Indian Journal of Dermatology, Venereology and Leprology Medknow Publications on behalf of The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) ISSN: 0378-6323 EISSN: 0973-3922 Vol. 71, Num. 2, 2005, pp. 131-133

Indian Journal of Dermatology, Venereology, Leprology, Vol. 71, No. 2, March-April, 2005, pp. 131-133

Letter To Editor

Familial speckled acral hypopigmentation: A new variant of reticulate acropigmentation?

Malakar Subrata, Sarma Nilendu, Lahiri Koushik, Bhadra Ranjan

Pigmentary Disorder Unit, Rita Skin Foundation, Kolkata - 700 106

Correspondence Address: Pigmentary Disorder Unit, Rita Skin Foundation, GD-381, Sector III, Salt Lake, Kolkata - 700106
koushik66@vsnl.com

Code Number: dv05043

Sir,

Reticulate acropigmentation disorders include reticulate acropigmentation of Kitamura (RAPK), Dowling Degos disease (DDD), acropigmentation of Dohi and dyschromatosis universalis heredetaria (DUH). While RAPK and DDD are characterized by hyperpigmentation, acropigmentation of Dohi and DUH have both hyper and hypopigmentation. Herein we report a case who has hypopigmentation in a speckled fashion on the sides of the dorsa of both the hands and feet.

A girl aged 14 years presented with speckled hypopigmentation on the sides of the dorsa of the hands and feet [Figure - 1] and [Figure - 2]. On enquiry she informed that her elder sister and cousin had similar lesions. Unlike other reticulate hypopigmentations they were confined only to the sides rather than the whole dorsa of feet and/or hands. Atrophy or pits on the dorsa and/or palms were absent. The pattern looked speckled due to hypopigmented macules of more or less uniform size (2-4 mm) on a background of normal colored skin. Biopsy from the hypopigmented area showed marked decrease in melanocytes. Dopa staining was negative [Figure - 3]. In skin sample of the patient the presence of melanocytes was rare and these very few cells showed negative result with DOPA staining. The most striking feature of this entity is alternate hypo and normol pigmentation in a symmetrical distribution.

In RAPK, multiple, hyperpigmented, irregularly angulated, atrophic macules of 1-5 mm are seen over the dorsa of hands and feet, the sides of the neck, and occasionally on the face in a symmetrical distribution.[1],[2] Palmar pits and breaks in an epidermal ridge pattern are characteristic of RAPK.[1] In DDD, dark brown non-atrophic macules of 1-4 mm are present over flexures, inner aspects of thighs, neck and submammary regions in a symmetrical distribution.[4] Other features of DDD are comedo-like, hyperkeratotic, follicular lesions over the face and acneiform pitted scars.[2] A combination of angulated, non-atrophic, dark brown, freckle-like macules and non-atrophic depigmented macules over the dorsa of the hands without any palmar pits are the main features of Dohi.[3] DUH has both hypo and hyperpigmentation and the distribution is generalized including acral areas. Recently, a localized form of DUH has also been reported.[3] RAPK and DDD are characterized by only hyperpigmentation whereas acropigmentation of Dohi and DUH have both hyper and hypopigmentation. The clinical pattern of hypopigmentation, as described in the entity of symmetric acroleukopathy in a family, dealt with an area of depigmentation of the whole of periungual region. But, that was neither reticulated nor speckled in character.[5] In our case the most interesting feature is alternate hypo and normal pigmentation. To the best of our knowledge speckled pattern of acral hypopigmentation has not been reported earlier and probably represents a new variant of reticulate acropigmentation.

REFERENCES

1.	Griffiths WA. Reticulate pigmentary disorders-A review. Clin Exp Dermatol 1984;9:439-50.  Back to cited text no. 1  [PUBMED]
2.	Dhar S, Kanwar AJ, Jebraili RE, Dawn G, Das A. Spectrum of reticulate and acral pigmentary disorders in northern India. J Dermatol 1994;21:598-603.  Back to cited text no. 2
3.	Dhar S, Malakar S. Localised Dyschromatosis Universalis Heredetaria. Pediatr Dermatol 1999;16:336.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.	Rebora A, Crovato F. The spectrum of Dowling-Degos disease. Br J Dermatol 1984;110:627-30.  Back to cited text no. 4  [PUBMED]
5.	Sugai T, Saito T, Hamada T. Symmetric acroleukopathy in mother and daughter. Arch Dermatol 1965;92:172-3.  Back to cited text no. 5  [PUBMED]

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