Idiopathic eruptive macular pigmentation: Report on two cases

Grover, Shabnam Bhandari; Basu, Atoshi

doi:10.4103/0019-5154.70698

Cited by 11 publications

(12 citation statements)

References 5 publications

(5 reference statements)

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“…[6] A study by Sanz de Galdeano et al [7] gave the criteria for diagnosis in 1996, namely: (a) Eruption of brownish, non-confluent, asymptomatic macules involving the trunk, neck and proximal extremities in children and adolescents (b) absence of preceding inflammatory lesions (c) no previous drug exposure (d) basal layer hyperpigmentation of the epidermis and prominent dermal melanophages without visible basal layer damage or lichenoid inflammatory infiltrate (e) normal mast cell count. The present case fulfilled all the above mentioned criteria and very few cases of similar nature have been reported [2,8] among Indians.…”

Section: Discussionsupporting

confidence: 68%

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Idiopathic eruptive macular pigmentation

Begum¹,

Ramachandra²,

Kumar³

2014

Indian J Paediatr Dermatol

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physical and systemic examination was unremarkable. Cutaneous examination revealed multiple brownish gray to dark, discrete, round to oval macules [ Figures 1 and 2]. The lesions on the lower abdomen had a velvety texture [ Figure 3 and 4]. Palms and soles were spared. The size varied from 0.5 cm to 3 cm. Darier's sign was negative. The mucosae, hair and nails were normal. Hematological investigations were normal. Biopsy showed moderate irregular acanthosis, slight papillomatosis [ Figure 5 and 6] and basal layer hyperpigmentation [ Figure 7 and 8]. The upper dermis showed sparse superficial lymphohistiocytic infiltrate. Few melanophages were seen in the papillary dermis. The mast cell number was normal. The final diagnosis was IEMP. No specific treatment was given.An unusual case of a 24-year-old woman lasting 21 years was characterized by several periods of spontaneous resolution followed by recurrences. [3] This case is reported for its rarity with an objective to increase its awareness among dermatologists, pathologists and pediatricians. A misdiagnosis can lead to unnecessary, sometimes dangerous management of a clinical entity which otherwise regresses spontaneously. ABSTRACTIdiopathic eruptive macular pigmentation (IEMP) is an uncommon, rather under-reported disease entity of the pediatric age characterized by asymptomatic, brownish hyperpigmented macules involving the neck and trunk with no preceding inflammation or exposure to drug. Here we report this case to increase awareness of this entity among dermatologists, dermatopathologists and pediatricians. A 11-year-old healthy boy presented with brownish-gray to dark, discrete, asymptomatic macules on the face, trunk, neck and limbs of insidious onset. Histopathologic examination showed melanophages, mild perivascular lymphohistiocytic infiltrate in the papillary dermis and papillomatosis. The natural course of the disease is spontaneous remission without treatment, which was so even in our patient. IEMP is a benign entity with an excellent prognosis as it exhibits spontaneous resolution. It falls into the differential diagnoses of asymptomatic hyperpigmentatory disorders in pediatric population. Awareness of the entity leads to avoidance of unnecessary aggressive damaging treatment.

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Section: Discussionsupporting

confidence: 68%

“…Less than 30 cases of IEMP have been reported in the literature so far, reflecting unfamiliarity with the entity. [2] We report one such case to highlight its existence and self-resolving course.…”

Section: Introductionmentioning

confidence: 93%

Idiopathic eruptive macular pigmentation

Begum¹,

Ramachandra²,

Kumar³

2014

Indian J Paediatr Dermatol

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“…In our case, the prominent histological feature was papillomatosis with basal pigmentation and accompanying hyperkeratosis without inflammation ( Figure 2). Whereas the pigmented papillomatosis and the absence of inflammatory infiltrates both appear to be constant features of the condition, it seems that both hyperkeratotic [1,7,9] and nonhyperkeratotic [2][3][4][5]10] forms exist, the latter being more common.…”

Section: Pathologymentioning

confidence: 99%

Asymptomatic brown patches in a 13‐year‐old boy

Manousaridis

Géraud

Wölfer

et al. 2014

J Deutsche Derma Gesell

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Ein 13-jähriger Junge wurde in unsere Einrichtung überwiesen, da sich auf seinem Körper seit einigen Monaten, zunehmend und mit einer diskreten Hyperkeratose einhergehend, braune Maculae von ca. 1 cm bis 5 cm Durchmesser entwickelten (Abbildung 1). Der junge Patient war asymptomatisch und entzündliche Erkrankungen waren keine vorausgegangen. Die Maculae, die vor allem im Bereich der linken Schulter, des linken Arms und der rechten Brust auftraten, wiesen ein ungleichmäßiges und asymmetrisches Verteilungsmuster auf. Sie folgten in ihrer Anordnung weder Spalt-noch Blaschko-Linien und zeigten auch keine segmentale Verteilung. Eine lokale Therapie mit Antimykotika und Glucocorticoiden hatte zu keiner Verbesserung des Befundes geführt. DifferenzialdiagnosenArzneimittelexanthem, postentzündliche Hyperpigmentierung, Mastozytose, Lichen planus pigmentosus, Erythema dyschromicum perstans, Acanthosis nigricans, konfluierende retikuläre Papillomatose (Morbus Gougerot-Carteaud).Abbildung 2 Papillomatose mit basaler Hyperpigmentierung und begleitender Hyperkeratose ohne Zeichen einer Entzündung.Abbildung 1 Asymptomatische braune hyperkeratotische Maculae.Ihre Diagnose? PathologieIn der histopathologischen Untersuchung zeigte sich eine Papillomatose, Orthohyperkeratose und Akanthose. Die epidermale Basalzellschicht war moderat hyperpigmentiert, in der Dermis kamen vereinzelt Lymphozyten vor. Eine Proliferation dermaler oder epidermaler Melanozyten konnte nicht nachgewiesen werden (Abbildung 2).

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“…[1,[3][4][5] No case report of IEMP prior to this mentions pigmented papillomatosis as a histological finding although the consensus has been that IEMP is a dermal hyper-melanosis with increased melanin in the basal layer of the epidermis. Pigmented papillomatosis appears to be the principal histological finding in all Indian cases and may be considered as an important diagnostic criterion for the diagnosis of this condition.…”

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confidence: 99%

Idiopathic eruptive macular pigmentation

Joshi¹

2015

Indian J Paediatr Dermatol

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papillomatosis and skin biopsy is essential for the diagnosis of IEMP and its differentiation from other clinical differential diagnoses.It has been suggested that IEMP is a variant of acanthosis nigricans [2,5] because clinically, individual lesions show a velvety surface that is reminiscent of acanthosis nigricans and histologically IEMP shares with acanthosis nigricans the finding of pigmented papillomatosis.The classification of acanthosis nigricans has been expanded [6,7] and includes obesity associated, syndromic, acral, unilateral, generalized, familial, drug induced, malignancy associated and mixed types. All these show similar clinical findings of hyperpigmented velvety flat plaques with pigmented papillomatosis on histology, a finding similar to lesions of IEMP.In sum, therefore, pigmented papillomatosis should be included as an important criterion for the diagnosis of IEMP and future studies should be directed to investigate the possibility of IEMP being a variant of acanthosis nigricans, to wit, eruptive acanthosis nigricans.

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Idiopathic eruptive macular pigmentation: Report on two cases

Cited by 11 publications

References 5 publications

Idiopathic eruptive macular pigmentation

Idiopathic eruptive macular pigmentation

Asymptomatic brown patches in a 13‐year‐old boy

Idiopathic eruptive macular pigmentation

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