| Erythema
Dischromicum perstans or Lichen Planus./
Eritema discromico perstans o liquen
plano.
Data-Medicos
Dermagic/Express No. 76
29 Septiembre 1.999. 29 September 1.999.
~ Eritema discromico perstans o Liquen Plano ? ~
~ Erythema dyschromicum perstans or Lichen planus ? ~
EDITORIAL ESPANOL
=================
En el año de 1.957 Oswaldo Ramirez en el primer Congreso Centro Americano de Dermatologia
describio por vez primera una dermatosis encontrada en su Pais, el Salvador, con el nombre de "Los cenicientos, problema clinico". En 1.961 Convit y Colaboradores consideraron esta enfermedad una variante del eritema perstans y la denominaron Eritema Cronico figurado con Melanodermia. La enfermedad fue aceptada como una nueva entidad nosologica en el 5to Congreso Ibero Latino Americano de Dermatologia Celebrado en Buenos Aires en 1963 con el Nombre de Eritema Discromico Perstans.
En Al año de 1.967 el mismo Oswaldo Ramirez describe un estudio epidemiologico de 139 casos bajo el nombre de Dermatosis cenicienta o Eritema Discromico Perstans. Despues de esta primera descripcion comenzaron a reportarse numerosos casos en MUCHOS PAISES.
En la decada de los 80 algunos autores comienzan a especular la posiblidad de que el Eritema discromico Perstans es una variante del liquen plano. Algunos lo denominaron LIQUEN PLANO PIGMENTOSO, esto en base a las siguientes caracteristicas:
1. El LIQUEN PLANO y el ERITEMA DISCROMICO PERSTANS tienen UN MISMO PATRON histopatologico: Una dermatitis liquenoide.
2.) El liquen plano se presenta a veces como maculas grisaceas.
3.) Se describieron casos de localizacion clinica con patron ZOSTERIFORME en ambas..
4.) Se han descrito casos de EDP asociados a medicamentos.
5.) El tratamiento es bastante dificil en ambos.
En 1984. Ramirez de nuevo hace una revison sobre todos los casos publicados y concluye que NO ES UNA ENFERMEDAD TROPICAL, sino de distribucion mundial, mas no la asocia con liquen plano.
42 años despues la controversia continua e incluso algunos autores hablan de 2 variantes de Eritema Discromico Perstans, Otros continuan insistiendo en que deberia unificarse el criterio de esta forma: ERITEMA DISCROMICO PERSTANS, una variante de LIQUEN PLANO, bajo la sinonimia de LIQUEN PLANO PIGMENTOSO. Yo estoy de acuerdo con esto 100% En estas 43 referencias, los hechos.
Bienvenido a DERMAGIC Dr. Eduardo Weiss(Miami).
Proxima edicion: SERENOA VS FINASTERIDE
....sera que una hierba es tan igual o mejor que el finasteride en la alopecia androgenica ????
Saludos a todos !!!
Dr. Jose Lapenta R.,,,
EDITORIAL ENGLISH
=================
In 1957 Oswaldo Ramírez, during the First Central-American Dermatology Congress in El Salvador; described for the first time a dermatosis found in his country, el Salvador, with the name "The Ashy. Clinical problem". In 1961, Convit et al. consider this disease as a variant ot erythema perstans and name it "Chronic Figured Erythema with Melanodermia". this disease was accepted as new nosologic entity in the Fifth Congress of the Ibero-Latin-American College of Dermatology in Buenos Aires in 1963 with the name of "Erythema Dyschromicum Perstans".
In To the year of 1.967 the same Oswaldo Ramirez describes an epidemiologic study of 139 cases under the name of Ashy Dermatosis or Erythema Dyschromicum Perstans. After this first description they began to be reported numerous cases in MANY COUNTRIES.
In the decade of the 80 some authors begin to speculate the probability that the Erythema Diyschromicum Perstans is a variant of the Lichen Planus. Some denominated it LICHEN PLANUS PIGMENTOSUM, this based on the following ones characteristic:
1. The LICHEN PLANUS and THE ERYTHEMA DYSCHROMICUM PERSTANS have the same histopathological picture: A lichenoid dermatitis.
2.) The lichen planus is sometimes presented as ashy macules.
3.) Cases of clinical localization were described with ZOSTERIFORM pattern in both.
4.) Cases of EDP associated to medications have been described.
5.) The treatment is quite difficult in both.
In 1984. Ramirez again makes a revision on all the published cases and it concludes that it IS NOT A TROPICAL ILLNESS, but of world-wide distribution, but it doesn't associate it with lichen planus.
42 years later the controversy continuous and some authors even speak of 2 variants of Erythema Dyschromicum Perstans, Others continue insisting in that it should become unified the approach in this way: ERYTHEMA DYSCHROMICUM PERSTANS, a variant of LICHEN PLANUS, under the synonymy of LICHEN PLANUS PIGMENTOSUM. I agree with this in 100%. In these 43 references, the facts.
Welcome to DERMAGIC Dr. Eduardo Weiss (Miami)
Next edition: SERENOA VS FINASTERIDE
... a herb is so same or better than the finasteride in the androgenic alopecia ????
Greetings to ALL, !!
