Generalized Punctate Leukoderma Following UVB Phototherapy in the Psoriasis Patients

Park, Yoon Kee; Hann, Seung Kyung; Hong, Kyung Tai; Kim, You Chan

doi:10.5021/ad.1990.2.2.93

Cited by 11 publications

(17 citation statements)

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“…were aged 7–38 years, and most were female children. And the four cases reported by Park et al 10 . were all female adults aged older than 20 years.…”

Section: Discussionmentioning

confidence: 92%

“…It appeared during and after PUVASOL treatment, which is a treatment of sun exposure 2 h after oral ingestion of psolaren. Thereafter, Park et al 10 . reported four cases of generalized punctate leukoderma after UVB phototherapy of psoriasis patients.…”

Section: Discussionmentioning

confidence: 99%

“…Also, Park et al . suggested that cumulative UVB phototoxicity may be the cause of leukoderma punctata 10 …”

Section: Discussionmentioning

confidence: 99%

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Case of leukoderma punctata after topical PUVA treatment

Park

Lee

2004

Int J Dermatology

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An 11‐year‐old Korean girl presented with a 2‐year history of asymptomatic multiple punctiform, hypopigmented and achromic spots predominantly on the outer aspect of her right forearm. She had been treated for segmental vitiligo on her right forearm with topical PUVA six times a week for 4 years at a local clinic. The lesions were very distinct, round hypopigmented macules 1–2 mm in diameter, predominantly in nonfollicular distribution (Fig. 1). Not only the site where topical psolaren had been applied but also areas on her right forearm where UVA was exposed for a long time for treatment of vitiligo developed multiple punctiform hypopigmented spots. She also had PUVA lentigenes on her right forearm. Laboratory studies including complete blood cell count, biochemistry, and endocrinologic studies were all within normal limits. There was no history of inflammatory lesions antedating the hypopigmentation. Skin biopsy was taken from punctiform hypopigmented macules. There were no specific findings in the hematoxylin‐eosin stained sections. However, marked reduction of melanin and melanocytes was noted with the Fontana‐Masson stain (Fig. 2) and the S‐100 stain (Fig. 3). With these clinical and histological findings the patient was diagnosed as having leukoderma punctata. 1 Multiple, hypopigmented, and achromic spots on the right forearm 2 Microscopic examination of a hypopigmented macule showing marked reduction of melanin (Fontana‐Masson stain, ×200) 3 S‐100 stain showing marked reduction of melanocytes in the basal layer (S‐100 stain, ×200)

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“…were aged 7–38 years, and most were female children. And the four cases reported by Park et al 10 . were all female adults aged older than 20 years.…”

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Case of leukoderma punctata after topical PUVA treatment

Park

Lee

2004

Int J Dermatology

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“…Dogra et al 5 first reported a case of leucoderma punctatum appearing after systemic PUVA therapy. Park et al 4 also suggested that cumulative UVB phototoxicity may be the cause of leucoderma punctatum. Special stains for melanocytes show a decreased number of functional melanocytes.…”

Section: Confetti-like Hypopigmentation: a Rare Complication Of Commomentioning

confidence: 99%

Confetti‐like hypopigmentation: a rare complication of common phototherapeutic modality

