Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 4331  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
E-IJD® - CORRESPONDENCE
Year : 2022  |  Volume : 67  |  Issue : 3  |  Page : 316
Dermoscopy of dermatopathia pigmentosa reticularis


Department of Dermatology, Venereology and Leprosy, Lady Hardinge Medical College, New Delhi, India

Date of Web Publication22-Sep-2022

Correspondence Address:
Apoorva Maheshwari
Department of Dermatology, Venereology and Leprosy, Lady Hardinge Medical College, New Delhi
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_895_21

Rights and Permissions



How to cite this article:
Maheshwari A, Garg T, Sanke S. Dermoscopy of dermatopathia pigmentosa reticularis. Indian J Dermatol 2022;67:316

How to cite this URL:
Maheshwari A, Garg T, Sanke S. Dermoscopy of dermatopathia pigmentosa reticularis. Indian J Dermatol [serial online] 2022 [cited 2022 Oct 6];67:316. Available from: https://www.e-ijd.org/text.asp?2022/67/3/316/356770




Sir,

Dermatopathia pigmentosa reticularis (DPR) was originally documented by Hauss and Oberste-Lehn in 1958, and is an uncommon reticulate pigmentary disorder.[1] Less than 20 cases are reported. Here, we describe brief history and examination of a classical case of DPR with Addisonian pigmentation. To our knowledge, this is first attempt at dermoscopy of this rare pigmentary disorder. Patient presented with reticulate pigmentation over face, neck, v of chest, forearms, dorsae of hands and feet and palms and soles, along with dystrophic nails, non-cicatricial alopecia of scalp with bleaching of pigmentation. Diffuse pigmentation was present in axillae, cubital fossae and groins. Patient was found to have megaloblastic anaemia with vitamin B12 and folic acid deficiency. Vitamin B12 and folic acid supplementation led to resolution of diffuse flexural pigmentation. Topical minoxidil led to reversal of scalp alopecia. We performed dermoscopy (using Timpac DL4 4th generation Dermlite dermatoscope; contact and non-polarized technique) of various sites which revealed following findings.

[Figure 1] shows dermoscopy of scalp. Hair density is reduced with fine vellus hair (red arrow). Light to dark brown pigment globules and reticular areas (yellow arrow) can be seen in perifollicular manner, along with white dots representing eccrine glands openings (blue arrow).
Figure 1: Dermoscopy of scalp

Click here to view


[Figure 2] shows dermoscopy of neck. Erythema can be appreciated in upper quadrant (red arrow) and brown reticular areas form a pseudonetwork like pattern (blue arrow) around eccrine gland openings (yellow arrow).
Figure 2: Clinical and dermoscopic image of neck

Click here to view


[Figure 3] and [Figure 4] are from palm and sole respectively, which show irregularly arranged hypopigmented (red arrow) and hyperpigmented (blue arrow) macules. Also, pseudonetwork like pattern (yellow arrow) can be appreciated along with preservation of normal ridge pattern.
Figure 3: Clinical and dermoscopic image of palm

Click here to view
Figure 4: Clinical and dermoscopic image of sole

Click here to view


[Figure 5] is dermoscopic image of volar aspect of a finger at the level of distal interphalangeal joint which shows preserved furrow ridge pattern over the middle phalanx (red arrow) in comparison to hypoplasia of furrow ridge pattern over the distal phalanx (blue arrow).
Figure 5: Dermoscopic image at level of DIP

Click here to view


Skin biopsy was taken from neck [Figure 6] and palms [Figure 7]a and [Figure 7]b. That from neck showed increased pigmentation in epidermis with dermis showing pigment incontinence and sparse perivascular inflammatory infiltrate and palmar biopsy showed epidermal hyperkeratosis with focal elongation of rete ridges with evidence of increased pigmentation (magnified in [Figure 7]b).
Figure 6: Histopathology from neck (40×; haematoxylin and eosin)

Click here to view
Figure 7: (a) Histopathology from palm (40×; haematoxylin and eosin). (b) Histopathology from palm (100×; haematoxylin and eosin)

Click here to view



   Discussion Top


DPR is characterised by a triad of widespread reticular pigmentation, non-scarring alopecia and nail changes. Other associated findings include adermatoglyphia, hypohidrosis or hyperhidrosis, palmoplantar hyperkeratosis and acral dorsal non-scarring blisters.[2]

Dermoscopy is a commonly used office investigation that aids in substantiating diagnosis and correlates with clinical and histological presentation of the disease in question. It has previously been used in few reticulate pigmentary disorders (as mentioned below) to ease the clinical diagnosis.

Dermoscopy of Dowling Degos disease, which has flexural reticulate pigmentation, shows follicular pits and irregular brownish projections around hypopigmented centre, while that of Acropigmentation of Kitamura conspicuous interruptions in the dermatoglyphics as canaliform structures aligned perpendicular to dermatoglyphics at irregular intervals.[3],[4] In Dyschromatosis Symmetrica Hereditaria, the hyperpigmented lesions show interconnected, variously pigmented appearances like reticulated hyperpigmented spots and dark brown spots on homogenous dark background.[5]

DPR is exceedingly rare ectodermal dysplasia with characteristic phenotypic features. The diagnosis can further be substantiated with dermoscopic evaluation. However, there is paucity of literature on the same and to the best of our knowledge, this is the first dermoscopic account of this rare disease.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Hauss H, Oberste-Lehn H. Dermatopathia pigmentosa reticularis. Dermatol Wochenschr 1958;138:1337.  Back to cited text no. 1
    
2.
Bux TS, Kim YK, Whang KU. A case of dermatopathia pigmentosa reticularis. J Dermatol 1997;24:266-9.  Back to cited text no. 2
    
3.
Nirmal B, Dongre AM, Khopkar US. Dermatoscopic features of hyper and hypopigmented lesions of Dowling Degos disease. Indian J Dermatol 2016;61:125.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Adya KA, Inamadar AC, Palit A. Reticulate acropigmentation of kitamura: A dermoscopic perspective. Indian Dermatol Online J 2020;11:128-30.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Oiso N, Murata I, Hayashi M, Amatsu A, Yoshida M, Suzuki T, et al. Dermoscopic features in a case of dyschromatosis symmetrica hereditaria. J. Dermatol 2011;38:91-3.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (2,350 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed116    
    Printed0    
    Emailed0    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal