Reticular
Pigmentation
Doç.Dr. Güneş Gür Aksoy
Ankara Numune Education &Research Hospital
Dermatology Clinic
Reticular
Pigmentation
• Age of onset
• Extent
(localised/generalised)
• Distribution
(flexural/acral)
• Hair, nail, tooth, ecrine
abnormalities?
• Systemic abnormalities?
Rule out:
• Reticular erythemas
– cutis marmarata
– livedo reticularis
– reticulated erythematous
mucinosis
– erythema infectiosum
• Poikiloderma:
hypo& hyperpigmentation, tlj, skin
atrophy
Prurigo
Pigmentosa
•
•
•
•
F: M 4:1,
21-27y
Intense pruritus
Unresponsive to
antihistamines,
topical
corticosteroids
Prurigo Pigmentosa
Histopathology
Early: perivascular/
interstisial neutrophilic
infiltrate
Vacuolar degeneration
Late: lymphocyte and
eosinophil rich lichenoid
infiltrate
Yoshiki Miyachi
Final: Hyperkeratosis,
parakeratosis,
melanophages
Whang et al, Derm Online J 2011.
Prurigo Pigmentosa:
Treatment
Etiology:
Strict diets?
H.pylori?
•
•
•
•
•
•
•
Minocyclin
Doxycyclin
Tetracyclin
Low dose isotretinoin
Potassium iodide
sulfamethoxazole
clarithromycin and
roxithromycin
Reticulated &
Confluent
Papillomatosis of
Gougerot and
Carteaud.
Davis et al. Br J Dermatol 2006
Prof.Dr.Emmanuel França
Confluent & Reticulated
Papillomatosis of Gougerot
and Carteaud (CARP)
•
•
•
•
Disorder of keratinization
17-21y
Scaly brown macules, papules,
patches, appearing reticulated and
papillomatous;
• central chest, upper abdomen, back
• Histologically, hyperkeratosis,
• acanthosis, and papillomatosis
Treatment CARP
Topical:
• isotretinoin
• erythromycin
• ketaconazole
• Calcipotriol
Systemic:
• Minocycline
• Azitromycin
• İsotretinoin
• etretinate
Erythema Ab Igne
• Pigmentation correspond to venous plexus
• Clue: wider spacing
than in genodermatoses.
Courtesy, Jeffrey Callen
Cole, Mary Beth,Smith, Michael L, p14871510, 2012, Dermatology.
Erythema ab igne:
treatment
! Malignancy risk:
SCC, MCC, cutaneous
marginal zone
lymphoma
• latency≥ 30y
• hydrocarbon-fueled
heat exposure
• 1064 nm Qswitched
Nd:YAG laser
with low fluence
• Topical 5-FLU
Drugs & Reticular
Pigmentation
• 5-Fluorouracil
• Bleomycin
• Cyclophosphamide
• generalised
• 10 days-26 weeks,
10 mo!
Reticular Pigmentation
due to 5-Fluorouracil
Allen BJ, et al.Int J Dermatol. 1995
Cyclophosphamide induced generalised reticular pigmentation
Youssef M. Int J Clin Pharm 2013
Dowling Degos
Disease
Gammaz H et al. Egyptian Dermatol
O J 2010
▪ flexural
▪ mutations keratin 5,
POFUT1
▪ Comedone-like lesions
on the back and neck
▪ Pitted facial scars
▪ small brown papules,
hyperkeratotic
▪ 0nset 30-40y
• Moderate orthokeratosis or
hyperkeratosis,
• thinning of suprapapillary
epithelium
• basal layer pigmentation
• filiform elongation of rete
ridges.
• Branching of the rete
ridges;‘antler-like’
Dowling Degos
Disease
Gammaz H et al. Egyptian Dermatol Online J 2010
Dowling Degos
Disease
Taşkapan O et al. JEADV 2014
Galli Galli Disease
‘Acantolytic Dowling Degos’
Schmieder A, J AmAcad Dermatol 2011
Galli Galli Disease
‘Acantolytic Dowling Degos’
Keratin 5
mutation
Reisenauer A.K. Et al. Br J Dermatol 2014
Reticulate acropigmentation
of Kitamura
• Atrophic lesions
• Dorsal hand & feet
• Pits on palms &
soles
• Auto dominant
• 10-20y
http://www.aip.nagoya-u.ac.jp/
Reticulate Acropigmentation of Dohi
Dyschromatosis Symmetrica Hereditaria
•
•
•
•
•
Auto dominant (smts recessive)
Progresive & Persistent
Dorsal hands& feet
Onset- infancy- early childhood
Hypo & hyperpigmented macules
Alvarez P et al, Folia Dermatol. 2007
Reticular
Acropigmentatin
Kitamura/Dohi
Acral
Acantholysis
Galli Galli
Disease
Dowling
Degos
Disease
Facial
Erythema
Haber
Syndrome
• Teşekkürler......
Download

1-Sözleşmeli Mübaşirlik Nihai Başarı Listesi