Longitudinal melanonychia is a normal pattern of nail pigmentation seen in patients with skin of color. Pigmentary demarcation lines. Comparison of Negroes with Japanese 2013 May-Jun;88(3):465-7. doi: 10.1590/abd1806-4841.20131764. 3 Facial PDLs (FPDLs) are more clearly visible in individuals with medium to dark colored skin. BTI Abuja is an internationally recognized college with ITEC and CIDESCO accreditation.Our students hold monthly supervised clinics providing services at very discounted rates. Micron. PMC Wolters Kluwer Health Data is temporarily unavailable. In one study, 79% of African American women and 75% of . 69,70. Pigmentary demarcation lines In all races, the dorsal skin of the limbs is darker than the ventral surfaces. Voigt-Futcher pigmentary demarcation lines. Okeke LI, George AO, Ogunbiyi AO, Wachtel M. Prevalence of linea nigra in patients with benign prostatic hyperplasia and prostate carcinoma. Physiologic pigmentation of the oral mucosa is commonly seen in patients with skin of color. Linear and whorled nevoid hypermelanosis. 2014 Jan;59(1):41-8. doi: 10.4103/0019-5154.123492. FOIA Terms of Use These are sharp demarcation lines that occur on different parts of the body. However, Sil et al recently reported blaschkoid LP in the setting of concurrent childhoodonset systemic lupus erythematosus.4. High bleomycin doses (accumulative dose: 100300 mg) are associated with the disease.62,64 However, it also occurs with low doses (1530mg), including intralesional injections of warts or vascular malformations.65,66 There is no effective treatment for bleomycin-induced flagellate dermatitis. Its distribution follows the Voigt's lines, which define the distribution of peripheral nerves. Pigmentary Demarcation Lines in Newborns. At the third stage, occurring between the age of 3 and 6 months, lesions develop into hyperpigmented whorled lesions that adhere to Blaschkos lines.31,32 Extra-cutaneous manifestations include multiple ocular, skull, dental, and palatal defects as well as neurological abnormalities such as epilepsy, microcephaly, mental retardation, and slow motor development.32, Diagnostic criteria for IP were initially established in 1993 and were revised in 2014.31,33 Major clinical criteria are the typical stages of skin eruptions distributed along Blaschkos lines, while minor criteria include dental anomalies, central nervous system abnormalities, alopecia or abnormal hair, nail dystrophy, palate anomalies, history of multiple male miscarriages in the mother, and typical histopathologic findings in a skin biopsy.33, Epidermal nevus develops sporadically with typical onset within the first year of life, with no gender predilection. If you believe Wordfence should be allowing you access to this site, please let them know using the steps below so they can investigate why this is happening. Few cases have shown stabilization of lesions with oral potassium aminobenzoate 12 g/day. Sil A, Chakraborty S, Panigrahi A, Mondal S. Blaschkoid lichen planus occurring in childhood systemic lupus erythematosus. FOIA Clinical Approach to Linear Hyperpigmentation: A Review Article NTM0MDYyMjJkZmU5ODE3ODZlZDgzM2RhYzQ3ZmEwNGVjNzI1N2JlNzI5YmE3 Hyper- or hypopigmentation along Blaschkos lines may coexist separately from atrophodermic areas.39 Patchy scarring alopecia, onychoschizia, and flattening of the nail plate can be seen, while the teeth are normal. Parry-Romberg syndrome: hemifacial atrophy limited to the dermal layer only. There are six types of pigmentary demarcation lines based on anatomic location3 [Table 21-1]. YmExZGU2N2ExMGI4MzNiYjAxNWMzMDgyMmQ3OTdhYTA3MWFjZmNlM2E1YWRi doi: 10.1111/j.1365-2230.2009.03247.x. Delmonte S, Parodi A, Rebora A. Pigmentary demarcation lines type B in a white non-pregnant woman. Federal government websites often end in .gov or .mil. The term nevus refers to a hamartoma of the epidermis and papillary dermis. 