Dr. Jose Lapenta R.,,,
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REFERENCIAS BIBLIOGRAFICAS / BIBLIOGRAPHICAL REFERENCES
===================================================================
1.) "Los cenicientos. Problema Clinico". (The Ashy. Clinical problem)
2.) "Eritema Discromico Perstans" (Eritema figurado cronico con
melanodermia).(Chronic Figured Erythema with Melanodermia)
3.) Sobre la Etiopatogenia del eritema discrómico perstans (Dermatosis Cenicienta). Posibilidad de una Melanosis Neuro-cutánea
4.) The ashy dermatosis (erythema dyschromicum perstans)
5.) Ashy dermatosis or lichen planus pigmentosus: what is in a name?
6.) ERYTHEMA DYSCHROMICUM PERSTANS (ASHY DERMATOSIS) THE ENTITY
7.) [Ashy dermatitis. Comments on 2 clinical forms].
8.) Unilateral ashy dermatosis occurring in a child.
9.) [Current status of ashy dermatosis. Synonym--erythema dyschromicum perstans].
10.) [Ashy-dermatosis--a case with spontaneous disappearance of the cutaneous
lesions].
11.) Erythema dyschromicum perstans and lichen planus.
12.) Ashy dermatosis. An apoptotic disease?
13.) Ashy dermatosis--a variant of lichen planus?
14.) Erythema dyschromicum perstans in early childhood.
15.) Fixed drug eruption presenting as erythema dyschromicum perstans: a flare
without taking any medications.
16.) Reticulate postinflammatory hyperpigmentation with band-like mucin deposition.
17.) Erythema dyschromicum perstans: report of a new case and critical review of
the literature.
18.) Involvement of cell adhesion and activation molecules in the pathogenesis
of erythema dyschromicum perstans (ashy dermatitis). The effect of
clofazimine therapy.
19.) Periorbital hyperpigmentation and erythema dyschromicum perstans.
20.) Erythema dyschromicum perstans and lichen planus: are they related?
21.) Erythema dyschromicum perstans. Immunopathologic studies.
22.) Simultaneously active lesions of vitiligo and erythema dyschromicum perstans.
23.) Mononuclear cell subpopulations and infiltrating lymphocytes in erythema
dyschromicum perstans and vitiligo.
24.) Chlorothalonil, a possible cause of erythema dyschromicum perstans (
ashy dermatitis).
25.) Lichen planus pigmentosus presenting in zosteriform pattern.
26.) [Erythema dyschromicum perstans versus lichen planus].
27.) Erythema dyschromicum perstans.
28.) Erythema dyschromicum perstans.
29.) [Erythema cinitiensis perstans].
30.) [Idiopathic eruptive macular pigmentation].
31.) [Erythema dyschromicum perstans].
32.) Erythema dyschromicum perstans. A follow-up study from northern Finand.
33.) Ingestion of ammonium nitrate as a possible cause of erythema dyschromicum
perstans (ashy dermatosis).
34.) [Erythema dischromicum perstans (ashy dermatosis). Report of two cases].
Pathologica 1993 Sep-Oct;85(1099):533-41
35.) [Ashy dermatosis].
36.) [Ashy dermatosis. Review of the literature and report of a case].
37.) [Ashy dermatosis (erithema dyschromicum perstans): prospective study of 23
patients].
38.) Reticulate, patchy and mottled pigmentation of the neck. Acquired forms.
39.) Lichen planus pigmentosus associated with acrokeratosis of Bazex.
40.) Ashy dermatosis and lichen planus pigmentosus: a clinicopathologic study of
31 cases.
41.) [Lichen ruber exanthematicus et pigmentosus in mercury poisoning. A
contribution to individual pathology in occupational medicine].
42.) [Lichen planus and lichen planus pigmentosus following gold therapy--case
reports and review of the literature].
43.) Lichen planus pigmentosus of the oral mucosa: a rare clinical variety.
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1.) "Los cenicientos. Problema Clinico". (The Ashy. Clinical problem)
Memoria del Primer Congreso Centro Americano de Dermatologia, San salvador,
1957:122-130 Ramirez, C.O
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2.) "Eritema Discromico Perstans" (Eritema figurado cronico con
melanodermia).(Chronic Figured Erythema with Melanodermia)
Dermat. Venezolana, 1961, 2:118-164
Convit, J., Kerdel-Vegas, F., Rodriguez, G.
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3.) Sobre la Etiopatogenia del eritema discrómico perstans (Dermatosis Cenicienta). Posibilidad de una Melanosis Neuro-cutánea Derm Venez 1995;
33:149-151
Homez-Chacin, 1. Barroso T.
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4.) The ashy dermatosis (erythema dyschromicum perstans): epidemiological study
and report of 139 cases.
Ramirez C.O. Cutis 1967; 3:244-7
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5.) Ashy dermatosis or lichen planus pigmentosus: what is in a name?
Arch Dermatol 1986 Feb;122(2):133
Bhutani LK
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6.) ERYTHEMA DYSCHROMICUM PERSTANS (ASHY DERMATOSIS) THE ENTITY
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SOURCE: Sobre la Etiopatogenia del eritema discrómico perstans (Dermatosis Cenicienta). Posibilidad de una Melanosis Neuro-cutánea
Derm Venez 1995;33:149-151 Homez-Chacin, 1. Barroso T.
ABSTRACT
In 1957 Oswaldo Ramírez, during the First Central-American Dermato-Iogy
Congress in El Salvador; described for the first time a dermatosis found in
his country wjth the name "The Ashy. Clinical problem". In 1961, Convit et
al. consider this disease as a variant ot erythema perstans and name it
"Chronic Figured Erythema with Melanodermia". this disease was accepted as
new nosologic entity in the Fifth Congress of the Ibero-Latin-American
College of Dermatology in Buenos Aires in 1963 with the name of "Erythema
Dyschromicum Perstans".
