Idiopathic Guttate Hypomelanosis Research Articles

Clinical and dermoscopic patterns of idiopathic guttate hypomelanosis

Depigmented skin lesions are of great concern in society, especially in the Indian subcontinent. These comprise many infective and inflammatory conditions that cause apprehension and anxiety among patients due to the social stigma attached to these conditions. Idiopathic guttate hypomelanosis (IGH) appears similar to many depigmented lesions and differentiation of IGH from these conditions is difficult clinically as well as histopathologically. IGH is one of the common causes of acquired leukoderma. It is also called disseminated lenticular leukoderma. The etiology is yet not clearly delineated, probably multifactorial. Various etiological factors have been proposed including ultraviolet (UV) exposure, post-phototherapy (psoralen and UVA monotherapy, narrowband-UVB), aging, genetic factors, trauma, and autoimmunity. Clinically, it is characterized by multiple, discrete porcelain-white round to oval macules of 2–5 mm average size. It most commonly occurs in the elderly. The most common sites observed are chronically sun-exposed areas such as the arm, pretibial regions, and forearm extensors. It is not easy to differentiate IGH from other hypo and depigmented conditions such as vitiligo, pityriasis versicolor, extragenital lichen sclerosus et atrophicus, guttate morphea, and post-inflammatory hypopigmentation. It poses a diagnostic challenge to dermatologists. One has to differentiate depigmented lesions from vitiligo as it carries tremendous social implications as social stigma, especially in India. Research on dermoscopic evaluation is uncommon in the literature, despite the abundance of clinic-epidemiological and histological studies of IGH. Four dermoscopic patterns, namely, petaloid, amoeboid, feathery, and nebuloid have been described. These patterns are specific to IGH and help clinicians to differentiate many depigmented skin lesions from IGH in clinical practice. Patients often seek cosmetic treatment. There has been no standard therapy for this condition. Newer treatment modalities range from topical agents to procedure-based therapies and have enhanced the therapeutic armamentarium.

Evaluation of diagnostic accuracy of dermoscopy in some common hypopigmented skin diseases.

Diagnosis of cutaneous hypopigmentation can sometimes be challenging. Dermoscopy may play a role in identifying hypo or-depigmented dermatoses. The aim was to investigate which dermoscopic criteria represent potent indicators for the diagnosis of vitiligo, nevus depigmentosus, pityriasis alba, hypopigmented pityriasis versicolor, idiopathic guttate hypomelanosis, hypopigmented mycosis fungoides (MF), lichen sclerosus et atrophicus and ash leaf hypopigmented macules of tuberous sclerosis, and evaluate their diagnostic accuracy. 168 individuals diagnosed with one of these hypopigmented disorders were evaluated for the presence or absence of predetermined dermoscopic criteria. Evaluation of dermatoscopic characteristics in each condition and analysis for sensitivity and specificity of dermatoscopic diagnosis in these hypopigmented lesions was performed. The starburst pattern, micro-koebnerization, and trichrome pattern were unique to vitiligo diagnosis. Vitiligo had higher comet-tail appearance, perifollicular pigmentation, and perilesional hyperpigmentation than other hypopigmented illnesses. Other hypopigmented lesions had greater incidence of amoeboid pattern, faint or diminished pigment network, islands of pigmentation, ill-defined boundaries, pseudopods, and widespread scaling than vitiligo. Finally, perifollicular scaling, comedo-like openings, blue-gray specks, and fibrotic regions excluded vitiligo. Dermoscopy can help identify common hypopigmented skin lesions and reduce the need for skin biopsy. Nevus depigmentosus, pityriasis alba and idiopathic guttate hypomelanosis were the top three hypopigmented dermatoses that could be diagnosed by dermoscopy with 100% sensitivity. Vitiligo was in the second rank (94.7%), followed by lichen sclerosis et atrophicus (93.3%) then hypopigmented MF at 81.2% sensitivity. Dermoscopy sensitivity was lowest in pityriasis versicolor and ash leaf macules of tuberous sclerosis (52.6% and 46.7%, respectively).

