While there in no consensus on etiology, some researchers suggest that melanocyte accumulation, direct toxicity, and post-inflammatory changes may be causative.30, Bleomycin is an effective chemotherapeutic drug for lymphoma, squamous cell carcinoma, and germ cell tumors.62 Flagellate hyperpigmentation occur in 1020% patients receiving systemic bleomycin.62,63 Clinical features typically begin as an itchy linear pigmentation arranged in a flagellated pattern on the back and chest. the contents by NLM or the National Institutes of Health. Clinical approach for linear hyperpigmentation. A day after delivery, the erythema had disappeared, spontaneously. These lesions fall into pigmentary and nonpigmentary categories.2, Pigmentary demarcation lines are normal boundaries of the skin that represent a transition between darker and lighter melanin pigment distribution corresponding to dermatomal innervation by spinal nerves. Although there have only been 29 cases of pigmentary demarcation lines associated with pregnancy reported to date, before ours, we experienced 3 . Pigmentary Demarcation Lines may be present in childhood and go unnoticed, only to return when triggering factors like puberty or pregnancy come to bear. government site. This article presents a rare case of pigmentary demarcation lines of the skin of the face and oral mucosa, which should be of interest to the general dentist. PDL is a common finding in dark-skinned women. It is also important to rule out child abuse in such cases.76, Cryofibrinogenemia is an infrequent cause of non-healing dermal ulcers. The lesions had clear boundaries between the hyperpigmentation and adjacent normal skin. Otherwise it is hidden from view. Hyperpigmentation can be congenital or acquired and may be either localized or diffuse. Widespread premature calcifications manifest as stippling (chondrodysplasia punctata) of the long bone epiphyses, tracheal cartilage, and vertebrae. Please try after some time. The most common of these will be discussed in this chapter including pigmentary demarcation lines, periorbital hyperpigmentation, acquired idiopathic pattern facial pigmentation (AIPFP), oral mucosal hyperpigmentation, palmar/plantar melanotic macules, and longitudinal physiologic melanonychia. Sharona Yashar; Jennifer Haley; Leslie Robinson-Bostom; Nianda Reid. High bleomycin doses (accumulative dose: 100300 mg) are associated with the disease.62,64 However, it also occurs with low doses (1530mg), including intralesional injections of warts or vascular malformations.65,66 There is no effective treatment for bleomycin-induced flagellate dermatitis. ZWU0YWY2YzNjMzBlNjA1YmRkMjljOTE0YmNiZjE1OGJiNDNiOWIwN2QzZGU3 NGVkNzVjMDI2ZmM5YmI2NjkzYWU0YjAzYzliNGE2ODI2MTY5OTIxYmI2ODBl Few cases have shown stabilization of lesions with oral potassium aminobenzoate 12 g/day. Lability of pigment in the darker-skinned population causes dramatic changes in skin color after inflammatory processes of the skin. Erythematous, edematous scaly papules or papulovesicles that coalesce to form plaques across a single or multiple lines, which are 24 cm wide. Diagnosis is challenging, as there are no definitive or agreed-upon criteria.77. Kanitakis J, Souillet A-L, Butnaru C, Claudy A. Melanocyte stimulation in focal dermal hypoplasia with unusual pigmented skin lesions: a histologic and immunohistochemical study, Linear and whorled naevoid hypermelanosis in a patient with trisomy 4 mosaicism, Linear and whorled nevoid hypermelanosis complicated with inflammatory linear verrucous epidermal nevus and ichthyosis vulgaris. COMMENT Matzumoto~ described pigmentary demarcation lines of the upper and lower limbs of Japanese persons in 1913; these studies have been con- firmed and expanded by several other authors.2-'~ The five presently recognized types of pigmentary demarcation lines are summarized in Table I. X-linked reticulate pigmentary disorder in a female patient, Molecular aspects of hypohidrotic ectodermal dysplasia, Incontinentia pigmenti (Bloch-Sulzberger syndrome), Incontinentia pigmenti diagnostic criteria update, Familial systematized epidermal nevus syndrome, Adult onset of inflammatory linear verrucous epidermal nevus in a mother and her daughter, Epidermal nevi and the epidermal nevus syndrome. These are sharp demarcation lines that occur on different parts of the body. Usually, resolve within one to three months. Extracutaneous manifestations include mental retardation, osteopathia striata, hypoplastic teeth, microphthalmia, strabismus, ectopia lentis, and coloboma of the iris and choroid. In females; patchy linear hyperpigmentation. MDc1MTIxMzZjZDU0NTkxMGU0OTUxZWQyMTMzMzUwZDE4ZDFiNDU3ZDYzYTc3 Longitudinal melanonychia is a normal pattern of nail pigmentation seen in patients with skin of color. Various causes including post-inflammatory changes, drug reactions, and mosaic genetic alterations result in hyperpigmentation along Blaschkos lines. Atasoy M, Aliagaoglu C, Sahin O, Ikbal M, Gursan N. Linear atrophoderma of Moulin together with leuconychia: a case