According to O. Ramírez. "Erythema Discromicum Perstans (Ashy Dermatosis)
is a chronic skin disease characterized by typical and marked changes in
color of the skin (hyperpigmented macules, black-board gray, variable), of
slow evolution, persistent, with no concomitant local alterations, but
which sometimes have repercussions on the psychic state of the patient,
according to the size of the lesion. It is not accompanied by any other
cutaneous or symptomatic abnormality. It is not influenced by climate,
racial, dietary or occupational factors". This dermatosis can appear at any
age, from one to eighty years. Either sex can be equally affected, even
though it is more frequent in females. lnitially lesions are localized,
but they can become generalized, not involving scalp, annexes or
palmo-plantar regions.
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7.) [Ashy dermatitis. Comments on 2 clinical forms].
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Med Cutan Ibero Lat Am 1986;14(2):95-9
Carvajal Huerta L, Uraga Pazmino E, Loayza Vivanzo E, Sabando Sanchez R,
Garcia Atiaga I, Jeny E
The typical clinical characteristic of the ashy dermatitis is the fact that
in case of light colored skin, the grey colour remains invariable. There is
a new clinical form which is called the Brown Cinder Dermatitis which is
characterized by a disciplined localization in the center of the face,
trunk or upper extremities together with an inexorable change of the grey
colour at the beginning to a brown colour at the end on the other it, has
be enhanced the existence of the nummular form which is characterized by
the existence of many greyish independent spots of circular or oval form
mainly at the level of the trunk.
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8.) Unilateral ashy dermatosis occurring in a child.
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Arch Dermatol 1984 Nov;120(11):1491-3
Urano-Suehisa S, Tagami H, Iwatsuki K
An unusual case of ashy dermatosis of Ramirez occurred in a 5-year-old-girl
who had ash-colored hyperpigmented macules and plaques on the left leg and
the left side of the trunk. These unilateral lesions showed histopathologic
changes of a lichenoid tissue reaction. Although the exact cause of ashy
dermatosis remains unknown, the positive test result for serum rheumatoid
factor and the granular deposition of IgM at the dermoepidermal junction
found in our case has immunologic implications.
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9.) [Current status of ashy dermatosis. Synonym--erythema dyschromicum perstans].
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Med Cutan Ibero Lat Am 1984;12(1):11-8
[Article in Spanish]
Ramirez O, Lopez Lino DG
A clinical, histopathological, therapeutical and epidemiologic review of
Ashy Dermatosis is done. This research has been taken from scientific
publications, computers and personal communications. In twenty five years
of scientific medical investigations it has not been determined its truth
etiology , nor its therapeutic; this confirms it, as a new nosologic entity
well defined. The epidemiologic researches are concludent that this is not
a tropical disease exclusively, but one of all over the world. We hope to
obtain more references on this dermatosis throughout the Sessions of
Specialties of CILAD regarding this disease.
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10.) [Ashy-dermatosis--a case with spontaneous disappearance of the cutaneous
lesions].
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Z Hautkr 1983 Jan 15;58(2):113-20
[Article in German]
Schneider I, Varga M, Zombai E, Husz S
A 14-years-old girl suddenly developed typical dermal signs of
ashy-dermatosis at the time of menarche. After one year, the signs began to
fade and had disappeared completely two years later. The direct
immunofluorescence and the ultrastructure resemble lichen planus. Endocrine
factors may have played a part in the presented case, considering the
sudden onset at the time of menarche.
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11.) Erythema dyschromicum perstans and lichen planus.
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Arch Dermatol 1982 Sep;118(9):683-5
Naidorf KF, Cohen SR
Erythema dyschromicum perstans (EDP) is a cutaneous pigmentary disturbance
originally considered to be a variant of erythema perstans. The nosologic
identity of EDP has been challenged repeatedly as the number of patients
with concurrent EDP-like eruptions and lichenoid disorders has increased.
In this report, we describe a woman who had EDP for two years before the
onset of classic lichen planus (LP). The active lesions of LP gradually
evolved into typical ashy-gray macules of EDP. This case provides further
support for the concept that EDP and EDP-like conditions should be
classified, in certain instances, as erythema dyschromicum variants of LP.
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12.) Ashy dermatosis. An apoptotic disease?
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Arch Dermatol 1981 Nov;117(11):701-4
Person JR, Rogers RS 3d
Of nine patients with ashy dermatosis, eight were women; most were young
adults when the dermatosis began. The incidences of atopy (five patients)
and thyroid disease (three patients) were striking. Although some of the
patients were clinically atypical, histologic study in all cases showed
basal cell vacuolation, Civatte bodies, pigmentary incontinence, and a mild
perivascular lymphohistiocytic infiltrate. Direct immunofluorescence
microscopy, performed in four cases, showed igM cytoid bodies. We
hypothesize that the postinflammatory hyperpigmentation in ashy dermatosis
and, perhaps, in other dermatoses may occur on the basis of basal cell
apoptosis.
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13.) Ashy dermatosis--a variant of lichen planus?
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Cutis 1980 Jun;25(6):631-3
Kark EC, Litt JZ
Immunofluorescence studies on a patient with clinical and histological
evidence of ashy dermatosis revealed a pattern commonly associated with
lichen planus. In view of these findings, the possibility of a relationship
between ashy dermatosis and lichen planus is suggested.
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14.) Erythema dyschromicum perstans in early childhood.