3). However, PDLs are not associated with specific symptoms. Please enable it to take advantage of the complete set of features! Commonly we see Patients with various facial hyperpigmentation who assume they have Melasma, and we know why. Pigmentary demarcation lines (PDL) are symmetric, bilateral, and are present from infancy to adulthood as physiological abrupt transition lines from heavily pigmented areas of the skin to more lightly pigmented areas. So, early detection of systemic findings will help decrease disease burden in these patients. Clinical approach for linear hyperpigmentation. NjYyMDI0YWUxZGFjYWUxMmI2MTJkZjY3ZmFmYjQ1YjJhNzE1YTJjMTJkZGQy Pigmentary demarcation lines over the face | Request PDF - ResearchGate -----END REPORT-----. An official website of the United States government. Lesions occur most commonly on the trunk, extremities, or neck.36 Moreover, the nevi follow Blaschkos lines and may have an abrupt midline demarcation. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Please enable it to take advantage of the complete set of features! Clinical Clues for Linear Hyperpigmentation That Follow Blaschkos Lines Without Associated Systemic Manifestations, Blaschkoid lichen planus (LP) is rare, manifesting as hyperpigmented inflammatory macules and patches arranged in a linear, S-shaped, or whorled pattern following Blaschkos lines (blaschkitis), without koebnerization. Before The term "pigmentary mosaicism" refers to patterned hypo- or hyperpigmentation resulting from a clone of skin cells with altered ability to produce melanin [ 1 ]. These lines may be present at birth, arise later in life, or occur during pregnancy.4. X-linked reticulate pigmentary disorder in a female patient, Molecular aspects of hypohidrotic ectodermal dysplasia, Incontinentia pigmenti (Bloch-Sulzberger syndrome), Incontinentia pigmenti diagnostic criteria update, Familial systematized epidermal nevus syndrome, Adult onset of inflammatory linear verrucous epidermal nevus in a mother and her daughter, Epidermal nevi and the epidermal nevus syndrome. Linear hyperpigmentation with extensive epidermal apoptosis: a variant of linear lichen planus pigmentosus? Would you like to access Botox, Dermal Fillers, Laser Hair Removal, Microneedling at monthly intervals with a discounted rate of 50%? Int J Dermatol. Pigmentary demarcation lines over the face. It typically manifests as microlivedo, an exquisite form of livedo reticularis that presents as focal violaceous patchy hyperpigmented streaks. Eight types of PDL (A to H) have been reported.69,70, Pigmentary demarcation lines in newborns present as a rare congenital pigmentation that follows the horizontal abdominal creases. PDLs are asymptomatic, and therefore, may be overlooked by patients and physicians. Fig. Patients may present with digital anomalies including absent or dystrophic nails, syndactyly, polydactyly, and camptodactyly.21, Linear and whorled nevoid hypermelanosis (LWNH) is an uncommon sporadic disease thought to occur secondary to mosaicism or cytogenetic aberrations and can present with associated extracutaneous abnormalities. Voigt-Futcher pigmentary demarcation lines. They include progressive cribriform and zosteriform hyperpigmentation (PCZH), unilateral nevoid acanthosis nigricans (UNAN), and linear macular amyloidosis (LMA). Pigmentary demarcation lines (PDL) are abrupt lines of transition from deeply pigmented areas to lightly pigmented areas in the skin. Cho E, Lim JH, Kim HS, Park YM, Lee JY, Kim HO. Epub 2009 Jun 10. Pigmentary demarcation lines in newborns present as a rare congenital pigmentation that follows the horizontal abdominal creases. Congenital and inherited hyperpigmentation disorders - UpToDate Females present with patchy linear hyperpigmentation that adheres to Blaschkos lines, and it is morphologically similar to stage III incontinentia pigmenti. Because the facial PDL which mimics Melasma is the major concern of skin of color, we would be focusing on it. Of the 19 cases we reviewed, 2 cases showed lines of both types A and B, whereas all the other cases showed type B lines. PCZH is a rare condition that presents at birth with Blaschkoid hyperpigmented lesions with no systemic symptoms.17 UNAN is a rare variant of acanthosis nigricans that usually tend to be unilateral and following lines of Blascko without any internal involvement.18 Macular amyloidosis is a depositional disease caused by amyloid deposition in the dermis. Pigmentary demarcation lines on the face in Saudi women. eyJtZXNzYWdlIjoiYmE4YjcwNjMzMDg3MjMzZGRiZTYzNmI1Mzk1YWE3Nzc1 PDL is a common finding in dark-skinned women. Type C, which are mid sternal, extending from the clavicle to the inferior border of the sternum. Type B, which appear during pregnancy on the lower limbs and regress after delivery. Lichen planus pigmentosus (LPP) is another rare form of LP that mostly affects adults with skin phototypes IIIV. 8600 Rockville Pike Christen-Zaech S, Hakim MD, Afsar FS, Paller AS. We describe the most common dermatological disorders that may present with linear hyperpigmentation following Blaschkos lines, and their associated systemic findings (Table 2). An official website of the United States government. HHS Vulnerability Disclosure, Help Groups A and C are the most distinct and occur in both Negroes and Japanese. X-linked hypohidrotic ectodermal dysplasias*, Caf-au-lait spots in McCuneAlbright syndrome, Linear postinflammatory hyperpigmentation. This div only appears when the trigger link is hovered over. 2019 Jun;18(3):700-702. doi: 10.1111/jocd.12884. Case 2. The site is secure. An official website of the United States government. Distinctive facial characteristics include an upswept frontal hairline and arched eyebrows. 2009 Dec;34(8):e573-6. Do not use or distribute without permission. 8600 Rockville Pike The circumscribed variant is observed more often than diffuse or linear forms. An examination of 380 patients was accomplished in order to determine the frequency of occurrence of pigmentary demarcation lines in an unselected population. National Library of Medicine A day after delivery, the erythema had disappeared, spontaneously. Received 2011 Mar 4; Revised 2011 May 25; Accepted 2011 Jun 22. Clinically, the presentation of LP varies depending on the subtype. Some authors consider ECDS and PRS as clinical variants of the same disease.44 Linear morphea also mostly affects the limbs, causing muscle atrophy, limb length discrepancies, and joint contractures (Figure 4).45. sharing sensitive information, make sure youre on a federal Genetic factors: Genetic predisposition has been observed. Blisters and erythema followed by linear hyperpigmentation. Mental retardation, digital anomalies, osteopathia striata, hypoplastic teeth, and ocular anomalies. However, even without therapy, the cutaneous manifestations are self-limiting and disappear within 68 months.64. On the demarcation lines of pigmentation observed among the Japanese, on inner sides of their extremities and on anterior and posterior sides of their medial regions. MeSH PDF PIGMENTARY DEMARCATION LINE - Dr. Krupa Shankar Canadian Board of Aesthetic Medicine (CBAM) Diploma. There are eight types of pigmentary demarcation lines. HHS Vulnerability Disclosure, Help ZThjZmY0YWY5ZjliZmIyNDMzYWVjMDYwMTJiMThhMjE1ODg2M2E2NjBkYTE2 1. Would you like email updates of new search results? ODdhZmU3MjY2OWZhMzEwYTdkZmJkNjI5MjBkNmYwODk2NDAwNTAyY2I2NDQ4 Al-Samary A, Al Mohizea S, Bin-Saif G, Al-Balbeesi A. Indian J Dermatol Venereol Leprol. A 32-year-old primigravida presented with asymptomatic, erythematous, pigmented patches on her lower extremities, which developed around the 18th week of her pregnancy. The exact cause of Pigmentary Demarcation Lines is still unknown and requires further research, however some notable triggering factors have been identified. The pigmentation was noticed by her during the 9th month of second pregnancy. However, dermal PIH is associated with dermatoses characterized by degeneration of the basal layer of the epidermis and inflammation at the dermalepidermal junction, such as lichen planus, lichenoid drug reactions, lupus erythematosus, and fixed drug eruptions.30 In some conditions, like lichen planus, the linear hyperpigmentation may result from koebnerization, which presents as linear hyperpigmentation that is not following Blaschko lines. An official website of the United States government. Pigmentary demarcation lines, also known as Futcher's lines or Voigt's lines, are physiological lines which correspond to borders of abrupt transitions between deeply pigmented surfaces and lighter surfaces. government site. Atrophic hyperpigmented streaks that may contain, hypopigmentation, and telangiectasias, fat tissue herniations and mucosal papillomas. Gupta, Lalit Kumar; Srivastava, Ankita; Khare, Ashok Kumar; Mittal, Asit; Balai, Manisha; Mehta, Sharad, Department of Dermatology, Venereology and Leprology, Rabindra Nath Tagore Medical College, Udaipur, Rajasthan, India, Address for correspondence: Dr. Lalit Kumar Gupta, Department of Dermatology, Rabindra Nath Tagore Medical College, Udaipur - 313 001, Rajasthan, India. This site uses cookies to provide, maintain and improve your experience. and transmitted securely. https://dermatology.mhmedical.com/content.aspx?bookid=2585§ionid=211764446. The tissue-specific processing of pro-opiomelanocortin. The change from darker to lighter pigment occurs at the junction of the extensor to flexor surface of the arm. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Pigmentary demarcation lines are classified into five groups (types A-E). Inherited factors in the affected skin, rather than inflammatory cells, cause the linear manifestations of these inflammatory conditions.3, The diagnosis of fixed drug eruption is the basis of the historical, clinical, and histological findings.60 Linear erythematous and hyperpigmented macular lesions following a neural distribution have been reported secondary to an intramuscular cephazolin injection.61, Flagellate hyperpigmentation can result from bleomycin, shiitake mushroom dermatitis, dermatomyositis, and persistent plaques of Still disease. Distinctive facial characteristics in addition to pulmonary, ocular, neurological and GI manifestations that are seen in males only. Pigmentary Demarcation Lines - Patient Care Online Beckers melanosis: associated abnormalities, Syndrome de McCune-Albright rvl par des taches caf-au-lait blaschko-linaires du dos, Recurrent dermatitis from jellyfish envenomation, A Sherlockian approach to contact dermatitis, Berloque dermatitis mimicking child abuse, Lichen planus in childhood: a series of 316 patients. NzZiOWY5NjcyZTllMjE1NmZkYWM5NTIxYzY5OTJmOWE3N2NhMWVhZDAzOGU4 The image below shows the areas of the face wherewe see the facial subtype F-H. Facial Pigmentary Demarcation Lines appear as symmetrical, non-patchy hyperpigmentation, seen on both sides of the face, extending from thecorners of the eyes to the temples in the pattern of a letter V or W ( refer to the before and after images at the top of this article ), or as a band from the angle of the mouth to the side of the chin. YTczZmNjY2NhMjFhZmJhM2UzMmFmYzAzYjE4OWQwMDY1OTdmODAxMWE2ZmVl COMMENT Matzumoto~ described pigmentary demarcation lines of the upper and lower limbs of Japanese persons in 1913; these studies have been con- firmed and expanded by several other authors.2-'~ The five presently recognized types of pigmentary demarcation lines are summarized in Table I. 8600 Rockville Pike Villani AP, Amini-Adl M, Wagschal D, Balme B, Thomas L. Linear atrophoderma of Moulin: report of 4 cases and 20th anniversary case review. En Coup de Sabre: unilateral skin atrophy on the paramedian forehead. MDkwNGZmZTMyMjE2NWY2MTQ0NmM2MDg3NGNkYjNhN2NjNGEwMjRmMTliNzJm The https:// ensures that you are connecting to the YjY5YjEyNTIzNThjZjBkMWI0ZDg2Y2I2NDY4MzYwMWQ4YzViZWYwOGM5Yjdh Bookshelf 1987;16:58490, 4. 2010 Jul-Aug;76(4):378-81. doi: 10.4103/0378-6323.66585. Clipboard, Search History, and several other advanced features are temporarily unavailable. Hormonal factors: These are changes noticed at puberty, pregnancy and with ageing. 