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Deepadarshan K, Harish MR, Shashikumar BM, Chandran P. Efficacy and safety of 10,600 nm fractional carbon dioxide laser versus 88% phenol in treatment of idiopathic guttate hypomelanosis: A prospective study. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2022. [DOI: 10.4103/jdds.jdds_24_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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El-Dash H, Adel S. Cutaneous manifestations in Egyptian children with beta-thalassemia major: Relationship with serum ferritin, thyroid profile, and treatment modalities. Pediatr Dermatol 2018; 35:639-643. [PMID: 29943859 DOI: 10.1111/pde.13570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cutaneous manifestations can be found in many patients with hematologic disorders, including thalassemia. METHODS Patients with beta-thalassemia major attending the pediatric department of Fayoum University Hospital from April 2016 to October 2016 (n = 100) were compared with controls (n = 100). Both groups underwent detailed history evaluation, clinical examination, and laboratory investigations, including complete blood count, liver and kidney function, serum ferritin, and thyroid profile. A single dermatologist conducted a clinical dermatologic examination for all participants. RESULTS Children with thalassemia had a greater prevalence of xerosis (72%), pruritus (52%), idiopathic guttate hypomelanosis (22%), urticaria (16%), ephelides (freckles; 13%), and scars (13%) than controls (P ≤ .001). We detected a significant relationship between serum ferritin and pruritus, xerosis, ephelides, idiopathic guttate hypomelanosis, urticaria, and age of patients with thalassemia (P < .05). Children without thyroid abnormalities were more likely to have xerosis, pruritus, idiopathic guttate hypomelanosis, urticaria, and ephelides (86%) than controls (P < .05). Although there was no significant difference in skin findings between patients who did and did not receive chelating agents (P > .05), a significant association was found between xerosis and the use of deferoxamine and deferiprone, whereas ephelides and urticaria were more common in patients receiving deferasirox. CONCLUSION Because cutaneous manifestations are common in Egyptian patients with beta thalassemia major, regular dermatologic follow-up is recommended for early management.
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Affiliation(s)
- Hanaa El-Dash
- Department of Pediatrics, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Shereen Adel
- Departments of Dermatology, Venereology, and STDs, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Kakepis M, Havaki S, Katoulis A, Katsambas A, Stavrianeas N, Troupis T. Idiopathic guttate hypomelanosis: an electron microscopy study. J Eur Acad Dermatol Venereol 2014; 29:1435-8. [DOI: 10.1111/jdv.12646] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 06/20/2014] [Indexed: 11/26/2022]
Affiliation(s)
- M. Kakepis
- Department of Dermatology; ‘Henry Dunant’ Hospital; Athens Greece
- 2nd Department of Dermatology and Venereology; National and Kapodistrian University of Athens Medical School; ‘Attikon’ General University Hospital; Athens Greece
| | - S. Havaki
- Department of Histology and Embryology; National and Kapodistrian University of Athens Medical School; Athens Greece
| | - A. Katoulis
- 2nd Department of Dermatology and Venereology; National and Kapodistrian University of Athens Medical School; ‘Attikon’ General University Hospital; Athens Greece
| | - A. Katsambas
- 1st Department of Dermatology and Venereology; National and Kapodistrian University of Athens Medical School; ‘Andreas Syggros’ Hospital; Athens Greece
| | - N. Stavrianeas
- 2nd Department of Dermatology and Venereology; National and Kapodistrian University of Athens Medical School; ‘Attikon’ General University Hospital; Athens Greece
| | - T.G. Troupis
- Department of Anatomy; National and Kapodistrian University of Athens Medical School; Athens Greece
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Shin J, Kim M, Park SH, Oh SH. The effect of fractional carbon dioxide lasers on idiopathic guttate hypomelanosis: a preliminary study. J Eur Acad Dermatol Venereol 2012; 27:e243-6. [PMID: 22646755 DOI: 10.1111/j.1468-3083.2012.04597.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Idiopathic guttate hypomelanosis (IGH) is a commonly acquired leucoderma that is characterized by discrete, round or oval porcelain-white macules ∼2-5 mm in diameter that increases in number with age. A variety of therapies with variable success rates, including cryotherapy, superficial abrasion and topical retinoids are currently being used. OBJECTIVES The effects of fractional CO(2) laser therapy on IGH were investigated in this pilot study. PATIENTS AND METHODS A total of 40 patients with IGH were enrolled. The hypopigmented lesions were treated using a 10 600-nm carbon dioxide fractional laser (CO(2) FL). Two months after a single treatment, physicians' clinical assessments were performed and the patients' overall satisfaction was evaluated. RESULTS The mean age of enrolled patients was 57.5 ± 10.9 years and the gender ratio was 7 : 33. The face was the most commonly treated area, although the extremities are epidemiologically the most frequently affected areas. Two months after treatment, objective assessments performed by two independent dermatologists indicated more than 50% improvement in 36 patients (90%), compared with baseline. In addition, 33 patients (82.5%) were very satisfied or satisfied with just one session of CO(2) FL treatment. Although a few patients complained of long-standing erythema and postinflammatory hyperpigmentation, these problems spontaneously resolved within 2 months after the assessments. No other noticeable side effects were observed. CONCLUSION CO(2) FL might be a very convenient and effective modality for treating IGH without significant side effects.