J Dermatol 1999 Feb;26(2):119-21
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Lee SJ, Chung KY
Department of Dermatology, Yonsei University College of Medicine, Seoul,
Korea.
Erythema dyschromicum perstans (EDP) is a rare disorder characterized by
asymptomatic, slowly progressive, ash-gray macular pigmentation of the skin
which usually occurs from age 5 through adult life. We have experienced two
cases of EDP in children aged 2 and 3, both exceptionally younger than the
previously reported cases. We therefore suggest that EDP should be included
in the differential diagnosis of pigmentary disorders occurring at an early
age.
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15.) Fixed drug eruption presenting as erythema dyschromicum perstans: a flare
without taking any medications.
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Dermatology 1998;197(4):383-5
Mizukawa Y, Shiohara T
Department of Dermatology, Kyorin University School of Medicine, Tokyo,
Japan.
Fixed drug eruption (FDE) can present as multiple pigmented macules that
flare at fixed sites even when the patient has taken no medications.
Although this presentation is not characteristic of FDE, it must be borne
in mind in order to make a correct diagnosis. We describe such a patient
whose condition was initially diagnosed as erythema dyschromicum perstans
(EDP). Immunohistochemically intraepidermal T cells were distributed
between basal and suprabasal keratinocytes in the lesional skin, a finding
suggestive of FDE. A flare occurred not only with exposure to theophylline
but also without exposure. A flare has never recurred and pigmented macules
faded gradually after avoiding theophylline. On the basis of these
findings, we recommend that patients with an EDP-like presentation be
examined completely for causes such as drugs before labeling the cutaneous
lesions.
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16.) Reticulate postinflammatory hyperpigmentation with band-like mucin deposition.
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Int J Dermatol 1998 Nov;37(11):829-32
Noto G, Pravata G, Arico M
Department of Dermatology, University of Palermo, Policlinico P. Giaccone,
Italy.
BACKGROUND: Mucinoses of the skin are a group of disorders sharing
accumulation of mucin in the skin or hair follicles. Postinflammatory
hyperpigmentation, with pigmentary incontinence, is due to loss of melanin
from epidermal basal cells and its accumulation in dermal macrophages.
METHODS: We describe clinicopathologic features of two patients presenting
with the association of pigmentary incontinence with an unusual diffuse,
band-like dermal deposition of mucin, clinically presenting with reticular
pigmented macular lesions. RESULTS: Two patients were observed with
asymptomatic, persistent, reticular, pigmented patches located in the
flexures, thighs, neck and back. Histology showed melanophages with a
diffuse, band-like dermal deposition of mucin, an increased number of
fibroblasts, a slight T-cell infiltrate and scattered mast cells. Blood
markers of lupus erythematosus were negative. CONCLUSIONS: These findings
may draw attention to pigmentary disorders such as lichen planus
pigmentosus, erythema dyschromicum perstans, pigmentatio maculos eruptiva
idiopathica, dermatopathia pigmentosa reticularis, prurigo pigmentosa and
frictional melanosis. None of these entities, however, includes mucin
deposition among its microscopic features. Macules were not preceded by
erythema or any other lesions. We suggest that our cases could belong to
group II of Rongioletti and Rebora's classification, i.e. they could be
cases of secondary mucin deposition in postinflammatory hyperpigmentation,
possibly in an unusual form of lichen planus pigmentosus or, less likely,
frictional melanosis.
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17.) Erythema dyschromicum perstans: report of a new case and critical review of
the literature.
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J Dermatol 1998 Nov;25(11):747-53
Combemale P, Faisant M, Guennoc B, Dupin M, Heyraud JD
Department of Dermatology, Military Hospital Desgenettes, Lyon, France.
Erythema dyschromicum perstans (EDP), described by Convit et al. in 1961,
is a rare dermatosis. Its relationship with ashy dermatosis (AD), described
by Ramirez in 1957, is still a matter of debate. We report a typical case
of EDP. The patient, of North African origin, had a dyschromic (hypo- and
hyperpigmented) eruption on the chest and limbs for 2 years. The lesions
were occasionally surrounded by a papular border which spread slowly and
centrifugally. Histological examination showed a lichenoid infiltrate. A
carcinoma of the lung was simultaneously discovered. No treatment was
given, EDP is infrequent and often considered identical to ashy dermatosis
in the literature. However, the clinical aspects of the two diseases
differ. The main features of these two diseases are reviewed and compared
on the basis of a literature review. We conclude that EDP and AD are
distinct clinical entities.
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18.) Involvement of cell adhesion and activation molecules in the pathogenesis
of erythema dyschromicum perstans (ashy dermatitis). The effect of
clofazimine therapy.
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Arch Dermatol 1997 Mar;133(3):325-9
Baranda L, Torres-Alvarez B, Cortes-Franco R, Moncada B, Portales-Perez DP,
Gonzalez-Amaro R
Department of Immunology, School of Medicine, University of San Luis
Potosi, Mexico City, Mexico.
OBJECTIVES: To assess the expression of several cell adhesion and
lymphocyte activation molecules in erythema dyschromicum perstans lesions,
and to evaluate the effect of clofazimine therapy on the expression of
these molecules. DESIGN AND METHODS: A prospective study. Skin biopsy
samples were obtained from patients before and after 3 months of
clofazimine therapy, and the expression of cell adhesion and activation
molecules was assessed by an immunohistochemical technique. SETTING: This
study was performed in a clinical referral center and an immunology
research laboratory. PATIENTS: We studied 6 patients with erythema
dyschromicum perstans. A diagnosis was made on the basis of clinical and
histological criteria. Two patients discontinued participation in the
study: one because of adverse effects and the other for unknown reasons.
