Erythema Dyschromicum Perstans

Abstract

Erythema dyschromicum perstans (EDP) is a peculiar pigmented condition of unknown etiology, resistant to any treatment (1-3). We report a typical case of EDP and discuss its differential diagnosis. CASE REPORTA 50-year-old farmer was referred to Miyazaki Medical College in November of 1978 for slower progressing pigmentation of 4 to 5 years' duration chiefly involving the torso and proximal aspects of the extremities. There had occasionally been mild pruritus. He had no significant drug history. His family and past history were noncontributory .Examination revealed rounded or geographically shaped gray and brown macules scattered over the trunk and extremities (Fig. 1). Some of the gray lesions were encircled by a ring of elevated erythema (Fig. 2). There were slightly scaling erythematous macules and brown lesions of varying shapes and intensities (Fig. 3). There was mild lymphadenopathy in the axillae and inguinal regions. New lesions of gray pigmentation were well bordered against normal skin, while older ones tended to be ill-defined.Delayed type hypersensitivity to PPD and Candida antigen was negative, although DNCB sensitization was achieved. Other laboratory data were essentially negative. Histological examination of an erythematous border in the abdomen revealed an atrophic epidermis containing microvesicIes and small round cells (Fig. 4); atrophied but deeply projected rete ridges, edema and a mild lymphocytic infiltration into the papillary layer of the dermis. Melanin granules were increased, partly in the basal layer, and there was incontinence of pigment ( Fig.

Erythema Dyschromicum Perstans: Report of a New Case and Critical Review of the Literature

“…On the other hand, despite the existence of some similarities between the two entities (of disputable specificity), the two dermatoses show important semiologic differ ences, and their differential diagnoses also include different diseases. So we therefore believe, in agreement with other authors (5,6), that two clinical entities should be distin guished ( Table 1): -Ashy dermatosis of Ramirez characterized by pigmented macules. It is common.…”

“…The dermatosis appears at any age (5 to 53 years), and predominantly affects men (17/23). The majority of cases (16) have been South American (1,(16)(17)(18)23); two were reported in Asia (5,14), three in the USA (15,18,19) and two in Europe (22) (including the present case).…”

“…The unifying view expressed in diis article was adopted by many authors, mostly from South America (9). However, some chal lenged the identity of these diseases (5,6). This controversy prompted us to review all cases in the literature published under the three different terms, EDP, AD, and der matosis cenicienta.…”

“…In the absence of stricdy specific criteria, its differ entiation from drug eruptions, lichen planus pigmentosus, and Pigmentatio Mac ulosa Multiplex Idiopatica remains unclear. The suggestion of Inoue (5) to unify all these entities (including AD) under the term of Pigmentatio Maculosa Multiplex Id iopatica seems justified.…”

“…Erythema Dyschromicum Perstans (EDP), described in 1961 by Convit (1), is a rare dis ease often considered in standard dermatol ogy textbooks (3,4) to be identical to the condition known as "Ashy dermatosis" (AD) as described by Ramirez (2). However the question of whether EDP and AD are one and the same disease or represent different entities is still a matter of debate (5,6). We report herein a new typical case of EDP and review the relevant literature in an attempt to clarify the relationship between these two diseases.…”