Spontaneous Re-pigmentation of Vitiligo Following Excision of Halo Congenital Melanocytic nevi: An Interesting Case Report

Summary@#Halo nevi (HN) are benign skin lesion that represent melanocytic nevi in which an inflammatory infiltrate develops, resulting in zone of depigmentation around nevus. Although Sutton originally described the lesion in 1916 as leukoderma acquista centrifugum, the lesions were noted earlier as evidenced in the painting by Matthias Grunwald cica 1512-1516. The prevalence of HNs in the general population is 1%, and HNs usually appear in childhood or early adulthood. Up to 26% of patients with HN have vitiligo, but in very few instances is there an association of HN around congenital melanocytic nevi (CMN) and vitiligo. The exact mechanisms responsible for the development of vitiligo and HN and its resolution are unknown. One of the most accepted hypotheses considers that both phenomena are a result of a self-limited immunologic response to pigmented cells, either in the “normal” skin or within the melanocytic lesion. Hereby we present a rare case report of a girl with halo CMN and infraorbital vitiligo. The halo CMN was excised which was followed by spontaneous improvement of vitiligo.

A Case Of Chemical Leukoderma Effectively Treated With Punch Graft Surgery

Chemical leukoderma is a hypomelanotic disorder due to destruction of melanocytes or inhibition of melanogenesis secondary to application of harmful chemicals household or industrial. It can be easily diagnosed clinically by a positive history of frequent exposure to a depigmenting agent at the site corresponding with the pattern of the object applied. It has a psychosocial significance because of the dyspigmented presentation of the disease which often simulates other conditions associated with social stigma, like leprosy or vitiligo. Here, we report a case of thirty year old female with chemical leukoderma who presented to us with depigmented patches over forehead (bindi leukoderma) and dorsae of feet (footwear dermatitis) caused by application of sticker bindi and wearing of rubber footwear respectively. Complete repigmentation was observed after treatment with topical corticosteroids and melanocyte transfer surgery.

Treatment of Laser Therapy-Induced Punctate Leukoderma Using a 308-nm Excimer Laser

Punctate leukoderma presents as numerous, distinct, round or oval depigmented spots. Recently, laser therapy-induced punctate leukoderma associated with various Q-switched laser and carbon dioxide laser have been reported. A 25-year-old man presented with numerous, discrete, round, confetti-like, depigmented macules on his left neck. He had undergone 3 sessions of 532-nm Q-switched Neodymium: Yttrium-Aluminum-Garnet laser treatment for café-au-lait macules three years ago. After the last laser treatment session, the punctate leukoderma had been developed. We started treatment with the 308-nm excimer laser twice a week. After 7 months of treatment duration, complete repigmentation was achieved without serious adverse effects. We recommend the 308-nm excimer laser as an effective treatment modality for laser therapy-induced punctate leukoderma.

A Case of Punctate Leukoderma after 1,064 nm Q-Switched Nd:YAG Laser

Punctate leukoderma is characterized of the destruction of melanocytes after chemical of physical damage. In addition, the term is broadly used to describe hypopigmented lesions induced in vitiligo patients after psolaren administration with ultraviolet A and in psoriasis patients with repetitive ultraviolet B phototherapy. The Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser in treating melasma is frequently reported to be associated with the cause. A 44-year-old woman presented to the department with numerous confetti-like hypopigmented macules on both cheeks for over a year. Weekly treatment of 1,064 nm Qswitched Nd:YAG laser (2.0–3.4 J, 8 mm spot-size) therapy at a non-dermatologic clinic had induced both hyperpigmentation and hypopigmentation lesions. Biopsy performed at both hyperpigmented and hypopigmented lesions revealed variable melanin pigmentation with segmental loss and infiltration of pigment incontinence. The patient was diagnosed with punctate leukoderma and was directed for narrow-band ultraviolet B phototherapy. Herein, we report a case of punctate leukoderma after inadvertent use of 1,064 nm Q-switched Nd:YAG laser.

A Case of Chemical Leukoderma (Occupational Vitiligo) Caused by p-tert-butylphenol (PTBP) / 대한피부과학회지

No abstract available.

Proposal of the New Term 'Leukoderma Nuchae' to Describe the Whitish Patch in the Spared Zone of Poikiloderma of Civatte to Differentiate It from Vitiligo / 대한피부과학회지

Poikiloderma of Civatte (PC) is a common, acquired condition that affects the face, neck, and upper chest of elderly persons due to life-long sun exposure. Poikiloderma describes skin manifestations of atrophic and telangiectatic lesions with pigmentary changes. We experienced three cases of patients who visited our department due to whitish patches on the anterior neck, which had been treated as vitiligo at private dermatological clinics. The patches mimicked vitiligo to the naked eye due to their color and relatively well-demarcated margin, but they were not accentuated under Wood's light. On MART-1 staining, there was no loss of melanocytes in the basal cell layer of the epidermis. Leukoderma on the anterior neck might be produced due to contrast with the neighboring skin showing PC. Based on our experiences, we propose a new dermatological term, 'leukoderma nuchae (LN)', to describe the spared zone of PC, to aid in differentiating this condition from vitiligo.