INTERVENTIONS: Patients were treated with clofazimine, 100 mg/d, for 3
months. MAIN OUTCOME MEASURES: Expression of cell adhesion and lymphocyte
activation molecules in skin biopsy specimens before and after clofazimine
therapy. RESULTS: Before clofazimine therapy, we detected a noticeable
expression of intercellular adhesion molecule 1 and major
histocompatibility complex class II molecules (HLA-DR) in the keratinocyte
basal cell layer. In addition, CD36, a thrombospondin receptor that is not
expressed by normal skin, was detected in the strata spinosum and
granulosum. The dermal cell infiltrate expressed the activation molecule
AIM/CD69 and the cytotoxic cell marker CD94. After clofazimine therapy, the
expression of intercellular adhesion molecule 1 and HLA-DR disappeared, as
well as the mononuclear cell infiltrate. CONCLUSIONS: Our results suggest
that some cell adhesion and activation molecules are involved in the
pathogenesis of erythema dyschromicum perstans. Clofazimine appears to have
an important effect on the inflammatory phenomenon of erythema dyschromicum
perstans.
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19.) Periorbital hyperpigmentation and erythema dyschromicum perstans.
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Can J Ophthalmol 1992 Dec;27(7):353-5
Ing EB, Buncic JR, Weiser BA, de Nanassy J, Boxall L
University of Toronto, ON.
Erythema dyschromicum perstans is a rare idiopathic dermatosis
characterized by ash-grey, well-demarcated skin lesions, which may involve
the face. We describe an 8-year-old girl with erythema dyschromicum
perstans presenting as bilateral acquired periorbital hyperpigmentation.
The changes seen on histologic study of a skin biopsy specimen were
consistent with the clinical diagnosis. The various causes of periorbital
hyperpigmentation and characteristics of erythema dyschromicum perstans are
reviewed.
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20.) Erythema dyschromicum perstans and lichen planus: are they related?
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J Am Acad Dermatol 1989 Aug;21(2 Pt 2):438-42
Berger RS, Hayes TJ, Dixon SL
Wilford Hall USAF Medical Center, Lackland Air Force Base, Texas.
A 53-year-old woman initially had lichen planus primarily on her
extremities. Approximately 1 year later, lesions consistent with erythema
dyschromicum perstans were observed. Both diseases cleared with
griseofulvin therapy but returned after discontinuation of the drug.
Retreatment with griseofulvin again resulted in clearing.
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21.) Erythema dyschromicum perstans. Immunopathologic studies.
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J Am Acad Dermatol 1989 May;20(5 Pt 2):882-6
Miyagawa S, Komatsu M, Okuchi T, Shirai T, Sakamoto K
Department of Dermatology, Nara Medical University, Japan.
Immunopathologic studies of a patient with clinical and histologic evidence
of erythema dyschromicum perstans revealed Ia antigen expression on
epidermal keratinocytes, pronounced OKT4 and OKT6 staining of epidermal
dendritic cells, and dermal infiltration of T lymphocytes of both
helper-inducer (OKT4) and suppressor-cytotoxic (OKT8) phenotypes--a pattern
commonly associated with lichen planus. These findings, taken in
conjunction with positive IgG staining on colloid bodies, suggest the
possibility that erythema dyschromicum perstans and lichen planus have
similar disease processes.
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22.) Simultaneously active lesions of vitiligo and erythema dyschromicum perstans.
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Arch Dermatol 1988 Aug;124(8):1258-60
Henderson CD, Tschen JA, Schaefer DG
Departments of Pathology, Baylor College of Medicine, Houston, Tex.
Recently, a patient presented to us with skin that had areas of normal
pigmentation, hyperpigmentation, and depigmentation. Workup eventually
showed him to have simultaneously active lesions of a depigmenting
disorder, vitiligo, and a hyperpigmenting disorder, erythema dyschromicum
perstans.
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23.) Mononuclear cell subpopulations and infiltrating lymphocytes in erythema
dyschromicum perstans and vitiligo.
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Histol Histopathol 1987 Jul;2(3):277-83
Gross A, Tapia FJ, Mosca W, Perez RM, Briceno L, Henriquez JJ, Convit J
Institut of Biomedicine, Caracas, Venezuela.
Erythema dyschromicum perstans (EDP) and vitiligo are two cutaneous
pigmentary dermatoses of unknown etiology. In the present study, the
leukocyte infiltrates in the affected skin of EDP and vitiligo patients
were studied using the avidin-biotin (ABC) immunoperoxidase technique and
monoclonal antibodies which recognise the following mononuclear cell
subgroups: T-suppressor/cytotoxic (CD8-Leu-2), T-helper (CD4 = OKT4),
T-suppressor + macrophages (Leu-15), Pan T (CD3 = Leu-4), macrophages
(Leu-M3) and Langerhans cells (CD1 = Leu-6), and other cellular markers
such as Ia antigens and the Interleukin-2 receptor (CD25 = TAC). The
immunocytochemical analysis showed a selective accumulation of CD3+, CD8+,
Leu-15-, T-cytotoxic cells in the epidermis of both EDP and early lesions
of vitiligo. In addition, an increase in the number of epidermal Langerhans
cells (CD1+) was observed in some cases of EDP and vitiligo. The CD4/CD8
ratios in affected and uninvolved skin for both disorders were not
significantly different, although values lower than unity were only
observed in the infiltrates of affected skin. Ia antigen positivity was
observed in the dendritic cells of the dermis and epidermis, as well as in
most of the lymphoid cells within the infiltrates for both diseases.