The correlation between dermoscopic patterns and histopathological features in idiopathic guttate hypomelanosis at a tertiary care center

The correlation between dermoscopic patterns and histopathological features in idiopathic guttate hypomelanosis at a tertiary care center

Do Egyptian children with beta-thalassemia major have specific cutaneous manifestations? A cross-sectional study

Background A wide continuum of cutaneous manifestations might accompany blood diseases and hemoglobinopathies, especially β-thalassemia. In this situation, cutaneous manifestations occur due to both hemoglobin disorder and treatment complications. These manifestations are usually neglected and frequently underdiagnosed among those patients. Aim To study the cutaneous manifestations in Egyptian children with β-thalassemia to minimize its subsequent complications. Furthermore, we aimed to analyze their relations to duration of disease and frequency of blood transfusions and other disease parameters. Patients and methods This was a cross-sectional study that included 158 patients with β-thalassemia major. All patients were subjected to detailed history, clinical examination, and laboratory investigations, namely, serum ferritin and hemoglobin level. All patients were subjected to meticulous dermatological examination by an experienced dermatologist to evaluate cutaneous manifestations. The data were analyzed using Student t test, Mann–Whitney U test, χ 2 test, and Fisher exact test. Results Xerosis was the commonest encountered cutaneous change (present in 61% of patients), followed by hyperhidrosis (30%), hyperpigmentation (28%), pruritus and pityriasis alba (25%), urticaria (22%), and idiopathic guttate hypomelanosis, scars, ephelides, contact dermatitis, discoid eczema, nail disorders, melasma, tinea, alopecia areata, and warts in descending order. Statistically significant relations were present between the presence of some cutaneous manifestations and disease duration. Conclusion Cutaneous manifestations are common among Egyptian children with β-thalassemia major. Both xerosis and hyperhidrosis are the commonest cutaneous signs in those patients. Some of those cutaneous manifestations are correlated with disease duration and frequency of blood transfusions.

Idiopathic guttate hypomelanosis: Issues of differential diagnosis and therapy

Hypomelanosis is an idiopathic guttate process with the appearance of small struts of hypopigmented, rounded patches on the skin. Despite the high caution of diseases among the population, this dermatosis, as a rule, remains unrecognized throughout life, and it is also difficult to consider this moment of therapy, remaining a cosmetic defect throughout life. This article provides information on the epidemiology, pathogenesis, manifestations, differential diagnosis and therapy of idiopathic guttate hypomelanosis.

Efficacy and Safety of 5-Fluorouracil Tattooing to Repigment Idiopathic Guttate Hypomelanosis: A Split-Body Randomized Trial.

Idiopathic guttate hypomelanosis (IGH) is a common skin disorder with no standard treatment. Assess the efficacy and safety of 5-fluorouracil (5FU) compared with saline, delivered using a tattoo machine, to repigment IGH lesions. This split-body randomized single-blinded trial recruited adults with symmetrical IGH lesions. A tattoo machine was used to deliver 5FU in IGH lesions of 1 limb and saline in the contralateral limb. Outcomes were the number of achromic lesions 30 days after treatment compared with baseline, patient satisfaction, and local or systemic adverse events. Twenty-nine patients (28 women) were included. The median number of achromic lesions decreased significantly in 5FU-treated limbs (baseline: 32, interquartile range (IQR) 23-37 × post-treatment: 12, IQR 6-18, p = .000003) and saline-treated limbs (baseline: 31, IQR 24-43 × post-treatment: 21, IQR 16-31, p = .000006), but reduction was significantly more pronounced in 5FU-treated limbs (p = .00003). All participants were satisfied or very satisfied with results on 5FU-treated limbs. There were no adverse events. 5-fluorouracil delivery using a tattoo machine was more effective than saline to repigment IGH lesions, with high patient satisfaction and no adverse events.Clinicaltrials.gov: NCT02904564.

