|
 
 |
| THE CLINICAL PICTURE |
|
| Year : 2014 | Volume
: 1
| Issue : 1 | Page : 31 |
|
Punctate leukoderma
Shraddha Uprety, Keshavamurthy Vinay, Muthu Sendhil Kumaran
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| Date of Web Publication | 26-Jun-2014 |
Correspondence Address:
Muthu Sendhil Kumaran
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160 012
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2349-5847.135439
How to cite this article:
Uprety S, Vinay K, Kumaran MS. Punctate leukoderma. Pigment Int 2014;1:31 |
A 40-year-old male patient with acrofacial vitiligo, presented with multiple punctate, well-defined depigmented macules, over chest, back, and proximal extremities [Figure 1] and [Figure 2]. They appeared 6 months after psoralen plus ultraviolet A (PUVA) sol (psoralen + sunlight) treatment. Based on history and clinical findings a diagnosis of punctate leukoderma was made. | Figure 1: Multiple punctate, well-defined depigmented macules, over back
Click here to view |
 | Figure 2: Close up of multiple punctate, well-defined depigmented macules, over the back
Click here to view |
Punctate leukoderma is an adverse effect of PUVA therapy, characterized by multiple discrete, hypopigmented or achromic, round to oval macules distributed over extremities, chest, and back. It is attributed to nuclear damage of both the keratinocytes and melanocytes caused by the formation of psoralen photo adducts. Histopathology demonstrates decrease, but not absence of melanocytes and melanin pigment. Ultrastructural studies have shown cellular damage with vacuolar degeneration of both keratinocytes and melanocytes.
The other clinical mimics of punctate leukoderma include vitiligo itself, tuberous sclerosis, chemical leukoderma, tinea versicolor and idiopathic guttate hypomelanosis. Idiopathic guttate hypomelanosis is a disease of advanced age in the pigmented races. The lesions are small, achromic, angulated macules distributed predominantly over extremities. The ultrastructural changes as seen in PUVA induced punctate leukoderma are not present. Vitiligo histopathologically shows absence of melanocytes and melanin pigment. Absence of fine scales and a negative KOH scraping can exclude the diagnosis of tinea versicolor.
[Figure 1], [Figure 2]
|
Search Pubmed for