin, while some areas were present with residual dermal papillary rings which were less intact with decreased melanin content; the border of lesions was obscure; some dermal papillary rings lost integrity in normal appearing skin adjacent to the vitiliginous skin. There was a complete disappearance of pigment in vitiliginous skin, clear border of lesions and intact dermal papillary rings with bright reflected light in adjacent normal appearing skin in stable vitiligo. Dendrite-like melanocytes with bright reflected light were noted in recovery-stage vitiligo. The CLSM imaging of nevus depigmentosus and progressive macular hypomelanosis was similar: dermal papillary rings were intact with decreased melanin content and weak reflected light in depigmented lesions. No significant difference was observed in the structure of dermal papillary rings or melanin content between vitiliginous skin and adjacent normal-appearing skin of nevus anemicus. Conclusion Combined with clinical manifestations, CLSM may serve as an auxiliary tool to discriminate vitiligo, nevus depigmentosus, progressive macular hypomelanosis and amelanotic nevus.