Clinicodermoscopic Study of Idiopathic Guttate Hypomelanosis at a Tertiary Care Hospital in Central India

Introduction: Depigmented skin lesions are commonly encountered in day-to-day practice and can cause significant social stigma. They are challenging to diagnose clinically and histopathologically. Idiopathic Guttate Hypomelanosis (IGH), a pigmentary condition commonly affecting older individuals, can lead to cosmetic deformity and have a significant psychological impact. Dermoscopic evaluation offers a quick and easy way to resolve diagnostic confusion and prevent unnecessary biopsies. Aim: To study the clinical and dermoscopic features of IGH. Materials and Methods: This cross-sectional observational study was conducted in the Department of Dermatology, Venereology, and Leprosy at Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh (MP), India from July 2021 to June 2022. A total of 180 patients with IGH lesions underwent a detailed clinical history, dermatological and systemic examinations, followed by dermoscopic examination. The collected data were statistically analysed using Statistical Package for Social Sciences (SPSS) version 20.0, and the results were tabulated in terms of distribution, frequency, and mean±Standard Deviation (±SD). Results: Among the 180 patients, the most affected age group was 51-60 years. A total of 108 (60%) were females and 72 (40%) were males. The most common site of involvement was the distal part of the lower extremity in 152 (84.4%) cases, followed by the distal part of the upper extremity in 115 (63.8%) cases. A total of 46 (25.5%) patients had a history of excessive sun exposure. Additionally, 21 (11.6%) patients had other associated features of photoaging, such as xerosis, solar lentigo, seborrhoeic keratosis, freckles, and actinic keratosis. The most common dermoscopic pattern observed was amoeboid in 103 (57.2%) patients, followed by feathery in 41 (22.7%), petaloid in 23 (12.7%), nebuloid in 13 (7.2%), and a combination of patterns in six percent of patients. Conclusion: The IGH was more common in females and older age groups, with the distal parts of the lower extremity being the most frequently involved site. Excessive sun exposure was a common risk factor for IGH, and several patients may have associated signs of photoaging. The most common dermoscopic pattern observed was amoeboid. Therefore, clinical dermoscopic examination can be helpful in identifying IGH and differentiating it from other depigmented lesions.

Salt-and-Pepper Dyspigmentation with Groove Sign in Erasmus Syndrome: A Double Jeopardy.

Salt-and-Pepper Dyspigmentation with Groove Sign in Erasmus Syndrome: A Double Jeopardy.

Evaluation of Clinical Knowledge Regarding Geriatric Skin Conditions among Thai Physicians

Objective: Assess the knowledge of common geriatric skin conditions in Thai physicians.Materials and Methods: This retrospective study was conducted among Thai physicians attending annual dermatology courses by the Dermatological Society of Thailand from 2016 to 2019. Data was assessed based on knowledge of diagnosis and management of common geriatric skin conditions.Results: A total of 197 participants, mainly general practitioners, were included. The highest percentage of correct diagnoses were benign erythematous, eczematous lesions (35.5%, senile purpura; 36.0%, xerotic eczema), and malignant diseases (35.5%, basal cell carcinoma; 27.4%, squamous cell carcinoma; 11.7%, subungual melanoma; 24.4%, acral lentiginous melanoma). In contrasts, the lowest percentage of correct diagnosis were premalignant diseases (0.5%, arsenical keratosis; 4.6%, actinic keratosis; 1.0% Bowen’s disease) and benign hypopigmented lesion (0.5%, stellate pseudoscar; 7.6%, idiopathic guttate hypomelanosis). Harmful treatment with systemic antifungal therapy was used in subungual melanoma (58.0%). Harmful management of senile comedone, subungual melanoma and acral lentiginous melanoma was significantly found in physicians given the incorrect diagnosis. (p = 0.027, p <0.001, p = 0.014, respectively).Conclusion: Most physicians recognized malignant lesions, benign erythematous or eczematous diseases in elderly skin. Surprisingly, almost all physicians couldn’t diagnose premalignant lesions and benign hypopigmented lesions.