report. Generalized erythema with thick, adherent, feathery scale; streaks and whorls of hyperkeratosis. A case of linear atrophoderma of Moulin successfully treated with methotrexate. While most patients develop non-sclerotic hyperpigmentation only, atypical presentations can present with bilateral telangiectasias, leukonychia, and lentiginous skin melanoma.12, There is no proven effective treatment for LAM, and both topical steroids and high-dose penicillin have been reported to be ineffective. We review this salient finding and approaches to its . Acquired, Idiopathic, Patterned Facial Pigmentation (AIPFP) Including Periorbital Pigmentation and Pigmentary Demarcation Lines on Face Follows the Lines of Blaschko on Face. Indian J Dermatol. Its distribution follows the Voigt's lines, which define the distribution of peripheral nerves. An Bras Dermatol. Type A lines, also termed Voigt (Futcher) lines, are sharply demarcated, frequently bilateral lines of pigmentation found at the anterolateral junction of the upper arms [Figure 21-1]. Finally, it was determined that seven of fifty black women (14%) had the new appearance of type B lines with pregnancy. On the demarcation lines of pigmentation observed among the Japanese, on inner sides of their extremities and on anterior and posterior sides of their medial regions. However, PDLs are not associated with specific symptoms. Owing to its rarity, consensus on the most effective method of classification is lacking. NjYyMDI0YWUxZGFjYWUxMmI2MTJkZjY3ZmFmYjQ1YjJhNzE1YTJjMTJkZGQy National Library of Medicine The medial border of the pigmentary band was sharply demarcated while laterally it merged imperceptibly into the surrounding normal skin. It is important to differentiate normal nail pigmentation from malignant melanocytic proliferations and extraneous pigment deposition. Sir, Facial pigmentary demarcation lines (PDL) were described by Malakar and Dhar in Indian population and are classified into 3 types F, G, and H. Increased incidence of PDL in females and type B PDL in pregnancy suggests that increased female sex hormones may cause PDL. 2019 Jun;18(3):700-702. doi: 10.1111/jocd.12884. Pigmentary demarcation lines are normal boundaries of the skin that represent a transition between levels of melanin pigment in the skin corresponding to dermatomal innervation. FOIA Clipboard, Search History, and several other advanced features are temporarily unavailable. Garcias-Ladaria J, Cuadrado Rosn M, Pascual-Lpez M. Epidermal nevi and related syndromes part 1: keratinocytic nevi, Epidermal and other congenital organoid nevi, X-linked dominant chondrodysplasia punctata, Mutations in the gene encoding 3- hydroxysteroid-8,7- isomerase cause X-linked dominant Conradi-Hnermann syndrome, En coup de sabre morphea and Parry-Romberg syndrome: a retrospective review of 54 patients. Keloidal scarring is common in patients with skin of color. Federal government websites often end in .gov or .mil. Pigmentary demarcation lines are rare physiologic pigmentations shaped as lines of deeper discoloration with abrupt transition from less pigmented areas. E-mail: [emailprotected]. . The three major clinical patterns are streaks and swirls following the Blaschko lines ( figure 1 ), a segmental or "checkerboard" distribution, and a phylloid (leaf-like) arrangement. However, there still may be a relationship between abnormal levels of sex hormones and PDLs. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Neoplasms such as squamous cell carcinoma, basal cell carcinoma, and keratoacanthoma may rarely develop in association with epidermal nevi.38, ConradiHnermannHapple (CHH) syndrome is a rare X-linked dominant disorder that occurs primarily in females. Post Inflammatory Hyperpigmentation: A prior history of the onset of an Inflammatory event on the affected area would help confirm this diagnosis. The site is secure. Commonly we see Patients with various facial hyperpigmentation who assume they have Melasma, and we know why. Pigmentary Demarcation Lines. Bethesda, MD 20894, Web Policies Occur following skin injuries, dermatitis, and other inflammatory conditions with a linear pattern, eg jellyfish or Rhus dermatitis, following allergic contact dermatitis. ZjM3ZTk5ODlkYjgxYTUxOTkyNTA5NmI3MjBhNjAyNTc0YTQwYjFkNzdiNjhi 2010 Jul-Aug;76(4):378-81. doi: 10.4103/0378-6323.66585. 8600 Rockville Pike 8600 Rockville Pike Pigmentary (Pigment means color) demarcation lines or PDLs, also known as Futcher's lines or Voigt's lines, are physiological (natural) abrupt transition lines from areas of deeper skin color to areas with lighter color . Hyperpigmentation lines may also affect the back and extremities. She had been diagnosed with stage 1E mantle cell lymphoma of the left conjunctiva two years ago, and was in complete remission after receiving chemotherapy of cyclophosphamide, doxorubicin, vincristine, and prednisolone. Do not use or distribute without permission. Micron. ZDEyZWRiNTM0YWEzMTRiNGQ3ZTFiNDJiNTA2YWQ3YzNkMWE4MWNiNjljOGM4 HHS Vulnerability Disclosure, Help Historically, the lack of recognition of benign variations in dark skin has led to unnecessary treatment and potentially poor results. The various types of pigmentary demarcation lines seen were Type A (38%), Type B (14%), Type C (24%), Type F (22%), Type G (4%), Type H (4%). This is more pronounced in pigmented skin, especially the anterolateral portion of the upper arm. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). None in the family had similar pigmentation. Accessibility The natural pigmentary demarcation boundaries of the skin can be classified as: Group A--lines along the upper limb with variable trans-pectoral extension; Group B--lines along the lower limb; Group C--paired lines in median or paramedian course on the chest with midline abdominal extension; Group D--posteromedian demarcation; and Group E--bilaterally symmetrical, obliquely oriented . No report of intraoral pigmentary demarcation lines was found in the literature. Careers. The incidence of lower mid-trunk hyperpigmentation (linea nigra) is affected by sex hormone levels. These lines are known and seen by dermatologists in the skin of African, Indian, and Japanese patients, usually females. Wongkietkachorn K, Intarasupht J, Srisuttiyakorn C, Aunhachoke K, Nakakes A, Niumpradit N. Linear atrophoderma of moulin:a case report and review of the literature, Linear atrophoderma of moulin: a rare entity. Creating a classification of linear hyperpigmentation will help dermatologists to reach the diagnosis and recognize and avoid potential systemic complications. Bicknell AB. government site. Before Although Jackson listed Beckers nevus as one of the nevoid skin diseases that follow Blaschkos lines,50,51 this fact was contradicted by Bolognia et al, who insisted that among the lesions listed by Jackson, Beckers nevus and linear scleroderma do not follow Blaschkos lines.1. Focal dermal hypoplasia (FDH) or Goltz syndrome is a rare disease associated with various cutaneous and extracutaneous anomalies. Type D and Type E PDL were not observed in any of the subjects screened. The full terms of this license are available at. Patchy distribution of sweat glands, and hyperpigmented patches that lacks adnexa mostly over the back. Akagi A, Ohnishi Y, Tajima S, Ishibashi A. Expectant treatment is used, and good results have been reported with the use of Q . A study of 124 Indian patients with lichen planus pigmentosus, Clinicopathological characteristics of lichen planus pigmentosus and its response to tacrolimus ointment: an open label, non-randomized, prospective study. In shiitake mushroom dermatitis, pruritic erythematous papules, vesicles, and edema develop on the face, scalp, trunk, and extremities 12 days after mushroom ingestion. Epub 2019 Feb 22. official website and that any information you provide is encrypted We describe the most common dermatological disorders that may present with linear hyperpigmentation following Blaschkos lines, and their associated systemic findings (Table 2). Careers. On the basis of their location they have been classified into eight types, type A to type H. The present study is an attempt to obtain a better understanding of the clinical types of pigmentary demarcation lines . An Bras Dermatol. The skin can provide diagnostic evidence of either local or systemic disease. Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Disease The prevalence is about 4% over age 40. Her medical and obstetric history were unremarkable. It occurs secondary to mosaicism that leads to a mutation in KRT1 or KRT10 versus ATP2A2.3436 ATP2A2 mutations in epidermal nevi are usually seen in acantholytic epidermal nevi and probably a mosaic form of Darier disease.37. Erythema dyschromicum perstans is seen more often in people with skin of color. [1] Five types (A-E) have been described. Pigmentary demarcation lines (PDLs) are abrupt transition lines between the areas of deeper pigmentation and the areas of lighter, normal pigmentation. The site is secure. Pigmentary demarcation lines are classified into five groups (types A-E). Results: The demarcation lines were far more common in women (9%) than in men (0.75%). Pigmentary demarcation lines are normal boundaries of the skin that represent a transition between darker and lighter melanin pigment distribution corresponding to dermatomal innervation by spinal nerves. Androgens likely play a key role, as the majority of cases appear in late childhood and adolescence. may email you for journal alerts and information, but is committed Pediatric morphea (localized scleroderma): review of 136 patients. Seventy-five percent of black male patients had at least one pigmentary demarcation line, with type C being most prevalent. Mental retardation, digital anomalies, osteopathia striata, hypoplastic teeth, and ocular anomalies. History of phototoxic product application followed by exposure to solar UVA. Zieleniewski , Schwartz RA, Goldberg DJ, Handler MZ. 2013;92:1001, 3. X-linked hypohidrotic ectodermal dysplasias*, Caf-au-lait spots in McCuneAlbright syndrome, Linear