Macrophages (Leu-M3) in EDP dermal infiltrates were generally found
adjacent to extracellular melanin pigment. Lymphocytes expressing TAC
(CD25) surface antigens were also present in the dermal infiltrates. These
morphological observations suggest a possible immune cell participation in
the dyschromia of such cutaneous disorders.
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24.) Chlorothalonil, a possible cause of erythema dyschromicum perstans (
ashy dermatitis).
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Penagos H; Jimenez V; Fallas V; O'Malley M; Maibach HI
Occupational Dermatology Service, Social Security Hospital, Panama.
Contact Dermatitis (DENMARK) Oct 1996 35 (4) p214-8 ISSN: 0105-1873
Language: ENGLISH
Document Type: JOURNAL ARTICLE
Journal Announcement: 9705
Subfile: INDEX MEDICUS
We studied 39 patients with erythema-dyschromicum-perstans-like
dermatitis seen at Changuinola Hospital in Panama. They were compared
with 41 controls. The 2 groups were native field workers of the banana
plantations exposed to many pesticides. In 34 patients, there was a
positive patch test reaction to 2,4,5,6-1,3-
tetrachloroisophthalonilnitrile (chlorothalonil, TCPN) 0.001% in acetone.
In 39 cases, biopsies showed a lichenoid tissue reaction compatible with a
chronic pigmented dermatitis or erythema-dyschromicum-perstans-like
dermatitis. Chlorothalonil is possibly the cause of the pigmented
dermatitis observed in the 39 banana farm workers studied. Until
additional studies are carried out, we consider this a possible rather
than definite cause-and-effect relationship.
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25.) Lichen planus pigmentosus presenting in zosteriform pattern.
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Cho S; Whang KK
Department of Dermatology, College of Medicine, Ewha Womans University,
Seoul, Korea.
J Dermatol (JAPAN) Mar 1997 24 (3) p193-7 ISSN: 0385-2407
Language: ENGLISH
Document Type: JOURNAL ARTICLE
Journal Announcement: 9709
Subfile: INDEX MEDICUS
Lichen planus pigmentosus (LPP) has thus far been described as a
condition of unknown etiology which clinically differs from the classical
lichen planus (LP) by exhibiting dark brown macules and/or papules mostly
in exposed areas and flexural folds and a longer clinical course without
pruritus or scalp, nail or mucosal involvement. Histopathologically, LPP
shows the typical changes seen in LP, but with thinning of epidermis. We
report a case of LPP that developed in a unilateral, zosteriform pattern
on the left flank of a 49-year-old man. This case seems to lie in the
middle of the spectrum between classical LP and ashy dermatosis, and, to
the best of our knowledge, is the first report of LPP presenting in the
zosteriform pattern.
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26.) [Erythema dyschromicum perstans versus lichen planus].
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Med Cutan Ibero Lat Am 1987;15(1):89-92
Leonforte JL, Pelaez de di Bari O
Erythema dyschromicum perstans and lichen planus have been regarded as
related. We describe the case of a 41 year old man presenting a relapsing
dermatitis consisting of erythematous patches leaving behind ashy-gray
macules. The lesions of lichen planus were atypical and the ashy dermatosis
was transient. The possibility that some cases of lichen planus lead to an
erythema dyschromicum perstans is discussed.
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27.) Erythema dyschromicum perstans.
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Cutis 1986 Jan;37(1):42-4
Lambert WC, Schwartz RA, Hamilton GB
A 29-year-old woman from Trinidad experienced the rapid onset of extensive
lesions characteristic of erythema dyschromicum perstans following an x-ray
study using orally administered contrast. Eleven months later a skin biopsy
specimen showed few epidermal changes but extensive incontinence of melanin
pigment and marked dilatation of lymphatics in the superficial dermis.
Results of a systemic evaluation were normal. The available data on this
disease are analyzed and conclusions offered regarding its nature and causes.
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28.) Erythema dyschromicum perstans.
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J Am Acad Dermatol 1980 Apr;2(4):295-302
Tschen JA, Tschen EA, McGavran MH
Erythema dyschromicum perstans (EDP) was first described in 1957, and
electron microscopic studies were reported in 1969. Herein, we describe
five cases and compare light and electron microscopic findings, direct and
indirect immunofluorescence, and dopa-positive melanocyte counts between
normal and affected skin. The results indicate that EDP is a clinically
characteristic disorder with a lichenoid reaction in its active phase. This
lichenoid reaction leads to a pronounced incontinence of pigment and to
decreased numbers of melanocytes and of tyrosinase activity in the involved
epidermis. These findings support the suggestion that EDP and lichen planus
pigmentosus are possible the same entity. Direct inmunofluorescence and
fine structural studies show similar findings to lichen plunus. Patients
have low-titer antibodies to extranuclear basal cell components.
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29.) [Erythema cinitiensis perstans].
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Med Cutan Ibero Lat Am 1980;8(1-3):11-4
Sittart JA, Tayah M
The authors report a case of Erythema Cinitiensis Perstans, in a thirty-one
years old white man. This dermatosis, reported in the literature also es
Ashy Dermatitis and Erythema Dyschromicum Perstans, is here in Brazil
exceptional. Clinically this dermatosis is characterized by the presence of
gray patches in a sometimes surrounded by an erythematous active border.