Body Mass Index (BMI) and Cutaneous Lesions among the Elderly Patients in a Tertiary Hospital in Rivers State

Aims: The aim of the study is to highlight that cutaneous lesion can be markers of nutritional status in the elderly.
 Study Design: This is a cross-sectional descriptive study.
 Place and Duration of Study: This study took place within the wards of University of Port Harcourt Teaching Hospital over a 3 month period.
 Methodology: A sample of 126 elderly patients were calculated as the sample size to be assessed for cutaneous lesions, of which 122 were fit enough to have their BMI assessed using standardized protocol of measuring height and weight. The BMI was calculated using the formula -BMI = kg/m2.
 Results: Out of the total, 55 of them representing 45.1% had normal BMI, 13 representing 10.7% were underweight, 33 (27%) over weight and 21(17.2%) obese. Underweight elderly patients were more likely than those with normal weight to have xerosis, itching, wrinkles, idiopathic guttate hypomelanosis and ulcers. The elderly with overweight and obesity were more likely to have dermatosis papulosa nigra, signs of post-bleaching syndrome and surgical scars.
 Conclusion: Complaints or observance of cutaneous lesions in elderly should be a reason to investigate nutrition and the solution may lie in nutrition based treatment. More research is however needed to further evaluate the association between cutaneous lesions and body mass index.

Unveiling idiopathic guttate hypomelanosis: pathology, immunohistochemistry, and ultrastructural study.

AbstractBackgroundIdiopathic guttate hypomelanosis (IGH) is a pigment disorder of unknown etiology. Despite its high prevalence and the unaesthetic appearance of the lesions, there are relatively few histological studies on this disorder. This is an important gap to understanding its pathogenesis.ObjectivesTo assess the microscopic structure of IGH lesions compared to normal adjacent skin areas and the possible interaction between melanocytes and the subjacent dermis.MethodsIn this cross‐sectional study, we took biopsy specimens of hypochromic lesions and adjacent normal skin from 20 patients with IGH. We analyzed the fragments using routine stains, immunohistochemistry, and electron microscopy.ResultsWe found superficial dermal fibrosis in 90% (18/20) of our IGH cases and unreported keratinocyte cytoplasmic changes on electron microscopy.ConclusionOur results suggest an interaction between melanocytes and the subjacent dermis in IGH. These findings can help to understand melanocyte biology and the pathogenesis of other achromic lesions.

Efficacy and safety of 10,600 nm fractional carbon dioxide laser versus 88% phenol in treatment of idiopathic guttate hypomelanosis: A prospective study

Efficacy and safety of 10,600 nm fractional carbon dioxide laser versus 88% phenol in treatment of idiopathic guttate hypomelanosis: A prospective study

Skin disorders in patients with diabetes mellitus: a review

Diabetes mellitus (DM) is a frequent metabolic disease whose prevalence is estimated to be around 9.3 % in the world population in the age group 20—79, corresponding to 463 million affected subjects. Moreover, this prevalence will probably increase in the course of the next years. It accounts for more than 90% of the diabetic patients. Besides systemic complications, those ay also be observed in dermatology. According to the region, the prevalence of skin disorders in patients suffering DM is ranging from 35.4 to 98.8 %. This makes these symptoms a frequent cause of consultation in dermatological practice. The most occurring disorders are skin infections, but yellow nails, candidiasis, acrochordons, limited joint mobility and idiopathic guttate hypomelanosis may also be frequently observed. Diabetic dermopathy and diabetic foot syndrome are also common, such as pigmentation disorders such as acanthosis nigricans and vitiligo. Differences between patterns of lesions remain unclear among types of DM (type 1 or type 2). Overall, cutaneous infection and xerosis showed to be highly prevalent and important skin disorders in several studies, regardless DM type. Among cutaneous infections, fungal aetiology appears to be the most common and those with bacterial origin are the less frequent.DM affects the skin through several mechanisms — High levels of glycaemia strongly affect skin homeostasis by impairing the normal functioning of keratinocytes in vitro, decreasing their proliferation and differentiation. They also lead to advanced glycation end products (AGEs) formation. The latter are formed from glycation of proteins, lipids and nucleic acids. They have various deleterious effects at skin levels: inducing reactive oxygen species (ROS) formation, impairing ROS clearance, as well as intra and extracellular proteins function, and inducing pro inflammatory cytokine through nuclear factor κβ (NF-κβ) pathway. AGE alters collagen properties, decreasing flexibility and solubility and increasing its rigidity, thickening dermal collagen, with increased cross linking from non-enzymatic glycosylation, participating in the development of fibrosis. In diabetic patients, the vascular changes found in the skin are similar to those caused by UV-exposure, i. e. thickening of the vessels walls, increasing from thigh to foot and most marked in the capillaries and leading to failure of vascular responsivenessThis paper is aimed to summarize all these pathologies, reporting their prevalence, giving a brief description of the symptoms, of their pathogenesis and guidelines for their management. Dermatologists have a key role in their treatment, but also in detecting new cases of DM when taking in charge these pathologies. They must also promote glycaemic control by these patients.

