Background

Hypopgimented skin lesions may be a very disfiguring condition. It is important to accurately diagnose the underlying disease since the treatment and disease associations vary so greatly. The following is a list of some major diseases.

Albinism
Clear Cell Papulosis
Piebaldism
Vitiligo

OUTLINE

Pathogenesis
Gross Appearance and Clinical Variants
Commonly Used Terms
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MELANOCYTOPENIC (MELANOCYTES DECREASED OR ABSENT)

ETIOLOGIC FACTORS	DISEASE
Chemical	Catechols (certain) Monobenzylether of hydroquinone Para-substituted phenols (certain) Sulfhydryls
Endocrine
Genetic	Ataxia telangiectasia Piebaldism Vitiligo (Alezzandrini's syndrome, Idiopathic, Vogt-Koyanagi-Harada syndrome) Waardenburg's syndrome Woolf's syndrome Xeroderma pigmentosa Ziprkowski-Margolis syndrome
Inflammatory	Actinic reticuloid Mycosis fungoides Onchocerciasis Pityriasis lichenoides chronica Pinta Yaws
Metabolic
Neoplastic	Halo nevus Leukoderma acquisitum centrifugum
Nutritional	Vitamin B12 deficiency
Physical	Burns (Ionizing, thermal, UV) Trauma
Miscellaneous	Alopecia areata Scleroderma

 

MELANOPENIC (MELANIN DECREASED OR ABSENT)

ETIOLOGIC FACTORS	DISEASE
Chemical	Arsenicals Chloroquin Glucocorticoids Hydroxychloroquin Hydroquinone Mercaptoethylamines Retinoids
Endocrine	Addison's disease Hypopituitarism Hypothyroidism
Genetic	Albinism (Types I-III oculocutaneous albinism)
Inflammatory	Leprosy Pityriasis alba Postinflammatory (DLE, eczema, psoriasis) Post-Kala-Azar Sarcoidosis Syphilis Tinea versicolor
Metabolic	Alpert's syndrome Chromosomal 5p defect Osteopathic striae Prolidase deficiency
Neoplastic	Melanoma (Halo)
Nutritional	Chronic protein loss Kwashiorkor Malabsorption Nephrosis Ulcerative colitis
Physical	Post dermabrasion Post laser
Miscellaneous	Canities Horner's syndrome Idiopathic guttate hypomelanosis Vagabond's leukoderma

 

NONMELANOCYTIC (NO MELANIN DEFECT)

ETIOLOGIC FACTORS	DISEASE
Chemical
Endocrine
Genetic	Nevus anemicus
Inflammatory	Woronoff's ring
Metabolic
Neoplastic
Nutritional
Physical
Miscellaneous	Anemia Edema

CLINICAL VARIANTS	CHARACTERIZATION
HYPOMELANOSIS OF ITO
Hypomelanosis of ITO. A study of 76 infantile cases. Pascual-Castroviejo I, Roche C, Martinez-Bermejo A, Arcas J, Lopez-Martin V, Tendero A, Esquiroz JL, Pascual-Pascual SI. Pediatric Neurology Service, University Hospital La Paz, Madrid, Spain.	Brain Dev 1998 Jan;20(1):36-43 Abstract quote We show the complications observed in a large series of children with hypomelanosis of Ito (HI) or incontinentia pigmenti achromians, studied in a neurology service over 30 years. Of the 76 patients, 35 were male (46%) and 41 female (54%) with ages ranging from newborn to 10 years at the time of the first visit. They were thoroughly studied from the clinical, genetic, psychological, neuroradiological, with computed tomography (CT) and/or magnetic resonance imaging (MRI), and electroencephalographic (EEG) points of view. Mental retardation was observed in 43 cases (57%) of whom eight (10%) showed autistic behavior; 16 (21%) were borderline and only 17 (22%) had a normal mental level (IQ > 85). Thirty-seven patients (49%) had seizures, consisting of infantile spasms in six cases (8%). Twelve cases showed macrocephaly and coarse facies, six had microcephaly, and 14 showed hypotonia with pes valgus and genu valgus. Three cases of cerebellar hypoplasia, another of intracranial arteriovenous malformation and another of distal spinal muscular atrophy were observed as well. Some other anomalies, such as syndactyly, clinodactyly, abnormalities of the skeleton, asymmetry of the facies, ears, body and/or extremities, gynecomastia and asymmetrical breasts, short stature, oral alterations, congenital cardiopathies and genital anomalies, were also occasionally found. Three children died, but necropsy was performed only in one. Anatomical and histological studies did not disclose specific findings.
PROGRESSIVE MACULAR HYPOMELANOSIS
Propionibacterium acnes and the Pathogenesis of Progressive Macular Hypomelanosis. Westerhof W, Relyveld GN, Kingswijk MM, De Man P, Menke HE. Netherlands Institute for Pigment Disorders, and the Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.	Arch Dermatol. 2004 Feb;140(2):210-4. Abstract quote   BACKGROUND: Progressive macular hypomelanosis is a common hypopigmentation mainly on the central parts of the trunk, predominantly in young adults, especially women. It is often mistaken for pityriasis versicolor and pityriasis alba. It occurs in all races and has been described in many parts of the world. We discovered follicular red fluorescence restricted to lesional skin. We suspected a relation with a porphyrin-producing bacteria residing in sebum of the pilosebaceous duct, and we therefore performed a study in 8 patients.Observation In all biopsy specimens taken from lesional skin of 8 women, we could demonstrate gram-positive bacteria in the pilosebaceous duct, and a mild perifollicular lymphocytic infiltrate was seen. In all but 1 patient, Propionibacterium acnes was yielded from cultured biopsy specimens taken from follicular lesional skin. Healthy follicular skin did not show bacteria in histological sections, and cultures did not yield anaerobic bacteria. CONCLUSIONS: There seems to be a relation between the presence of P acnes and the hypopigmented macules. We propose that a factor is produced by these strains of P acnes, which interfere with melanogenesis. Based on these observations, we are undertaking a clinical trial to find a treatment for this troubling, intractable disease.

Modified from Fitzpatrick's Dermatology in General Medicine, Fifth Edition. 1999. McGraw-Hill. Pg. 946-947.

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Last Updated 2/23/2004

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