Bhatnagar

Kanwar

Parsad

et al. 2007

Acad Dermatol Venereol

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Confetti-like hypopigmentation: a rare complication of common phototherapeutic modalityEditor Hypopigmentation and vitiligo occurring during psoralen and ultraviolet A (PUVA) therapy have been described in the literature. 1,2 Leucoderma punctatum, a confetti-like hypopigmentation, as a distinct entity was first described by Falabela et al. 3 A 21-year-old woman presented with multiple asymptomatic, punctiform, achromic spots of 1-month duration, distributed predominantly on extensor aspect of extremities. She had vitiligo vulgaris and was being treated with trimethylpsoralen 0.6 mg/kg, three times per week, followed by UVA exposure for 3 months before appearance of these lesions. Before starting PUVA treatment she was given 8 months' treatment of narrowband ultraviolet B (NBUVB), during which no similar lesion was observed. She was shifted to PUVA as there was minimal improvement of vitiligo with NBUVB. She had skin type V and had 40% repigmentation of the vitiliginous lesions over this period. Her disease was stable during therapy. On examination she had several small hypopigmented to depigmented macules, round to oval in shape, with well-defined margins and measuring about 1.5 mm, which were distributed over the repigmented areas ( fig. 1). These lesions were distributed over extensor aspect of the extremities and were predominantly perifollicular. There was no history of phototoxic reaction or inflammatory lesions. Skin biopsy was taken from a representative lesion, which showed patchy loss of pigment in basal keratinocytes with mild hyperkeratosis of the epidermis. The photochemotherapy was subsequently discontinued.Falabela et al. 3 first described leucoderma punctatum in 1988, in 13 vitiligo patients during and after PUVASOL (oral psoralen followed by solar UV exposure) treatment as leucoderma distinct from idiopathic guttate hypomelanosis and vitiligo. Later, Park et al. 4 reported four cases of generalized punctate leucoderma after UVB phototherapy for psoriasis. Most of the cases were females. Dogra et al. 5 first reported a case of leucoderma punctatum appearing after systemic PUVA therapy. Recently, it has been reported after topical PUVA treatment for segmental vitiligo by Park et al. 6 The typical skin lesions described are multiple discrete well-defined macules of size varying from 0.5 to 1.5 mm, most commonly located on the upper and lower extremities. Special stains for melanocytes show a decreased number of functional melanocytes. In ultrastructural study by Falabella et al., 3 cellular damage within keratinocytes and melanocytes was evident in form of intracellular oedema and intracytoplasmic vacuolar degeneration. Although pathogenesis is not well understood, the most likely cause is PUVA and UVB phototoxiciy-induced damage to melanocytes. Park et al. 4 also suggested that cumulative UVB phototoxicity may be the cause of leucoderma punctatum. In this case, perhaps the exposure to both NBUVB and PUVA was the cause of phototoxicity and appearance of these lesions. It is important to be aware o...

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“…Precise pathogenesis of punctate leucoderma induced by phototherapeutic modalities has not been elucidated. However, it is suggested that the most likely cause is phototoxicity‐induced damage to melanocytes considering the results from a skin biopsy presenting patchy loss of pigment in basal keratinocytes and special stains demonstrating a decreased number of functional melanocytes 1–4 . Although pathologic evaluation could not be performed in our patients, we might guess that some forms of confetti hypopigmentation may have resulted from a QSNY‐induced damage to melanocytes.…”

mentioning

confidence: 95%

Punctate leucoderma after melasma treatment using 1064‐nm Q‐switched Nd:YAG laser with low pulse energy

Kim¹,

Js²,

Cho

2009

Acad Dermatol Venereol

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diarrhea. Alopecia, oedema, facial erythematous rash, hair depigmentation, stomatitis, xerosis and subungueal splinter haemorrhages have been reported. Two cases of inflammation of actinic keratoses and a case of erythema multiforme subsequent to therapy with sorafenib have also been described. 3,4 We have presented a particular case which represents a unique form of dermatologic toxicity to sorafenib that has not previously been described in the literature.The use of tyrosine kinase inhibitor may result in a wide range of cutaneous side effects. Thus, it is important to know them to adapt the management of these dermatologic toxicities. References 1 Wilhelm SM, Carter C, Tang L et al. BAY 43-9006 exhibits broad spectrum oral anti-tumor activity and targets the Raf/MEK/ERK pathway and receptor tyrosine kinases involved in tumor progression and angiogenesis. Cancer Res 2004; 64: 7099-7109. 2 Clark JW, Eder JP, Ryan D, Lathia C, Lenz HJ. Safety and pharmacokinetics of the dual action Raf kinase and vascular endothelial growh factor receptor inhibitor, BAY 43-9006, in patients with advanced, refractory solid tumors. Clin Cancer Res 2005; 11: 5472-5480. 3 Lacouture ME, Desai A, Soltani K et al. Inflammation of actinic keratoses subsequent to therapy with sorafenib, a multitargeted tyrosine-kinase inhibitor. EditorHerein, we would like to demonstrate three patients with melasma presenting punctate leucoderma after the treatment using 1064-nm Q-switched Nd:YAG laser (QSNY) with low pulse energy. A total of 259 patients (15 men, 244 women; mean age, 38 years; range, 21-67 years; Fitzpatrick skin types IV) had been treated using Figure 2 Image showing prominent follicular hyperplasia, mostly limited to the follicular isthmus, acanthosis with regenerative changes and a mild perifollicular lymphocytic inflammatory infiltration (haematoxylin-eosin. ×40). Figure 1Image showing multiple, grouped, monomorphous, follicular keratotic, skin coloured, 1-mm papules affecting the face.

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Generalized Punctate Leukoderma Following UVB Phototherapy in the Psoriasis Patients

Cited by 11 publications

References 0 publications

Case of leukoderma punctata after topical PUVA treatment

Case of leukoderma punctata after topical PUVA treatment

Confetti‐like hypopigmentation: a rare complication of common phototherapeutic modality

Punctate leucoderma after melasma treatment using 1064‐nm Q‐switched Nd:YAG laser with low pulse energy

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