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E-IJD® - CORRESPONDENCE
Year : 2022  |  Volume : 67  |  Issue : 5  |  Page : 628
Isolated Melanocytic Hyperpigmentation of the Distal Digits – A Case Report and Review of the Literature


1 Department of Dermatology and Venereology, Královské Vinohrady University and Third Faculty of Medicine; Department of Pharmacology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
2 Department of Dermatology and Venereology, Královské Vinohrady University and Third Faculty of Medicine, Prague, Czech Republic

Date of Web Publication29-Dec-2022

Correspondence Address:
Emanuel C Marques
Department of Dermatology and Venereology, Královské Vinohrady University and Third Faculty of Medicine; Department of Pharmacology, Second Faculty of Medicine, Charles University, Prague
Czech Republic
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_277_22

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How to cite this article:
Marques EC, Gkalpakiotis S, Arenbergerová M, Arenberger P. Isolated Melanocytic Hyperpigmentation of the Distal Digits – A Case Report and Review of the Literature. Indian J Dermatol 2022;67:628

How to cite this URL:
Marques EC, Gkalpakiotis S, Arenbergerová M, Arenberger P. Isolated Melanocytic Hyperpigmentation of the Distal Digits – A Case Report and Review of the Literature. Indian J Dermatol [serial online] 2022 [cited 2023 Feb 8];67:628. Available from: https://www.e-ijd.org/text.asp?2022/67/5/628/366117




Sir,

We present the case of a 10-week-old female with isolated melanocytic hyperpigmentation of the distal digits (IMHDD). IMHDD was noticed 67 days after birth. Our first physical and dermoscopic examination were performed 72 days postpartum [Figure 1]a and [Figure 1]b. Other tests/procedures were not conducted. No therapy was recommended, our patient was only periodically reviewed. Further physical and dermoscopic examinations were performed on days 122 [Figure 2]a and [Figure 2]b and 170 [Figure 3]a and [Figure 3]b. The condition gradually faded away.
Figure 1: (a) clear periungual hyperpigmentation. (b) dermoscopy: clear margin between hyperpigmented and normal pigmented skin at the site of the distal phalanx joint

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Figure 2: (a) fading of periungual pigmentation. (b) dermoscopy: less pronounced pigmentation from the proximal nail fold up to the distal phalanx joint

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Figure 3: (a) near-complete resolution of periungual hyperpigmentation. (b) dermoscopy: very discrete pigmentation concentrated only at the proximal nail fold

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Our patient was born at 40 weeks gestation. Her delivery was vaginal and spontaneous (birth weight: 3170 g; height: 51 cm). Immediately after delivery, she was reported to be slightly icteric (a disorder that quickly and spontaneously regressed). Additionally, congenital duplicity of her right renal pelvis and ureter and nonfunctional right megaureter were diagnosed. For that reason, she was systemically treated since birth with cefuroxime 25 mg q.d. for two months; nine days before IMHDD arose, cefuroxime was switched to sulfamethoxazole/trimethoprim 40 mg q.d. Apart from this, from clinical history, our patient was healthy. A complete physical examination revealed no findings. She was breastfed daily, with no use of artificial infant formulas. Her family history was irrelevant.

IMHDD or benign periungal hyperpigmentation, is characterized by an asymptomatic transitory form of hyperpigmentation on the dorsal sides of the distal phalanges of the fingers and toes of the newborn. Hence, it is classified among transient benign disorders of infancy.[1] It is considered a self-limiting condition; no diseases have ever been reported to be associated with it.[1]

Typically, it appears within the first months of life and fades away between the first and second years.[2] It is known to be rather common among dark-skinned individuals and quite uncommon or rare among fair-skinned populations.[1],[3]

Some speculate that it is caused due to sex hormones impregnation; others report that it might be caused by increased friction and suction of the fingers.[2] The diagnosis is purely clinical. However, when in doubt, examination under Wood light or dermoscopy can prove helpful. Since biopsies have never been taken, histological features remain unknown. Suggested differentials are acanthosis nigricans and melanoma.[3] Hyperpigmentation of the distal phalanges due to vitamin B12 deficiency has also been described.[4] No treatment is necessary.[3]

In literature, two variants of IMHDD are described: isolated periungual hyperpigmentation of the fingers only or periungual hyperpigmentation of the fingers and toes[3] – our patient presented with the latter.

Although IMHDD has never been associated with other disorders, our patient suffered from congenital duplicity of her right renal pelvis and ureter and a nonfunctional right megaureter. Duplicity results from an anomalous origin of two ureteric buds or branching of a single ureteral bud developing from a very short common excretory duct. The pathogenesis of megaureter remains unclear. As congenital malformations of the same system (genitourinary), these conditions can be interrelated.[5] Of notice, there was an antibiotic switch performed nine days after her first IMHDD manifestations. Dermoscopy is a good tool for the follow up of IMHDD.

Acknowledgements

The authors thank Anshu Jha, MD (James Cook University Hospital, Middlesbrough, United Kingdom) for her collaboration in writing this article.

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.
Snehal B, Kajal A, Kavyashree A, Reshma B. Acromelanosis disease and its overview. World J Pharm Pharm Sci 2018;1712-9.  Back to cited text no. 1
    
2.
Taieb A, Ezzedine K, Morice-Picard F. Diagnosis of some common and uncommon hyperpigmentation disorders in children. Dermatologica Sin 2014;32:211-6.  Back to cited text no. 2
    
3.
Iorizzo M, Oranje AP, Tosti A. Periungual hyperpigmentation in newborns. Pediatr Dermatol 2008;25:25-7.  Back to cited text no. 3
    
4.
Agarwal A, Saini AG, Attri S. Reversible hyperpigmentation and paraparesis: A simple remedy!. J Pediatr 2018;201:294.  Back to cited text no. 4
    
5.
Annigeri VM, Hegde HV, Patil PB, Halgeri AB, Rao PR. Congenital giant megaureter with duplex kidney presenting as abdominal lump in a neonate. J Indian Assoc Pediatr Surg 2012;17:168-70.  Back to cited text no. 5
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