3.24.51.182 Miura O. Diagnosis is challenging, as there are no definitive or agreed-upon criteria.77. Interestingly, this was observed to conform to what has been previously mentioned as pigmentary demarcation line type F (PDL-F). - Pigmentary demarcation lines A arm - Pigmentary demarcation lines A chest - Pigmentary demarcation lines B - Pigmentary demarcation line F . Mild basal layer pigmentation was observed in previous reports of PDLs that examined the biopsies, histopathologically8. Short hyperpigmented linear streaks present around the ulcer. 2004;35(3):193-200. doi: 10.1016/j.micron.2003.11.006. Epub 2009 Jun 10. Federal government websites often end in .gov or .mil. Before Complete cooking of shiitake mushrooms prevents this disorder.30, Serpentine supravenous hyperpigmentation (SSH) is a rare condition that presents with linear hyperpigmentation over superficial veins caused by chemotherapy infusion. OTNmNmVmNjZjZGE3YjYxYTRiNThmMTVhOGY5ODNjZTEzNzViMzk2OGZjY2Q2 FOIA Linear hyperpigmentation is a rare presentation of different dermatological diseases. These lesions fall into pigmentary and nonpigmentary categories.2, Pigmentary demarcation lines are normal boundaries of the skin that represent a transition between darker and lighter melanin pigment distribution corresponding to dermatomal innervation by spinal nerves. Pigmentary demarcation lines during pregnancy. Pigmentary demarcation lines: a population survey - PubMed MWRiMjM0OTU1MTgwZTI4MTgzM2Y5NTEwMzkyOGJmZWY3MmYwMGE3ODVhMjMy MTM1ZGUzMzA1OTE5YmJkNTAyMzcxNzczMTZjMWFlOWIyNjk1MDEyMzUzYTRm Accessibility She had not received any hormonal therapy during pregnancy. The .gov means its official. The inciting factors of the pigmentary changes in the pregnancy include fetoplacental hormone production or alterations in clearance, which may increase the plasma availability of hormones, such as estrogens and progesterone4. Pigmentary demarcation lines are normal boundaries of the skin that represent a transition between darker and lighter melanin pigment distribution corresponding to dermatomal innervation by spinal nerves. A study of 124 Indian patients with lichen planus pigmentosus, Clinicopathological characteristics of lichen planus pigmentosus and its response to tacrolimus ointment: an open label, non-randomized, prospective study. PMC Patchy distribution of sweat glands, and hyperpigmented patches that lacks adnexa mostly over the back. Clinical Clues for Linear Hyperpigmentation That Does Not Follow Blaschkos Lines with Associated Cutaneous and Systemic Manifestations. Shiitake mushroom dermatitis occurs in individuals who have ingested raw or undercooked shiitake mushrooms (Lentinula edodes).67 Lentinan, a thermolabile toxin in shiitake mushrooms, is probably responsible for this dermatosis which has a typically negative result in prick and patch tests. your express consent. These lines are known and seen by dermatologists in the skin of African, Indian, and Japanese patients, usually females. [3] Hormonal alterations in the levels of estrogen, progesterone, and melanocyte-stimulating hormone during pregnancy are likely to be involved. Somani VK, Razvi F, Sita VN. 2019 Jun;18(3):700-702. doi: 10.1111/jocd.12884. YmFjZjBkNGIxMDViYzk4ZTZkNzQ4ZTRmMDE3MTA0NzVmNDUwZjhhN2Q5NGE2 Counseling and reassurance is what is generally required owing to the benign and self limiting nature of the condition. Musculoskeletal & neurological findings are associated with epidermal nevus syndrome. Miljkovi J, Beli M, Godi A, Klemenc P, Marin J. Sigal-Nahum M, Konqui A, Gaulier A, Sigal S. Bleomycin induced hyperpigmentation with yolk sac tumor, Bendamustine-induced flagellate dermatitis. Clinical onset varies between 1 day and 9 weeks after bleomycin administration. While it is commonly associated with pregnancy (linea gravidarum), it can also be found in males and non-pregnant females, especially in younger age groups. Historically, the lack of recognition of benign variations in dark skin has led to unnecessary treatment and potentially