Thursday, November 08, 2012

Hypopigmented Rings

18 year old college coed with two month history of two incompletely hypopigmented rings on abdomen.  No contacts to area recalled.  On no meds.

O/E:  On right and left abdomen, there are two relatively subtle 5 cm in diameter rings.  No scale.  Possibly a few small incompletely hypopigmented macules on abdomen as well.

Clinical Photo:
Labs:  N/A

Path: Will offer to biopsy

Diagnosis:  Hypopigmented Contact Dermatitis?

Question:  Has anyone seen anything like this?

Chemical leukoderma
Kathryn E O’Reilly MD PhD, Utpal Patel MD PhD, Julie Chu MD, Rishi Patel MD, Brian C Machler MD
Dermatology Online Journal 17 (10): 29  OA Full Text
Department of Dermatology, New York University, New York, New York
Abstract: Chemical leukoderma is defined as an acquired, hypopigmented dermatosis that results from repeated cutaneous application of an agent that destroys epidermal melanocytes in genetically susceptible patients. Chemical leukoderma may develop both at the site of contact with the chemical as well as remotely from the exposure. Avoidance of the causative agent may lead to spontaneous repigmentation, but treatments commonly used in vitiligo, such as narrow-band ultraviolet B phototherapy, PUVA photchemotherapy, or topical immunosuppressants, often are necessary. We present a case of chemical leukoderma secondary to pyrethroid insecticides that has progressed despite avoidance of the agent for over ten years.

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