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Affiliation(s)
- J Shin
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Shin MK, Jeong KH, Oh IH, Choe BK, Lee MH. Clinical features of idiopathic guttate hypomelanosis in 646 subjects and association with other aspects of photoaging. Int J Dermatol 2011; 50:798-805. [DOI: 10.1111/j.1365-4632.2010.04743.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kim SK, Kim EH, Kang HY, Lee ES, Sohn S, Kim YC. Comprehensive understanding of idiopathic guttate hypomelanosis: clinical and histopathological correlation. Int J Dermatol 2010; 49:162-6. [DOI: 10.1111/j.1365-4632.2009.04209.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
BACKGROUND Beta-thalassemia major affects multiple organs and is associated with considerable morbidity and mortality. The goal of this analysis was to document the frequency of skin diseases among patients with beta-thalassemia major. METHODS A sample of 78 patients with beta-thalassemia major was recruited and interviewed at the thalassemia clinic between April and June 2008. A dermatologist completed a skin examination of each patient and recorded any skin disease present. The patients' laboratory results and treatment modalities were recorded from the charts. RESULTS Sixty-five (83.3%) of the 78 patients examined had a diagnosed skin disease: pruritus (37.2%), xerosis (34.6%), scars (24.4%), ephelides (23.1%), skin irritation/erythema caused by deferoxamine pump (12.8%), idiopathic guttate hypomelanosis (6.4%), pityriasis alba (6.4%), tinea infections (5.1%), verruca vulgaris (5.1%), urticaria (3.8%), hyperhidrosis, contact dermatitis, and acne (2.6%), necrobiosis lipoidica (1.3%), melasma (1.3%), and others (14.1%). Pruritus and xerosis increased in frequency with age. The mean serum ferritin level was higher in patients with xerosis than in those without (5607.7 +/- 2997.5 ng/mL and 4285.2 +/- 4732.4 ng/mL, respectively) (P1/4 0.005). Moreover, xerosis was observed significantly more frequently inpatients using deferoxamine and deferiprone than in those using deferasirox (P1/4 0.047, P1/4 0.027, and P1/4 0.273, respectively). CONCLUSION Skin diseases, especially pruritus and xerosis, are observed highly frequently inpatients with beta-thalassemia major. Treatment is needed for these patients who already have other significant morbidities.
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Affiliation(s)
- Asena Cigdem Dogramaci
- Department of Dermatology, School of Medicine, Mustafa Kemal University, Antakya, Hatay, Turkey.