Spontaneous regression of a congenital melanocytic nevus.

Congenital melanocytic nevus (CMN) may rarely regress which may also be associated with a halo or vitiligo. We describe a 10-year-old girl who presented with CMN on the left leg since birth, which recently started to regress spontaneously with associated depigmentation in the lesion and at a distant site. Dermoscopy performed at different sites of the regressing lesion demonstrated loss of epidermal pigments first followed by loss of dermal pigments. Histopathology and Masson-Fontana stain demonstrated lymphocytic infiltration and loss of pigment production in the regressing area. Immunohistochemistry staining (S100 and HMB-45), however, showed that nevus cells were present in the regressing areas.

Chemical Leukoderma Improved by Low-dose Steroid Pulse Therapy

Chemical leukoderma occurs due to the toxic effect of a specific chemical preceding allergic contact dermatitis. The mechanism is either destruction or inhibition of melanocytes by the offending substance. Clinicohistopathologically, no absolute criteria can differentiate chemical leukoderma from vitiligo. However, chemical leukoderma can be diagnosed clinically by a history of repeated exposure to a known or suspected depigmenting agent at the primary site. There is no agreed treatment guideline for chemical leukoderma. We report a healthy 51-year-old man who had multiple hypopigmented macules and patches on his face, neck, arms and legs after exposure to occupationally related chemicals. The lesions were recalcitrant to topical corticosteroids, but they showed much improvement after 3 cycles of systemic steroid pulse therapy. We suggest this therapy may be a good treatment option for chemical leukoderma.

13 Cases of Leukoderma Punctata after Narrowband UVB Therapy in Vitiligo Patients / 대한피부과학회지

BACKGROUND: Leukoderma punctata is a peculiar disorder with punctiform, hypopigmented and achromic spots. Histopathologically, a focal reduction of melanocytes and melanin granules are found in the depigmented macule. The phototoxic effect of phototherapy on melanocytes has been suggested as the most likely cause. This occurs mostly after application of systemic or topical psolaren on photochemotherapy. However, a case following narrowband UVB therapy is very rare. OBJECTIVE: The purpose of our study was to investigate the characteristics of leukoderma punctata patients and find the cause of leukoderma punctata. METHODS: We reviewed the medical records of leukoderma punctata patients, and a skin biopsy was taken from punctiform hypopigmented macules. The tissues were stained with hematoxyline and eosin, Fontana-Masson, and dopa-oxidase. RESULTS: The average age of patients was 51 years old. There was no difference between results of male and female patients. Involvement sites of patients were mostly the arms and legs. 76% of patients did not have preceding subjective symptoms. In eight of nine patients, a marked reduction of melanin and melanocytes was noted with both Fontana-Masson staining and dopa-oxidase staining. The average total period of PUVA therapy was 26 months and average total dose of PUVA irradiation was 351.2 J/cm2 in leukoderma punctata patients. Before leukoderma punctata developed, the average total period of narrowband UVB therapy was 6.9 months and average total dose of narrowband UVB was 22.45 J/cm2. The results suggest that leukoderma punctata developed in very small dose of narrowband UVB, although it did not develop with large doses of PUVA. CONCLUSION: Narrowband UVB (311 nm) is the most likely spectrum for development of leukoderma punctata.

A Case of Leukoderma Punctata after Topical PUVA Therapy in Segmental Vitiligo Patient / 대한피부과학회지

Leukoderma punctata is a rare side effect of photochemotherapy such as psoralen with solar ultraviolet light (PUVASOL) or psoralen with ultraviolet A (PUVA), and manifests as numerous discrete punctate, hypopigmented and achromic spots. Histopathologically, a focal reduction of melanocytes and melanin granules are found in the depigmented macules, revealed by S-100 and Fontana-Masson staining. The phototoxic effect of photochemotherapy on melanocytes has been suggested as the most likely cause. This occurs mostly after systemic psoralen on photochemotherapy. However, a case following topical PUVA therapy is very rare. We report a rare case of leukoderma punctata in a 6-year-old female after topical PUVA therapy for segmental vitiligo.