poor results. Careers, Unable to load your collection due to an error. Transition pigmented lines that follow the horizontal abdominal creases. Patients usually notice blisters and erythema, which then progress to linear hyperpigmentation that ultimately fades weeks to months after the offending agent is removed.56 Another related condition is phytophotodermatitis, where the patient develops phototoxic reactions caused by sun exposure after contact with furocoumarins-containing plants such as lemon, grapefruit, parsley, and others.57. Pigmentary demarcation lines are abrupt transition lines between the areas of deeper pigmentation and the areas of lighter, normal pigmentation. Hypoplasia of the ipsilateral breast, areola, nipple and arm, ipsilateral arm shortening, lumbar spina bifida, thoracic scoliosis and pectus carinatum, and enlargement of the ipsilateral foot. Our focus is on the diagnosis and treatment of both cosmetic and and non-cosmetic skin conditions in all ages, and the improvement and enhancement of physical appearance. Pigmentary demarcation lines (PDLs) are physiological abrupt transitions between hyperpigmented and lighter skin, a common and sometimes troubling feature of normal skin. Atasoy M, Aliagaoglu C, Sahin O, Ikbal M, Gursan N. Linear atrophoderma of Moulin together with leuconychia: a case report. Disclaimer. ODdjYjMyYjNkMGNlOWY0ODhkNDI5ZDI5YWMxZGY4MjViODUwN2ZmYjdhZTI5 Your access to this site was blocked by Wordfence, a security provider, who protects sites from malicious activity. Nakama T, Hashikawa K, Higuchi M, Ishii N, Miyasato M, Hamada T, et al. Linear limb variant: a unilateral band of sclerotic, hyperpigmented and hypopigmented plaque that affects the limbs, causing muscle atrophy, limb length discrepancies, and joint contractures (. Resolves leaving hypopigmentation or hyperpigmentation. Please click Continue to continue the affiliation switch, otherwise click Cancel to cancel signing in. Pruritic linear streaks of gray-brown to dark brown macules and papules either in a photodistribution or in an intertriginous pattern. Type B pigmentary demarcation lines : Indian Dermatology Online - LWW Early detection of any underlying disease is vital, especially in cases with effective management, because the disorder may make it difficult to manage hyperpigmentation. Approximately 79% of women of African descent have at least one such demarcation line. Unauthorized use of these marks is strictly prohibited. They are seen in a majority of dark-complexioned women and a substantial percentage of light-complexioned ones too. It presents as dark brown macules and patches that follow Blaschkos lines and predominately affects sun-exposed areas (especially the forehead, temples, and neck) and flexor folds. Methods: About 4000 consecutive patients, both males and females, attending our skin clinic were examined for the presence of any pigmentary demarcation lines on the face, from October 1998 to February 2000. Pigmentary demarcation lines are classified into five groups (types A-E). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Epub 2019 Feb 22. NWYyMDdmMjY5MWNhNmVjYmM1MWJhM2JlYTRkZjQ5NGU4NjE4MmZhMDFmN2U1 Glinick SE, Alper JC, Bogaars H, Brown JA. Creating a classification of linear hyperpigmentation will help dermatologists to reach the diagnosis and recognize and avoid potential systemic complications. Pruritic hyperpigmented macules and patches with scarring alopecia and perifollicular erythema and scales mostly over scalp and face. It usually resolves within one to three months.68, Pigmentary demarcation lines (PDL) are symmetric, bilateral, and are present from infancy to adulthood as physiological abrupt transition lines from heavily pigmented areas of the skin to more lightly pigmented areas. Pigmentary demarcation lines over the face - Indian Journal of An official website of the United States government. It is classically linked to 5-FU, but it has also been reported with other chemotherapy like docetaxel, fotemustine, and vinorelbine.