The lesions may occur on any area of the integument, sparing the hair
scalp, palms, soles and nails. The therapy has been ineffective in all the
cases, but one reported by Stevenson and Miura and in our case, where the
patients have improved after Dithiazanine iodide treatment due to
intestinal parasitoses by the Tricocephalus trichiurus.
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30.) [Idiopathic eruptive macular pigmentation].
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Ann Dermatol Venereol 1978 Feb;105(2):177-82 PORTUGAL
Degos R, Civatte J, Belaich S
The feeling of the authors is that their seven reported cases of a
pigmented dermatosis are different from the ashy dermatosis and from the
erythema dyschromicum perstans. This disease, which affects children and
teenagers, males as well as females, is characterized by pigmented macules
5-25 mm in diameter, affecting the neck, the trunk and the limbs. The first
symptom is whether a pigmented spot, or an erythematous, papular or
achromic lesion; in the latter instance the pigmentation occurs only
secundarily. In most of the cases this dermatose is slowly and
spontaneously regressive. The histological picture is not really specific.
In one case there was a marked intraepidermal dyskeratosis of the sweat
duct openings. The etiology remains unknown.
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31.) [Erythema dyschromicum perstans].
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Hautarzt 1977 Oct;28(10):539-41
Moller-Vietheer M, Goos M
The case of a 4 1/2 year old girl with the typical clinical picture of
erythema dyschromicum perstans is presented. A survey of the literature on
this dermatosis is described.
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32.) Erythema dyschromicum perstans. A follow-up study from northern Finand.
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Dermatologica 1977;155(1):40-4
Palatsi R
Four patients with ashy dermatosis are described. Their ages varied from 8
to 12 years. Three had typical widespread macular eruptions and one had a
linear lesion not described before. The follow-up investigation revealed
that the eruption disappeared within 2 years in three of the patients. One
patient could not be followed. The duration of the disease and the
linearity of one lesion resembled lichen ruber planus.
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33.) Ingestion of ammonium nitrate as a possible cause of erythema dyschromicum
perstans (ashy dermatosis).
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Dermatologica 1975;150(5):287-91
Jablonska S
Clinically and histologically typical erythema dyschromicum perstans has
been provoked by repeated ingestion of very small amounts of a fertilizer,
ammonium nitrate. It has been used by a boy who has noticed accidentally
that after licking the fertilizer he developed hyperpigmentations. His main
purpose was to avoid school attendance, and he developed a very ingenious
method of licking the fertilizer once in several weeks in such a way that
it did not produce any digestive or other troubles. His brother, an
uniovular twin who had no contact with ammonium nitrate, was healthy. The
case supports Pinkus' hypothesis that this type of lesions may be related
to some environmental contaminant. Attention is called to a possible food
contamination by ammonium nitrate.
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34.) [Erythema dischromicum perstans (ashy dermatosis). Report of two cases].
Pathologica 1993 Sep-Oct;85(1099):533-41
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[Article in Italian]
Paradisi M, Mostaccioli S, Celano G, Angelo C, Ruatti P, Ferranti G, Onetti
Muda A, Faraggiana T
IV Divisione e Dermatologia Pediatrica, IDI-IRCCS, Roma.
Clinical, histological and ultrastructural investigations of two cases of
Erythema Dischromicum Perstans (EDP) are reported. EDP is a chronic
pigmented lesion of the skin, and its etiology is still unknown. The
reported cases showed clinical and ultrastructural differences from what
already described in the literature. EDP is also difficult to differentiate
from other cutaneous pigmented lesions: clinical and morphologic
differences and/or similarities are therefore discussed and compared. The
usefulness for a correct diagnosis of the co-existence of optical and
ultrastructural lesions which are not pathognomonic per se, is also stressed.
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35.) [Ashy dermatosis].
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Vestn Dermatol Venerol 1989;(11):57-8
[Article in Russian]
Kasimov N, Kiiamov FA, Naimova MR
Five patients with ashy dermatitis are described, aged 6 to 14, one boy and
four girls. The process is characterized by dirty grayish or
ash-gray-colored maculae on the skin of the trunk and limbs. These maculae
do not tend to fuse, nor exfoliate; they are not associated with any
subjective sensations. Thorough examinations have not revealed any
osteomuscular or visceral abnormalities. The disease runs a benign course,
and only the cosmetic defect worries the patients.
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36.) [Ashy dermatosis. Review of the literature and report of a case].
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Med Cutan Ibero Lat Am 1988;16(1):31-6
[Article in Portugese]
de Azevedo LM, Porto JA
Servico de Dermatologia do Hospital Universitario Pedro Ernesto, da
Universidade do Estado do Rio de Janeiro.
The authors make a review of the epidemiologic, etiopathogenic, clinical,
laboratory and therapeutic aspects of ashy dermatosis, described in 1957 by
Ramirez in El Salvador, of which more than 150 cases have been described up
to now in different continents. The disease is exclusively cutaneous,
presents peculiar clinical features with a lichenoid tissue reaction, and
has no specific treatment or known etiology. The authors report a case in a
Brasilian man, followed up for three years. The treatment of a T. trichiura
infestation did not change the cutaneous features, as opposed to what has
been reported.
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37.) [Ashy dermatosis (erithema dyschromicum perstans): prospective study of 23
patients].
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Med Cutan Ibero Lat Am 1988;16(5):407-12
[Article in Spanish]
Navarro Jimenez BR, Sanchez Navarro LM
Servicio de Dermatologia, Universidad Autonoma, Benito Juarez, Oaxaca,
Mexico.