Characteristics of Occupational Skin Diseases Compensated with the Industrial Accident Compensation Insurance from 1999 to 2003 / 대한피부과학회지

BACKGROUND: Of occupational diseases, although skin is a commonly affected site, skin diseases are rarely reported and have been poorly compensated in the past due to their relatively low morbidity rate. OBJECTIVE: The purpose of this study was to analyze the characteristics of occupational skin diseases compensated by the Industrial Accident Compensation Insurance which is managed by the Korea Labor Welfare Corporation (KLWC). METHOD: Using the KLWC database, we selected 216 cases of occupational skin diseases which had been compensated between 1 January 1999 and 31 December 2003. We analyzed the characteristics (sex, age, type of occupational disease, exposure material, type of industry and occupation, etc.) of occupational diseases, using data from the KLWC records and from cases that had been investigated by the Korea Occupational Safety and Health Agency (KOSHA). RESULTS: 216 cases were compensated by the KLWC, with men accounting for 76.4% (165 cases) of the cases. The most common age group was 50-59 years of age (n=73, 33.8%). The majority of diseases were contact dermatitis (116 cases, 53.7%), cellulitis (36 cases, 16.7%), leukoderma (11 cases, 5.7%), urticaria (9 cases, 4.2%) and scabies (7 cases, 3.2%). The causal hazardous agents of 147 cases were plants (72 cases, 49.0%), chemicals (32 cases, 21.8%), drugs (7 cases, 4.8%) and oils and greases (5 cases, 3.4%). The major types of industry were public administration and defence (91 cases, 42.1%), manufacturing (57 cases, 27.1%), other community, repair and personal service activities (13 cases, 6.0%), construction (12 cases, 5.6%) and business activities (11 cases, 5.1%). The type of occupation included elementary occupations (115 cases, 53.2%), craft and related trades workers (30 cases, 13.9%), plant and machine operators and assemblers (20 cases, 9.3%) and service workers (18 cases, 8.3%). CONCLUSION: From this study, we were able to elucidate the kind of occupational skin diseases and the characteristics of workers. Many of the compensated cases belonged to daily-paid workers in the public service, especially forestry care workers. The most commonly occurring disease was allergic contact dermatitis. This suggests that a management policy must be established to prevent occupational skin diseases occurring among workers in the above types of industry. Also, this study suggests that more research needs to be conducted to elucidate the relationship between exposure to hazardous agents and occupational skin diseases such as occupational skin cancers, leukoderma and trichloroethylene induced Stevens-Johnson Syndrome.

Study on situation and clinical characters of leukoderma during 1/2000-1/2005

A prospective and cross-sectional study on 135 patients with leukoderma at the Central Military Hospital N0 108 and the Military Hospital N0 105 showed that: the disease developed at age of 10-19 (26.67%), mainly in patients under 40 year of age (82.98%), females more than males. 16.3% of patients have family history with leukoderma, mainly siblings (45.45%), parents (22.72%). Psychological trauma was observed in 18.52% of patients, 30.37 % of patient have other diseases, mainly gastro-duodenal ulcer (24.44%). The lesions developed in head, neck and face area (55.56%), four limbs (28.14%); pervasive form (60.74%), localized form (11.85%). The disease at moderate level (39.26%), serious level (31.11%); mild level (29.63%). The disease is the most common at progressive stage (75.56%), stable stage (24.44%), and period of disease less than 5 years accounted for 65.19%.

Clinical evaluation in UV-B radiation microphototherapy for leukoderma / 中华医学美学美容杂志

Objective To evaluate the effectiveness of UV-B radiat io n exclusively on a variety type of leukoderma .Methods In open trail, 45 cases of a variety of leukoderma were randomly selected including preg nant striates (20 cases), stretch marks (1 case), postoperative petechia (4 case s), traumatic petechia (10 cases), radiation petechia (2 cases), generalized vit iligo (6 cases) and leukoderma with unknown cause (2 cases) were treated with Re lume UV-B re-pigmentation generator (photo range 290-320 mm), once per week with an adjusting dose for 3-20 treatments. Results 42 cases c ompleted with followed-up after 14 months of UV-B radiation microphototherapy. 64.3% (27 cases) achieved excellent results, including 10 cases of pregnant str iates, 8 cases of traumatic petechia, 4 cases of postoperative petechia and 5 c ases of peneralized vitiligo. 28.6% patients were satisfied with results (12 ca ses), including 7 cases of pregnant striates, 1 case of traumatic petechia, 1 c ase of generalized vitiligo, 1 case of stretch mark and 2 cases of leukoderma wi th unknown causes. 7.1% (3 cases) had no effect. 33.3% (14 cases) required suppl emental treatment after 2-5 months of the initial therapy. Conclusion The UV-B radiation microphototherapy is effective in restoring pigmenta tion in those affected by a variety of leukoderma except radiation petechia. The result of repigmentation is related to the type of leukoderma.

Generalized Punctate Leukoderma Following UVB Phototherapy in the Psoriasis Patients

No abstract available.