Clinical Cases
in Pigmentary
Disorders
Torello Lotti
Michael Tirant
Davinder Parsad Editors
Clinical Cases in Dermatology
Series Editor: Robert A. Norman
Clinical Cases in Dermatology
Series Editor
RobertA.Norman
Tampa,FL,USA
This series of concise practical guides is designed to facilitate the clinical decision-
making process by reviewing a number of cases and dening the various diagnostic
and management decisions open to clinicians.
Each title is illustrated and diverse in scope, enabling the reader to obtain relevant
clinical information regarding both standard and unusual cases in a rapid, easy to
digest format. Each focuses on one disease or patient group, and includes common
cases to allow readers to know they are doing things right if they follow the case
guidelines.
More information about this series at http://www.springer.com/series/10473
Torello Lotti • Michael Tirant • Davinder Parsad
Editors
Clinical Cases
in Pigmentary Disorders
Clinical Cases in Dermatology
ISBN 978-3-030-50822-7 ISBN 978-3-030-50823-4 (eBook)
https://doi.org/10.1007/978-3-030-50823-4
© Springer Nature Switzerland AG 2020
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Editors
Torello Lotti
Dermatology
University of Rome Guglielmo Marconi
Rome
Italy
Davinder Parsad
Department of Dermatology
Postgraduate Institute of Medical
Education and Research
Chandigarh
India
Michael Tirant
Dermatology
University of Rome Guglielmo Marconi
Rome
Italy
Department of Dermatology
Hanoi Medical University
Hanoi
Vietnam
v
Contents
1 15-Year-Old Female with Palmar, Periorbital, Oral Mucosal,
and Gingival Hyperpigmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Mahin Alamgir, Britney N. Wilson, Young Lee, and Babar Rao
2 A 5-Year-Old Boy with White Spots on His Trunk, Acne,
and Pink Urine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Mahin Alamgir, Britney N. Wilson, and Babar Rao
3 A 58-Year-Old Male with Bronze Hyperpigmented
Skin Over the Nape of the Neck and Extremities . . . . . . . . . . . . . . . . 9
Britney N. Wilson, Mahin Alamgir, and Babar Rao
4 Hypomelanotic Diffuse Macules in a 13 Years Old Boy . . . . . . . . . . . 13
Pierangela Rana and Fabio Arcangeli
5 White Maculo-papular Lesions in a 13-Year-Old Boy . . . . . . . . . . . . 17
Annalisa Franch and Fabio Arcangeli
6 A 6-Year-Old Child with Patches of Discoloration . . . . . . . . . . . . . . . 21
Seyyede Zeinab Azimi and Alireza Firooz
7 A 23-Year-Old Girl with White Hair from Birth . . . . . . . . . . . . . . . . . 25
Seyyede Zeinab Azimi and Alireza Firooz
8 A Patient with Acrofacial Depigmentation and Chronic Fatigue . . . . 29
Mirna Šitum, Vedrana Bulat, Maja Kovačević, and Andy Goren
9 Erythematous Spot in a Young Female Patient with Generalised
Hypopigmentation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Mirna Šitum, Vedrana Bulat, Maja Kovačević, and Andy Goren
10 Progressive Reticulated Pigmentation of the Folds . . . . . . . . . . . . . . . 41
Katerina Damevska, Anastasiya Atanasova Chokoeva,
Ivana Dohcheva Karajovanov, and Anita Najdova
vi
11 Multiple Café-Au-Lait Macules Since Birth . . . . . . . . . . . . . . . . . . . . . 47
Xue-Gang Xu, Ya-Xin Guo, and Xing-Hua Gao
12 A Teenager with Sudden and Localized Hair Graying . . . . . . . . . . . . 53
Özgür Gündüz
13 A Middle-Aged Female with Hyperpigmentation . . . . . . . . . . . . . . . . 59
Johannes F. Dayrit, Maria Juliet Enriquez-Macarayo,
and Evangeline B. Handog
14 Generalized Mottled Hyperpigmentation
in a 28-Year-Old Filipino Woman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Johannes F. Dayrit, Maria Juliet Enriquez-Macarayo,
and Evangeline B. Handog
15 A Young Man with Pigmentation on the Tongue . . . . . . . . . . . . . . . . . 71
Marta Kurzeja, Małgorzata Olszewska, and Lidia Rudnicka
16 Larval Secretions and Dark Facial Spots . . . . . . . . . . . . . . . . . . . . . . . 75
Zekayi Kutlubay, N. Deniz Esin, Defne Özkoca, Ümit Türsen,
and Erdal Polat
17 Dark Facial Spots and Rash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Lawrence Chukwudi Nwabudike and Alin Laurentiu Tatu
18 The Dermatologist’s Fingernail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Lawrence Chukwudi Nwabudike, Alin Laurentiu Tatu,
Diana Sabina Radaschin, and Valeriu Ardeleanu
19 A Young Female with Hyperpigmentation on Face Showed
Few Weeks Before Visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Sudip Parajuli, Upama Paudel, Anil Kumar Das,
and Dinesh Binod Pokhrel
20 A Six-Year Boy with Hypopigmented Lesions
on the Neck, Retroauricullary, and on the Lateral Face . . . . . . . . . . . 95
Asja Prohic
21 Homogenous Black Pigmented Lesion of the Fifth Toe . . . . . . . . . . . . 99
Alin Laurentiu Tatu, Diana Sabina Radaschin,
Florin Ciprian Bujoreanu, and Lawrence Chukwudi Nwabudike
22 Piperine Extract and White Patches . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Alin Laurentiu Tatu, Bianca Mihaila, Rodica Dinica,