LB792 Minoxidil and dutasteride drug tattooing for male Androgenetic Alopecia

Men are frequently affected by androgenetic alopecia. A variety of drug therapies, including, but not limited to, topical or oral minoxidil, oral 5-alpha-reductase inhibitors (finasteride, dutasteride), and new therapies such as platelet-rich plasma injections have been adopted by dermatologists in the management of androgenic alopecia. The drug tattooing technique is a drug delivery technique that utilizes tattoo machine and disposable microneedles cartridges to deliver drug formulations to the superficial dermis and has been employed for the treatment of scars and idiopathic guttate hypomelanosis.

Dermoscopy of acquired pigmentary disorders: a comprehensive review.

Dermoscopy has traditionally been used for the diagnosis of neoplasms and more recently in the evaluation of inflammatory conditions. Recent observational studies have suggested a role for dermoscopy in identifying and differentiating acquired pigmentary disorders. This comprehensive review will summarize the growing literature on the use of dermoscopy for pigmentary disorders. A literature review was performed on PubMed dating from inception to October 2020. The following pigmentary disorders were included in this study: melasma, solar lentigines, poikiloderma of Civatte, exogenous ochronosis, lichen planus pigmentosus, erythromelanosis follicularis faciei et colli, pigmented contact dermatitis, Riehl's melanosis, postinflammatory hyperpigmentation, erythema dyschromicum perstans, ashy dermatosis, confluent and reticulated papillomatosis, acanthosis nigricans, pityriasis versicolor, tinea versicolor, idiopathic guttate hypomelanosis, and vitiligo. Search terms used included each pigmentary disorder along with the terms "dermoscopy" or "dermatoscopy." Relevant case reports and case series were included. Many pigmentary disorders have unique and distinguishable features on dermoscopy. Given that these disorders can be clinically challenging for clinicians and emotionally distressing for patients, dermoscopy provides an additional, useful tool in the evaluation and assessment process.

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Do oxidative stress and melanin accumulation contribute to the pathogenesis of idiopathic guttate hypomelanosis: A prospective case-control study.

Oxidative stress parameters have been reported to be significantly higher than controls in diverse disorders of pigmentation but no such data seem to be extant for IGH. To verify whether heightened oxidative stress levels are seen in patients with IGH (compared with matched controls) and quantify the same in blood using appropriate biochemical markers. Further, an attempt to determine if there might be any correlation between the amount of oxidative stress and the severity of the disease. This prospective case-control study was conducted in Northern India. Thirty Indian patients (Fitzpatrick skin phototype (SPT) IV-V) were included. The diagnosis of IGH lesions was confirmed based on characteristic clinical, and dermoscopic characteristics and confirmed on histopathological examination (H & E) of one of the lesions. The oxidative stress enzyme level was significantly higher among the cases compared to controls which were statistically significant (p<0.05). A positive correlation was also observed between the levels of these markers and number of lesions, but this finding was statistically not significant [p>0.05]. Assessment of melanin level by Dopa staining method in the IGH lesions revealed irregularly distributed melanin with areas of high and low melanin content and greater accumulation in the basement layer. The results of this probably the first study evaluating oxidative stress in IGH show that the oxidative stress is increased in patients with IGH. Level of oxidative stress seems to be correlated with both age of the patient (more in the elderly) and number of lesions.

