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  Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 9  |  Issue : 2  |  Page : 107-109  

Multispectral dermatoscopic features of chemical leucoderma with pigmented contact dermatitis


1 Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication19-Mar-2018

Correspondence Address:
Balakrishnan Nirmal
Department of Dermatology, DVL-2, Christian Medical College, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_104_17

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   Abstract 


Chemical leukoderma is characterized by pigment loss on constant exposure to chemical agents. Its association with pigmented contact dermatitis is rare. Here, we report a 40-year-old female presenting with depigmented macule with surrounding hyperpigmentation over the upper forehead. We used a multispectral dermatoscope by which decreased pigment network was better visualized with blue light, and gray granular dots were better appreciated with yellow light. Shorter wavelengths delineate epidermal features better whereas longer wavelengths highlight dermal features in multispectral dermatoscopy.

Keywords: Chemical leucoderma, dermatoscope, pigmented contact dermatitis


How to cite this article:
Nirmal B, Santhikiran B, Mukhopadhyay S. Multispectral dermatoscopic features of chemical leucoderma with pigmented contact dermatitis. Indian Dermatol Online J 2018;9:107-9

How to cite this URL:
Nirmal B, Santhikiran B, Mukhopadhyay S. Multispectral dermatoscopic features of chemical leucoderma with pigmented contact dermatitis. Indian Dermatol Online J [serial online] 2018 [cited 2020 Feb 29];9:107-9. Available from: http://www.idoj.in/text.asp?2018/9/2/107/227782




   Introduction Top


Chemical leucoderma, also known as occupational or contact leucoderma, is an acquired hypopigmentary disorder induced by repeated usage of routine domestic products due to pigment blockade, decreased melanin synthesis, and melanocyte destruction.[1] Chemical leucoderma is a better term because lesions are usually not confined to the site of contact, pathogenesis is not similar to contact dermatitis, and is commonly induced by nonoccupational day-to-day household products. Common inducers include derivatives of phenol, para-phenylenediamine, mercury, arsenic, cinnamic aldehyde, corticosteroids, retinoids, otic preparations, and systemic medications (chloroquine, fluphenazine).[2]

Chemical leucoderma has been rarely reported to occur along with pigmented contact dermatitis.[3] Pigmented contact dermatitis is a type of noneczematous contact dermatitis originally described by Osmundsen [4] in a series of patients presenting with pigmentation due to optical whitener in washing powder. It is commonly caused by fragrances, textiles, cosmetics, hair color, and toiletries. The allergen concentration causing pigmented contact dermatitis is too low to cause spongiotic dermatitis and instead causes basal cell cytolysis and pigment incontinence, presenting clinically as reticulate brownish or slate gray pigmentation.[5]


   Case Report Top


A 40-year-old female from Jharkhand, India presented with a history of depigmented macule over the forehead with atrophy and surrounding hyperpigmentation [Figure 1]a for the past 1 year. She also complained of depigmented macules over the lips [Figure 1]b, vulva, and legs for the past 10 years. She gave history of a custom of application of sindhur (kumkum) over the upper part of the forehead as well as hair color application.
Figure 1: (a) Depigmented macule with surrounding hyperpigmentation over the sindhur region of the forehead. (b) Depigmented macules over the lips

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We used a multispectral dermatoscope which gives a 10× magnification (Dermlite DL II Multispectral, 3Gen Inc, USA) which emits light at three wavelengths viz. 470 nm, 580 nm, 660 nm corresponding to blue, yellow, and red color, respectively. Images were captured using Nikon1 AW1 (14.1 MP mirrorless camera, Nikon Corp., Tokyo, Japan). The features seen under white light included blotchy erythema, linear irregular vessels, decreased pigment network, gray granular dots, blotches, and target structures [Figure 2]. Blue light highlights superficial features [Figure 3] whereas yellow light defines deeper findings [Figure 4].
Figure 2: White light dermatoscopy (10×): Blotchy erythema, linear irregular vessels, decreased pigment network (thin arrow), gray granular dots (star), blotches, and target structures (thick arrow)

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Figure 3: Blue light dermatoscopy (470 nm, 10×): Highlights discontinuity in pigment network (thin arrow)

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Figure 4: Yellow light dermatoscopy (580 nm, 10×): Highlights grayish granular dots, globules (star), and target structures (thick arrow)

