The Itch that… freckles? Development of lentigines in areas of resolved chronic atopic dermatitis

Abstract

We report two pediatric patients with a history of chronic lichenified atopic dermatitis (AD) who subsequently developed eruptive lentigines at sites of resolved AD. The occurrence of this phenomenon in eczematous dermatoses in the absence of topical calcineurin inhibitor (TCI) use is rarely reported in the literature.

The delicate relation between melanocytes and skin immunity: A game of hide and seek

“…On the other hand, areas of chronic itch can also result in increased freckling, especially in children with fair skin types. This phenomenon has been reported both in atopic dermatitis and in psoriasis (LaRosa et al, 2015;Shayegan & Lauren, 2019). A proposed mechanism is the sudden loss of suppression of melanocytes by cytokines such as TNFα and IL-17, leading to melanocyte activation (LaRosa et al, 2015).…”

Appearance of lentigines in an atopic dermatitis patient treated with dupilumab

“…2 Although the development of lentigines at sites of resolved atopic dermatitis has been reported after treatment with topical corticosteroids and topical tacrolimus, it remains a rare phenomenon. 3 The pathophysiology involved in the occurrence of lentigines is not yet well understood. However, some data have demonstrated the link between inflammatory pathway and melanogenesis.…”

“…), as observed in psoriasis. 3 Interestingly, while the pathway and its inhibition under treatment remains the same, only a minority of patients develop lentigines under treatment. Thus strongly suggests allelic variations that might predisposed to develop lentigines.…”

Odyssey toward an understanding of acquired postinflammatory lentiginosis

“…2). Shayegan and Lauren [9] described two additional pediatric patients with milder atopic dermatitis who were using topical desonide and who subsequently developed eruptive lentiginosis at sites of resolved eczema. The authors hypothesized that chronic inflammation can by itself trigger hyperproduction of pigment, or that chronic use of topical corticosteroids in conjunction with ultraviolet light exposure could produce low-level cutaneous immunosuppression rendering the skin more vulnerable to development of solar lentiginosis.…”