Role of Homoeopathic Medicine in the treatment of Pityriasis Alba: A case report

Hypo-pigmentation of skin, although is not a life threatening disease, but is considered to be a social stigma, so invariably associated with significant psychological trauma and social isolation [1]. Pityriasis Alba is one of the cause of secondary hypo-pigmentation. Others include Pityriasis Versicolour, Idiopathic Guttate Hypomelanosis, Phenylketonuria etc. It is a type of eczema presenting as de-pigmented areas on the face, particularly in children, with or without scale [2]. Even though it is commonly encountered in dermatological practice, there is paucity of Indian studies on the subject.3A case presented in this paper of 23 years old female suffering from Pityriasis Alba of 3 months duration. The lesion started with a reddish popular lesion on lateral aspect both the elbow joint. In 3-4 days, it started converting into pale patches. An individualized homoeopathic medicine, Ignatia Amara was prescribed followed by Bacillinum which showed complete resolution of the disease. This case report suggests homoeopathic treatment as a promising complementary or alternative therapy in such type of skin lesion. Hypo-pigmentation of skin, although is not a life threatening disease, but is considered to be a social stigma, so invariably associated with significant psychological trauma and social isolation [1]. Pityriasis Alba is one of the cause of secondary hypo-pigmentation. Others include Pityriasis Versicolour, Idiopathic Guttate Hypomelanosis, Phenylketonuria etc. It is a type of eczema presenting as de-pigmented areas on the face, particularly in children, with or without scale [2]. Even though it is commonly encountered in dermatological practice, there is paucity of Indian studies on the subject.3A case presented in this paper of 23 years old female suffering from Pityriasis Alba of 3 months duration. The lesion started with a reddish popular lesion on lateral aspect both the elbow joint. In 3-4 days, it started converting into pale patches. An individualized homoeopathic medicine, Ignatia Amara was prescribed followed by Bacillinum which showed complete resolution of the disease. This case report suggests homoeopathic treatment as a promising complementary or alternative therapy in such type of skin lesion.

5-Fluorouracil in Dermatology: The Diverse Uses Beyond Malignant and Premalignant Skin Disease.

5-fluorouracil (5-FU) is widely used for treatment of malignant and premalignant skin cancers; however, its use in other common cutaneous conditions has been less widely reported. We investigated the off-label uses of 5-FU beyond malignant and premalignant skin disease. We conducted a literature review searching multiple databases to evaluate the evidence for the off-label uses of 5-FU. The level of evidence was evaluated and selected accordingly listing the studies with the highest level of evidence first using the Oxford Centre of Evidence-Based Medicine 2011 guidance. We found underlying evidence to support the use of 5-FU for a wide range of noncancerous cutaneous indications including scarring (keloid, hypertrophic), pigmentary disorders (vitiligo, idiopathic guttate hypomelanosis), cutaneous infections (viral warts, molluscum contagiosum), inflammatory dermatoses (Darier's disease, Hailey-Hailey disease and sarcoidosis), and cosmetic indications (photoaging, treatment of filler nodules and granulomas). In selected patients, 5-FU can be as effective as more established treatments, with fewer side-effects.

A clinical study of idiopathic guttate hypomelanosis and its association with diabetes mellitus

Objectives: To study the clinical profile of idiopathic guttate hypomelanosis (IGH) and its association with diabetes mellitus (DM). Materials and Methods: A 1-year descriptive study was carried out in clinically diagnosed cases of IGH. A detailed history was taken and a thorough dermatological examination was carried out in each case. Serum fasting blood sugar [FBS] and postprandial blood sugar (PPBS) levels were determined in all cases. FBS and PPBS were assessed in age- and sex-matched individuals without IGH who were included as the comparative group. Results: There were a total of 102 patients (n = 102) with IGH in the designated study period. The male/female ratio was 1:3.08. The mean age was 36.7 years. The most common age group was 61–70 years (29, 28.4%). History of chronic sun exposure was present in 19 (18.6%). Thirty-one patients (30.4%) showed lesions affecting upper limb, lower limb, and trunk. In the present study, 23 patients with IGH had DM. In the age- and sex-matched comparative group, 19 patients had DM (18.6%). The difference was not statistically significant (P = 0.498). In the present study, 17 patients (17/23, 73.9%) with IGH and DM had 20 lesions or more, while 6 patients (6/23, 26.1%) with IGH and DM had &lt; 20 lesions. Among the 79 non-diabetic patients with IGH, 57 (72.2%) had 20 lesions or more and 22 (27.8%) had less than 20 lesions. This was not statistically significant (P = 0.868). Limitations: Small sample size was the major limitation. Conclusion: There was no association between IGH and DM in this study and there was no association between number of lesions of IGH and DM.