During the period between january 1984 to july 1987 in the Hospital Unit
"Presidente Juarez" ISSSTE, Oaxaca (Mexico), for the first time was given
dermatology consult to 2,683 patients among them, 23 who had ashy
dermatosis (Erithema dyschromicum perstans), a study was done for the
present time and the future of the same, discarding it as possible cause of
that nosological entity: treponemal disease, parasitic, infectious, hepatic
and renal. It is commented in relation with the ashy dermatosis and lichen
planus, the clinicals variants and the possible sun etiology.
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38.) Reticulate, patchy and mottled pigmentation of the neck. Acquired forms.
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Dermatology 1998;197(3):291-6
Lautenschlager S, Itin PH
Outpatient Clinic of Dermatology, Triemli Hospital, Zurich, Switzerland.
Besides the inherited forms of mottled and reticulate pigmentation, a vast
number of diseases and trigger mechanisms can lead to acquired pigmentation
of the neck. Nonhereditary variants of reticulate and mottled pigmentation
can affect the neck as a typical site and therefore may give a diagnostic
clue or it can occur sporadically on the neck as well as on other sites. A
well-known and important factor in the pathogenesis is exposure to
sunlight. Sun-induced pigmentation often presents on the neck and may
result from phototoxic, photoallergic and cumulative actinic damage.
Frequent forms comprise berloque dermatitis, Riehl's melanosis,
poikiloderma of Civatte and tanning bed lentigines. Different infections
may also lead to this distinct skin alteration as pediculosis capitis,
pityriasis versicolor and syphilis II. Treatment-induced irregular
pigmentations may occur after applications of topical agents (e.g.
diphenylcyclopropenone), systemic medication (e.g. 5-fluorouracil,
chlorpromazine), as a complication of laser resurfacing or as a chronic
graft-versus-host reaction. Different neoplasms may also involve the neck.
Widespread pigmented basal cell carcinoma, cutaneous T-cell lymphoma,
syringolymphoid hyperplasia and histiocytic diseases may lead to
reticulated pigmentation. Various other infrequent conditions as connective
tissue diseases, malnutrition, lichen planus pigmentosus and others are
summarized. The neck, a readily accessible site to medical inspection, may
have an underestimated value for the diagnosis of different skin diseases.
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39.) Lichen planus pigmentosus associated with acrokeratosis of Bazex.
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Clin Exp Dermatol 1994 Jan;19(1):70-3
Sassolas B, Zagnoli A, Leroy JP, Guillet G
Department of Dermatology, C.H.U. Brest, France.
A patient with an acquired pigmentation related to lichen planus
pigmentosus is described. Features of acrokeratosis of Bazex were
associated, related to a head and neck carcinoma. Both cutaneous conditions
disappeared after treatment of the neoplasia. Diagnostic criteria of lichen
planus pigmentosus are reviewed. The paraneoplastic nature of this original
observation of lichen planus pigmentosus is discussed.
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40.) Ashy dermatosis and lichen planus pigmentosus: a clinicopathologic study of
31 cases.
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Int J Dermatol 1992 Feb;31(2):90-4
Vega ME, Waxtein L, Arenas R, Hojyo T, Dominguez-Soto L
Department of Dermatology, Hospital General Dr. Manuel Gea Gonzalez, Mexico
City, Mexico.
The clinical and histopathologic characteristics of patients with ashy
dermatosis (n = 20) and lichen planus pigmentosus (n = 11) were analyzed.
We found significant clinical differences between both dermatoses,
supporting our opinion that they are two separate conditions. Both
dermatoses were histologically similar.
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41.) [Lichen ruber exanthematicus et pigmentosus in mercury poisoning. A
contribution to individual pathology in occupational medicine].
=================================================================
Z Hautkr 1990 Nov;65(11):1013-8, 1021
[Article in German]
Marsch WC, Groebe G
Zentrum der Dermatologie und Venerologie, Abteilung I, Johann Wolfgang
Goethe-Universitat, Frankfurt am Main.
We report on a 21-year-old man professionally exposed to mercury, who
developed lichen planus. This case must be regarded as a dispositional
reaction and is in Germany entitled to indemnification in terms of a
"quasi-occupational disease". The clinical signs and the probably
non-allergic pathomechanism are comparable with those of lichen planus
induced by gold. In diseases due to occupational intoxication, we face an
individual disposition regarding the degree of clinical symptoms, which has
to underly any expert opinion on indemnity.
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42.) [Lichen planus and lichen planus pigmentosus following gold therapy--case
reports and review of the literature].
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Z Hautkr 1986 Mar 1;61(5):315-9
[Article in German]
Ingber A, Weissmann-Katzenelson V, David M, Bialowons M, Feuerman EJ
We report on two typical cases of lichen planus and lichen pigmentosus
appearing after gold therapy. The characteristics of lichen planus induced
by drugs are emphasized, and the literature is reviewed.
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43.) Lichen planus pigmentosus of the oral mucosa: a rare clinical variety.
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Dermatologica 1981;162(1):61-3
Laskaris GC, Papavasiliou SS, Bovopoulou OD, Nicolis GD
In this paper, we describe a case of lichen planus of the mouth with
intense melanosis, in a middle-aged white male. Due to its unusual clinical
characteristics, we believe that this case represents a rare variant of
lichen planus of the oral mucosa. The histopathologic findings,
differential diagnosis and its possible connection with lichen planus
pigmentosus of the skin are discussed.
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DATA-MEDICOS/DERMAGIC-EXPRESS No (76) 29/09/99 DR. JOSE LAPENTA R.
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