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Arrunategui A, Trujillo RA, Marulanda MP, Sandoval F, Wagner A, Alzate A, Falabella R. HLA-DQ3 is associated with idiopathic guttate hypomelanosis, whereas HLA-DR8 is not, in a group of renal transplant patients. Int J Dermatol 2002; 41:744-7. [PMID: 12452995 DOI: 10.1046/j.1365-4362.2002.01630.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The etiology of idiopathic guttate hypomelanosis (IGH) remains uncertain; however, solar exposure and heredity have been proposed as causative factors. OBJECTIVE To explore the genetic predisposition to the development of IGH. METHODS A comparative case-control study was performed at a dermatology department at a university hospital. Forty-seven subjects (22 renal transplant patients and 25 controls) were enrolled. Clinical examination and human leukocyte antigen (HLA) determination were performed. RESULTS In the group of subjects with HLA-DQ3 (10/13, P = 0.025), there was a statistically significant (P < 0.05) positive association for the presence of IGH; in the group of subjects with HLA-DR8 (6/6, P = 0.023), there was a statistically significant negative association for the presence of IGH. CONCLUSIONS The presence of HLA-DQ3 in patients with IGH suggests a genetic basis in a group of renal transplant subjects. HLA-DR8 was found in patients without IGH, and it could play a role as a "protective factor" preventing subjects from developing IGH.
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Affiliation(s)
- Adriana Arrunategui
- Department of Dermatology, School of Medicine, Universidad del Valle, Cali, Colombia
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Abstract
BACKGROUND Squamous cell carcinoma (SCC) is the most common skin cancer in African Americans, but its incidence is low. Although incompletely described in the literature, an increased incidence of SCC in sun-protected areas in black patients has been reported. OBJECTIVE This study was conducted to better define the incidence, characteristics, and cutaneous markers of SCC occurring on the legs in African Americans. METHODS We did a 5-year retrospective chart review of patients diagnosed with SCC in the dermatology clinic of an inner city hospital in the southern United States. RESULTS A total of 35 African Americans had biopsy-proven SCC during the study period. Sixteen patients had lesions on the legs; all of them were elderly African-American women, and most showed atypical lesional and perilesional features. CONCLUSION SCC is not rare on the legs of elderly African-American women. It can present with atypical features, and physicians must be alert to this possibility. Accompanying cutaneous changes may assist in its diagnosis.
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Affiliation(s)
- Calvin O McCall
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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Wallace ML, Grichnik JM, Prieto VG, Shea CR. Numbers and differentiation status of melanocytes in idiopathic guttate hypomelanosis. J Cutan Pathol 1998; 25:375-9. [PMID: 9765023 DOI: 10.1111/j.1600-0560.1998.tb01761.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The etiology and pathogenesis of idiopathic guttate hypomelanosis (IGH) are largely unknown. To investigate whether the pathologic alteration in IGH involves changes in melanocytic differentiation, cell number, or both, we studied nine lesions of IGH by immunoperoxidase, using monoclonal antibodies against the KIT receptor and a panel of melanocyte differentiation antigens (tyrosinase-related protein-1, tyrosinase, and gp100/pme117). In each case, compared with grossly normal non-lesional skin, IGH lesions showed markedly reduced numbers both of KIT+ cells and of cells expressing melanocyte differentiation antigens (p < 0.0001). Double immunofluorescence labeling of lesions revealed only scattered cells with a less-differentiated phenotype, i.e. cells positive for KIT but having low or undetectable TRP-1. These results indicate that the pathogenesis of IGH involves an absolute decrease in the number of melanocytes; a block in melanocyte differentiation does not appear to be a major component of the process.
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Affiliation(s)
- M L Wallace
- Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710, USA
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Disorders of Melanin Pigmentation. Dermatology 1991. [DOI: 10.1007/978-3-662-00181-3_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Ploysangam T, Dee-Ananlap S, Suvanprakorn P. Treatment of idiopathic guttate hypomelanosis with liquid nitrogen: light and electron microscopic studies. J Am Acad Dermatol 1990; 23:681-4. [PMID: 2229495 DOI: 10.1016/0190-9622(90)70273-k] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Idiopathic guttate hypomelanosis is a common skin disorder of unknown cause. Our studies have shown that significantly fewer dopa-positive melanocytes are in the white macules of idiopathic guttate hypomelanosis than in normal skin. By electron microscopy we observed that the melanocytes in the lesional skin were round and less dendritic with fewer melanosomes than in normal pigment cells. Lesions gently frozen with liquid nitrogen repigmented in 6 to 8 weeks. The number of dopa-positive melanocytes was significantly greater in the repigmented areas than in untreated lesions but less than in normal skin.