Olimpia Dumitriu Buzia, Diana Sabina Radaschin,
and Lawrence Chukwudi Nwabudike
23 Repigmentation of Palpebral White Patch . . . . . . . . . . . . . . . . . . . . . . 109
Diana Sabina Radaschin, Alin Laurentiu Tatu,
Lawrence Chukwudi Nwabudike, and Valeriu Ardeleanu
Contents
vii
24 A Case of Dark Spots in a 57-Year-old Female . . . . . . . . . . . . . . . . . . 115
Nguyen Van Thuong, Le Huu Doanh, and Michael Tirant
25 A Challenging Variant of Hyperpigmentary Disorders . . . . . . . . . . . . 119
Nguyen Van Thuong, Le Huu Doanh, and Michael Tirant
26 A Child with Hypopigmented Patches . . . . . . . . . . . . . . . . . . . . . . . . . 123
Le Huu Doanh, Nguyen Van Thuong, and Michael Tirant
27 A Woman with Facial Hypopigmented Macules . . . . . . . . . . . . . . . . . 127
Nguyen Van Thuong, Le Huu Doanh, and Michael Tirant
28 A Woman with Progressive Diffuse Symmetric
Hyper and Hypopigmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Le Huu Doanh, Nguyen Van Thuong, and Michael Tirant
29 A Young Woman with Facial Hyperpigmented Macules . . . . . . . . . . . 137
Le Huu Doanh, Nguyen Van Thuong, and Michael Tirant
30 Asymptomatic Hyperpigmentation Without Preceding
Inflammation in a Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Le Huu Doanh, Nguyen Van Thuong, and Michael Tirant
31 Brown Patches in a 51-Year-Old Man . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Nguyen Van Thuong, Le Huu Doanh, and Michael Tirant
32 Dyschromatosis in a 23-Year-Old Male . . . . . . . . . . . . . . . . . . . . . . . . . 149
Le Huu Doanh, Nguyen Van Thuong, and Michael Tirant
33 Facial Hypopigmentation in a Vietnamese Woman . . . . . . . . . . . . . . . 153
Le Huu Doanh, Nguyen Van Thuong, and Michael Tirant
34 An Elderly Masked Man . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Yasemin Yuyucu Karabulut, Gözde Arslan, Ahmet Çelik,
and Ümit Türsen
35 Hyperpigmented Plaques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Emin Gündüz, Ümit Türsen, and Yasemin Yuyucu Karabulut
36 A Painful White Streak on the Leg . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Uwe Wollina
37 A Pruritic Erythematous Rash After Childbirth . . . . . . . . . . . . . . . . . 173
Uwe Wollina
38 A Reddish-Brownish Pruriginous Plaque on the Trunk . . . . . . . . . . . 177
Uwe Wollina
39 Fever and Generalized Erythema
with Multiple Macular Hypopigmentations . . . . . . . . . . . . . . . . . . . . . 181
Uwe Wollina
Contents
viii
40 Multiple Macular Hypopigmentations on the Lower Legs . . . . . . . . . 185
Uwe Wollina
41 Painful Discoloured Great Toe of a Young Man . . . . . . . . . . . . . . . . . . 189
Uwe Wollina
42 Reddish Brown Nodules and Plaques in an Elderly
Man with Prostate Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Uwe Wollina
43 Whitish Translucent Papules and Plaques on Fingers and Palms . . . 197
Uwe Wollina
44 Yellowish Axillary Hair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Uwe Wollina
45 Hypopigmented Facial Patches in a 44-Year-Old Female . . . . . . . . . . 205
Fariba Ghalamkarpour, Shirin Zareshari, and Zahra Asadi-Kani
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Contents
1© Springer Nature Switzerland AG 2020
T. Lotti et al. (eds.), Clinical Cases in Pigmentary Disorders,
Clinical Cases in Dermatology, https://doi.org/10.1007/978-3-030-50823-4_1
Chapter 1
15-Year-Old Female withPalmar,
Periorbital, Oral Mucosal, andGingival
Hyperpigmentation
MahinAlamgir, BritneyN.Wilson, YoungLee, andBabarRao
A 15-year-old Asian female presents to the emergency room due to a 4-month his-
tory of increasing fatigue, nausea, and vomiting. She vomited between 3 and 12
times a day and displayed signs of dehydration due to her inability to tolerate oral
intake. She also complained of a 12lb weight loss despite no changes in diet and a
sense of lightheadedness when she stands abruptly. She was diagnosed with alope-
cia areata 2 years ago and was treated with monthly intralesional triamcinolone
injections for 3 months.
Physical examination of the scalp revealed three well-dened patches of hair loss
without scarring. Further examination revealed hyperpigmentation of the area
around the eyes, dorsa of the hands, palmar creases, buccal mucosa, oral cavity, and
gingiva (Figs.1.1 and 1.2). The patient reported this hyperpigmentation has wors-
ened over the last year.
Her temperature is 99.7°F, pulse is 89/min, and blood pressure is 101/67mmHg.
Her pregnancy test came back negative, sodium level was 127mEq/L, potassium
was 5.6mEql/L, thyroid-stimulating hormone was 4.2μU/mL, AM cortisol was
1μg/dL.
Dermatology was consulted. What’s your diagnosis?
M. Alamgir (*) · B. Rao
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
B. N. Wilson
New Jersey Medical School, Newark, NJ, USA
Y. Lee
Chungnam National University, Daejeon, South Korea
