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| CASE REPORT |
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| Year : 2014 | Volume
: 1
| Issue : 1 | Page : 23-24 |
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Persistent type B pigmentary demarcation lines in pregnancy
Raghavendra Kalasapura, Akshy Kumar, Devendra Kumar Yadav, Suresh Kumar Jain
Department of Skin and Venereal Diseases, Government Medical College, Kota, Rajasthan, India
| Date of Web Publication | 26-Jun-2014 |
Correspondence Address:
Raghavendra Kalasapura
Department of Skin and VD, Government Medical College, Kota, Rajasthan
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2349-5847.135435
Pigmentary demarcation lines (PDLs) are abrupt demarcation lines between the areas of light and dark pigmentation and also called as Futcher's or Voigt lines. These lines are most commonly seen in upper and lower limbs but can also be seen in other body parts. They occur almost in all races, but the incidence is more in Japanese, Caucasians and Negros. Treatment is not necessary because of transitory and asymptomatic nature of PDL. If at all required, it is due to cosmetic concerns only. We are reporting a rare case of type B PDL persisting even after 1 year postpartum. Keywords: Futcher′s line, Pregnancy, Type B pigmentary demarcation lines
How to cite this article:
Kalasapura R, Kumar A, Yadav DK, Jain SK. Persistent type B pigmentary demarcation lines in pregnancy. Pigment Int 2014;1:23-4 |
| Introduction | |  |
Pigmentary demarcation lines (PDL), also known as Futcher's or voigt lines, usually occur in upper and lower limbs. These are abrupt demarcation lines between light to dark pigmentation area and considered to be a physiological phenomenon. The incidence is more among Negroes and Japanese races of females but reported in Indian patients also. [1] Based on the site of occurrence, they are classified into type A to H [2],[3],[4] [Table 1]. Among them, most commonly seen subtypes are Type A and B. Type B PDL is almost always associated with pregnancy. They are self-resolving in nature, but sometimes may persist throughout the life. However, there are very few case reports about their persistence after 6 months postpartum. [5] We are reporting a rare case of type B PDL in a pregnant female who presented to us with persistent PDL even after 1-year postpartum.
| Case Report | | |
A 24-year-old female presented with asymptomatic dark demarcation lines in the posterior aspect of lower limbs since 1-year. Initially, patient noticed dark lines during her second trimester. They were asymptomatic, and she was least concerned. However, after delivery the lines persisted. There was no history of any medications or family members having similar complaints. On cutaneous examination a curvilinear, hyper pigmented, well-demarcated pigmentary lines were extending from ankle to buttocks, situated on the posterior-medial aspect of the lower limbs [Figure 1] with no scales or any discontinuity. On doing diascopy, there was no blanching or exaggeration of the lesions. Based on the history and clinical examination, diagnosis of type B PDL was made. | Figure 1: Curvilinear hyper pigmented well-demarcated line extending from ankle to buttocks situated on the posterior-medial aspect of lower limb
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| Discussion | | |
Pigmentary demarcation lines presents as an abrupt transition between areas of light and dark pigmentation, most commonly on the trunk and lower extremities than in any other part of the body. [5] The first case was described in Japanese patients by Matzumoto, [6] Subsequently, Futcher described the same condition in the black population in 1938. [7] PDLs are the most frequent in Black and Japanese populations, fairly common in East Indians, and rare in Caucasians. [8] It has been proposed that the various PDLs are dominantly inherited among the family members of Japanese and Negroes. [9] The occurrence of PDL among females more compared to males. According to Somani et al. [4] the number of male patients with demarcation lines was negligible (0.74%) when compared with the number of females (8.3%). The cause for PDLs is still an enigma. According Selmanowitz and Krivo [1] PDLs are streaks of melanocyte accumulation along the embryological axial line, but not along the blaschko lines as in type A PDLs. The familial pattern and female predominance lead to the hypothesis of cutaneous mosaciasm pigmentary pattern by paternal X chromosome Lyonization More Details. [10] The pathogenesis of PDLs in pregnancy is still unknown. According to Delmonte et al., [11] PDL lesions are associated with the distribution of the cutaneous peripheral nerves and the pigmentary differences result from neurogenic inflammation. Some other hypothesis mentions that compression of peripheral nerves at S1 and S2 by an enlarging uterus in pregnancy results in the pigmentary abnormality, [12] due to increased vascularity during pregnancy or a local trigger factor coupled with high levels of estrogen, progesterone, and melanocyte-stimulating hormone may offer possible explanations. [8] In a survey of the population, James et al. have reported that out of 75 patients of PDL, 14% developed type B lines during pregnancy only. [13] Actually the PDLs are a minor cosmetic disfigurement and usually self-resolving after pregnancy. Nakama et al. [14] reviewed 19 cases of pregnancy-associated type B PDLs, all of which resolved within a year of delivery. Although Type B PDLs are transitory, but in some cases they may persist [15] as seen in our case. The persistence of type B PDL may be due to unmasking or exaggerations of congenital demarcation lines during pregnancy because of hormonal changes, but still the reason is not known. Various therapeutic modalities have been tried that is Kligman regimen, sun protection, glycolic acid peels and alexandrite lasers, but the response is variable.
| References | | |
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| 14. | Nakama T, Hashikawa K, Higuchi M, Ishii N, Miyasato M, Hamada T, et al. Pigmentary demarcation lines associated with pregnancy. Clin Exp Dermatol 2009;34:e573-6.
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| 15. | Ruiz-Villaverde R, Blasco Melguizo J, Naranjo-Sintes R. Pigmentary demarcation lines in a pregnant Caucasian woman. Int J Dermatol 2004;43:911-2.
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[Figure 1]
[Table 1]
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