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Affiliation(s)
- T Ploysangam
- Lions Suphannahong Dermatology Clinic, Chulalongkorn Hospital, Bangkok, Thailand
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Abstract
A review of the basics of pigment cell biology is followed by a discussion of the characteristics of several disorders of hypopigmentation. By determining such features as inheritance pattern, time of onset (congenital, childhood, adulthood), natural history (stable vs progressive), type of pigment loss (diffuse or circumscribed), distribution of lesions (generalized vs localized), degree of pigment loss (incomplete or complete), number of melanocytes, if any, in biopsy specimens of affected areas, type of melanocytic dysfunction, and associated inflammation or infection, one can classify the disorders of hypopigmentation. The proposed pathophysiology for each disorder of hypomelanosis is presented.
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Affiliation(s)
- J L Bolognia
- Department of Dermatology, Yale University School of Medicine, New Haven, CT 06510
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Affiliation(s)
- O Benmaman
- Department of Dermatology, University of Puerto Rico School of Medicine, San Juan
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Abstract
Thirteen patients with vitiligo (1 segmental, 4 focal, 8 generalized) aged 7 to 38, most of them female children, developed numerous punctate hypopigmented and achromic spots. The spots measured 0.5 to 1.5 mm and were located primarily on the sun-exposed areas of the extremities; they appeared following treatment with PUVASOL. Two of these patients experienced a reduction of this leukodermic defect, whereas the remaining patients showed a stable clinical course. Dopa and Fontana stains disclosed, in most cases, decreased but not absent functional melanocytes and a marked reduction of melanin. Ultrastructural studies demonstrated slight to severe damage of keratinocytes and melanocytes similar to that previously reported in vitiligo patients. The phototoxic effect of PUVASOL therapy is suggested as a possible etiologic factor in these patients. A probable relationship among idiopathic guttate hypomelanosis, leukoderma punctata, and vitiligo is discussed.
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Affiliation(s)
- R Falabella
- Department of Internal Medicine, Hospital Universitario del Valle, Cali, Columbia, South America
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Falabella R, Escobar C, Giraldo N, Rovetto P, Gil J, Barona MI, Acosta F, Alzate A. On the pathogenesis of idiopathic guttate hypomelanosis. J Am Acad Dermatol 1987; 16:35-44. [PMID: 3805391 DOI: 10.1016/s0190-9622(87)70003-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Idiopathic guttate hypomelanosis is a common leukodermic dermatosis of obscure origin, consisting of small 2- to 5-mm achromic or hypopigmented macules, mainly affecting the exposed upper and lower extremities. In a group of 400 consecutive dermatologic patients, idiopathic guttate hypomelanosis was much more prevalent in women than in men. However, in both sexes this prevalence became more common with advancing age. In another group of fifteen patients with idiopathic guttate hypomelanosis and fifteen normal controls matched by age, sex, and skin type, the following was found: A cause-effect relationship between chronic actinic exposure and the development of idiopathic guttate hypomelanosis could not be established by statistical studies. A family aggregation survey disclosed a higher prevalence of idiopathic guttate hypomelanosis in the family of patients with idiopathic guttate hypomelanosis than in the control group. Epithelial atrophy, patchy absence of melanocytes and melanin, flattening of the rete pegs, and basket weave hyperkeratosis were the most prominent histologic findings of idiopathic guttate hypomelanosis. Minigrafts of normal skin implanted in idiopathic guttate hypomelanosis lesions did not modify the achromic defects, whereas intralesional triamcinolone with or without grafts improved the appearance of these lesions.
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Stricker M, Meley M, Chassagne JF, Beurey J. Congenital cranio-facial dysmorphosis associated with Ito's syndrome (incontinentia pigmenti achromians): a case report. BRITISH JOURNAL OF PLASTIC SURGERY 1984; 37:472-6. [PMID: 6498382 DOI: 10.1016/0007-1226(84)90133-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The authors describe a child who presented multiple congenital malformations affecting the cranio-facial region and the extremities associated with a rare skin lesion (incontinentia pigmenti achromians).
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