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Patch testing was performed using the Indian Standard series of allergens (Systopic Pharmaceutical Ltd, India) approved by the Contact and Occupational Dermatoses Forum of India (CODFI), and showed 2+ for paraphenylenediamine (PPD) at 48 and 96 h. Histopathology of the forehead lesion, which included both hypo and hyperpigmented areas, showed epidermal atrophy with flattening of rete ridges, reduction of pigmentation of basal layer, basal cell vacuolation with occasional necrotic keratinocytes, band-like moderately dense lymphohistiocytic infiltrate, and pigment incontinence [Figure 5].
Figure 5: Hematoxylin and eosin section (400×) shows basal cell vacuolation, loss of basal pigmentation in the epidermis, and band-like inflammatory basal pigmentation is there infiltrates with pigment-laden macrophages in the superficial dermis

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   Discussion Top


Incidence of chemical leucoderma in developing countries is increasing with the use of poorly regulated daily usage of products.[6] The term chemical vitiligo is used to denote distant spread of depigmented lesions even after stopping exposure to the offending substance for 1 year where the offender triggers the initiation of autoimmunity resulting in the development of vitiligo. Chemical leucoderma occurring in individuals with pre-existing vitiligo may have a vitiligo diathesis, as in our patient.[7] Kumkum is a powder applied in the Hindu tradition over the centre of the forehead to denote the marital status of a woman. The chemicals in kumkum include azo dye, toluidine red, erythrosine, fragrance, turmeric powder, paraben, and groundnut oil. The positive patch test to PPD in our patient can be explained by its crossreactivity to azo dye in kumkum or a reactivity to PPD in hair color.[8]

Hyperpigmentation can sometimes be the only presenting sign of contact dermatitis developing as a result of inflammation at the dermoepidermal junction causing pigment incontinence from the basal layer to the upper dermis.[9] Dermatoscopic features described in pigmented contact dermatitis include pseudonetwork, gray dots or granules, telangiectatic vessels, flour-like scales, and perifollicular whitish halo.[10]

The loss of continuity of the pigment network corresponds to the loss of melanin from the basal layer of the epidermis owing to chemical leucoderma seen clearly with 470 nm blue light of the multispectral dermatoscope. The grayish granular dots and blotches correspond to melanin incontinence in papillary dermis, and hence, more evident with 580 nm yellow light of the multispectral dermatoscope. This is because higher wavelength yellow light penetrates deeper when compared to the lower wavelength blue light.

Dermatoscopy of chemical leucoderma with pigmented contact dermatitis has not been reported in the literature. Features of chemical leucoderma are superficial and better seen at 470 nm. The features of pigmented contact dermatitis are deeper and better seen at 580 nm, which are invisible to superficial penetrating blue light. Though features of both chemical leucoderma and pigmented contact dermatitis on dermatoscopy are visible under white light, multispectral dermatoscopy has an advantage by highlighting superficial changes with blue light and deeper changes with yellow light.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Jappe U, Hausen BM, Petzoldt D. Erythema-multiforme-like eruption and depigmentation following allergic contact dermatitis from a paint-on henna tattoo, due to para-phenylenediamine contact hypersensitivity. Contact Dermatitis 2001;45:249-50.  Back to cited text no. 1
    
2.
O'Reilly KE, Patel U, Chu J, Patel R, Machler BC. Chemical leukoderma. Dermatol Online J 2011;17:29.  Back to cited text no. 2
    
3.
Tan C, Zhu WY, Min ZS. Co-existence of contact leukoderma and pigmented contact dermatitis attributed to Clematis chinensis Osbeck. Contact Dermatitis 2008;58:177-8.  Back to cited text no. 3
    
4.
Alagappan U, Tay YK, Lim SP. Pigmented contact dermatitis secondary to benzyl salicylate. Acta Derm Venereol 2013;93:590.  Back to cited text no. 4
    
5.
Shenoi SD, Rao R. Pigmented contact dermatitis. Indian J Dermatol Venereol Leprol 2007;285-7.  Back to cited text no. 5
    
6.
Bajaj AK, Saraswat A, Srivastav PK. Chemical leucoderma: Indian scenario, prognosis, and treatment. Indian J Dermatol 2010;55:250-4.  Back to cited text no. 6
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7.
Ghosh S, Mukhopadhyay S. Chemical leucoderma: A clinico-aetiological study of 864 cases in the perspective of a developing country. Br J Dermatol 2009;160:40-7.  Back to cited text no. 7
    
8.
Nath AK, Thappa DM. Kumkum-induced dermatitis: An analysis of 46 cases. Clin Exp Dermatol 2007;32:385-7.  Back to cited text no. 8
    
9.
Trattner A, Hodak E, David M. Screening patch tests for pigmented contact dermatitis in Israel. Contact Dermatitis 1999;40:155-7.  Back to cited text no. 9
    
10.
Wang L, Xu AE. Four views of Riehl's melanosis: Clinical appearance, dermoscopy, confocal microscopy and histopathology. J Eur Acad Dermatol Venereol 2014;28:1199-206.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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