postinflammatory hyperpigmentation. YTRjY2I3OTExNTEyZjY2MzlmMjM3ODUyOGM0NmU1NzI4YjRlZTM0ZjJmMGRh Type B pigmentary demarcation lines of pregnancy involving the anterior thighs and knees Ann Dermatol. They are classified into 5 groups, based on their locations; type A involving the lateral aspect of the upper anterior arms; type B involving the posteromedial portion of the lower extremities . The site is secure. All Rights Reserved. Type B, which appear during pregnancy on the lower limbs and regress after delivery. A unilateral linear band of sclerotic, atrophic, and hyperpigmented plaques affecting the left forearm of an eight years old boy. Kim BS, Seo S-H, Jung HD, Kwon K-S, Kim M-B. Pigmentary Demarcation Lines in Pregnancy. Please consult the latest official manual style if you have any questions regarding the format accuracy. It was also described that PDL-F extended as periorbital pigmentation. The most common MRI scan findings accompanying morphea are T2 hyperintensities in the subcortical white matter and corpus callosum, focal tissue atrophy, and calcifications.48,49, Becker nevus is an acquired hyperpigmentation and hypertrichosis on the upper trunk or proximal upper limb. In this reaction, epidermal cell damage leads to inhibition of cell proliferation and DNA synthesis, with subsequent edema, erythema, and excess melanin production presenting as linear hyperpigmentation. YmZlNGU2ZTUzZWNhNGZmMjQ4Y2MwYTZiZGQ0MGU3ZjY0NDlhYTE4OWI4MjBi PIH is the most common cause of acquired hyperpigmentation and is more common in darkly pigmented individuals. 8600 Rockville Pike Unconjugate E3 was 1.475 multiples of the median (MoM), indicating a higher level than the median value, but within the normal range. Hormonal influences could possibly explain the female preponderance. The erythematous changes in our patient may have resulted from the alteration of estrogen levels in pregnancy. Would you like to access Botox, Dermal Fillers, Laser Hair Removal, Microneedling at monthly intervals with a discounted rate of 50%? Pruritic linear streaks of gray-brown to dark brown macules and papules either in a photodistribution or in an intertriginous pattern. Unable to load your collection due to an error, Unable to load your delegates due to an error. Facial Pigmentary Demarcation Lines have been seen to respond very well to topical depigmentingproducts and chemical peel sessions, as was used in the before and after above. Blaschkos lines are attributed to the migration lines of epidermal cells during embryogenesis and are characterized by a V-shaped pattern on the posterior midline, S-shape on the abdomen, and spiral on the posterior scalp.1,2 To the best of our knowledge, there is no existing clinical approach for linear hyperpigmentation diagnosis. We describe the most common dermatological disorders that may present with linear hyperpigmentation following Blaschkos lines without associated systemic findings (Table 1). The role of hormonal alterations in PDLs is further supported by the report of a nonpregnant woman with type B PDLs, receiving long-term estrogenic medication6. This div only appears when the trigger link is hovered over. and transmitted securely. http://creativecommons.org/licenses/by-nc/3.0. A triad of sparse hair, missing or peg-shaped teeth, and ability to sweat. This site needs JavaScript to work properly. Pigmentary demarcation lines (PDL) are symmetric, bilateral, and are present from infancy to adulthood as physiological abrupt transition lines from heavily pigmented areas of the skin to more lightly pigmented areas. En Coup de Sabre: unilateral skin atrophy on the paramedian forehead. MTM1ZGUzMzA1OTE5YmJkNTAyMzcxNzczMTZjMWFlOWIyNjk1MDEyMzUzYTRm The tissue-specific processing of pro-opiomelanocortin. 1987;16:58490, 4. An official website of the United States government. Skeletal anomalies are usually asymmetric. Melasma has gained popularity over the years because skincare enthusiasts and professionals speak about it more often than other kinds of facial hyperpigmentation. Type B pigmentary demarcation lines in a Chinese amenorrheic woman. This type of pigmentary demarcation line occurs in the posterior aspect of the legs, extending from the perineum to the ankle. Hypoplasia of the ipsilateral breast, areola, nipple and arm, ipsilateral arm shortening, lumbar spina bifida, thoracic scoliosis and pectus carinatum, and enlargement of the ipsilateral foot. It may present as a linear patch or plaque associated with scaling alopecia, followed by scarring over the scalp or face. government site. Interestingly, this was observed to conform to what has been previously mentioned as pigmentary demarcation line type F (PDL-F). Your access to this site was blocked by Wordfence, a security provider, who protects sites from malicious activity. Separation of data by age groups enabled us to determine that the age of onset is in early childhood in the majority of cases. Q Switched Alexandrite Laser has also shown promising results.
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