[5] Genetic and hormonal influences have also been suggested.
Hormonal disorders had been previously discarded by an endocrinologist.
Arunachalam M, Bruscino N, Bassi A, Difonzo E. Type A and B pigmentary demarcation lines in a white, pregnant woman - a rare observation?
These lesions are mostly seen during the third trimester of pregnancy and most frequent in Black and Japanese populations and rare in Caucasians (Bonci and Patrizi, 2002). These are most often observed in darker races and are considered to be normal variants of pigmentation.
Este tipo de linha de demarcao pigmentar ocorre na face posterior dos membros inferiores estendendo-se do perneo ao tornozelo.
There are eight types of pigmentary demarcation lines.
James WD, Meltza MS, Giml MA, Berger TG, Rodman OG.
She did not report similar pigmentation or hyperemia in her previous pregnancy. bras.
1.
Physiologic pigmentation of the oral mucosa is commonly seen in patients with skin of color. The skin can provide diagnostic evidence of either local or systemic disease. GP Leeds, "I think it was one of the best courses for GPs I have attended Gravidez; Hiperpigmentao; Transtornos da pigmentao.
images for use on the website.
4.
Scalp
Work conducted at a Private Clinic - Curitiba (PR), Brazil.
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given and further information.
(Portuguese), Text
2. The patient was diagnosed with type B; PDL based on her medical history, physical examination and histopathological findings. .switcher .option a:hover {background:#fff;}
These have most often been described in the skin of Africans and Japanese. In male black individuals, type B lines have already been observed; however, in white individuals, they are present only in women.33.
(English), https://doi.org/10.1590/abd1806-4841.20131764.
Eur J Dermatol. Bukhari IA. (EN), An.
We do however hope that visitors to this site can contact us regarding comments that are considered misleading or incorrect so that we can continue to improve the site.
Arch Dermatol.
Information for patients, carers, Case: A 3-months pregnant multigravida white woman aged 34 presented to our dermatology clinic due to the presence of asymptomatic dark demarcation lines that appeared on her posterior legs.
solar keratosis), Fordyce
- Type B, which appear during pregnancy on the lower limbs and regress after delivery.
Scaly / rough / peeling
2002;138:127-8.
(3). J Cosmet Dermatol. 44. Privacy Policy The pathogenesis of type B PDL is largely unknown.
1987;16:584-90. Mouth These lines may be present at birth, arise later in life, or occur during pregnancy.4. you can keep this webpage open when working for ease of access. Thank you.
Pruritis ani 25. Analytical cookies are used to understand how visitors interact with the website. Herein we report a rare case of type B PDL in a white pregnant female, presenting with persistent lesions that occurred during the first trimester of pregnancy and continued even after 1-year postpartum.
2b). Perioral dermatitis 21. [4], Five naturally occurring PDLs, labeled A-E, have been described:[1],[4], [5]. Linhas de demarcao pigmentar so linhas fisiolgicas que correspondem a transies abruptas entre reas mais escuras e mais claras.
Normal to low hormonal levels have been reported.
Rare variants are type D that is commonly seen in the posteromedial area of the spine and type E that occurs in the bilateral aspect of the chest from the mid third of the clavicle to periareolar skin. .switcher a:hover img {opacity:1;}
training in dermatology.
2011; 21: 787-8.
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5. (English), Resumo
3. Fourteen percent of black women have type B PDLs during pregnancy.22.
Pigmentary demarcation lines: a population survey. The exact cause of pigmentary demarcation lines is still an enigma. Rash arises periodically lasting days-weeks The remaining types, F, G and H, are rarer variants of PDL that are seen on various facial areas. By clicking Accept, you consent to the use of ALL the cookies. Our primary objective is to educate GPs, nurses, other diagnosis and management of common and important skin conditions.
(a) Bilateral, symmetrical, well-demarcated, hypo and hyper-pigmented patches spreading from the inner aspects of the thighs down to the popliteal fossae and distal medial portion of the calves and (b) A non-determined hypo-pigmentation on the anterior aspect of the left thigh, (a) Dilation of small vessels and perivascular lymphocytic infiltration in the papillary dermis.
Eczema - gravitational (venous) 13.
Regression occurs spontaneously from 6 to 12 months after delivery; hence, treatment is not required. 162.241.173.220
Protection Policy. She also had generalized cutaneous hyperemia that blanched completely on diascopy.
Arch Dermatol.
Ma HJ, Zhao G, Dang YP.
Int J Dermatol.
Successful use of Q-switched Alexandrite 755nm has been reported. Dermatological emergencies 9.
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Darker areas of skin
Warts, Consent Forms: The PCDS always needs good
Since PDL are asymptomatic, they are usually considered to be a minor cosmetic disfigurement which may be overlooked and observed without treatment.
They are classified into eight types, from A to H, based on the site of occurrence.
James WD, Caster JM, Rodman OG.
The British Association of Dermatologists has released its latest position state General Dermatology Diagnostic Tool
Another topic of discussion is the very early onset of PDL in this case before the 18th week which is commonly reported as the beginning time of lesions during pregnancy.
She had also received progesterone injections for 3 months.
.switcher .option a {color:#000;padding:3px 5px;} They neither correspond to the lines of Blaschko that mark the distribution of linear nevoid conditions, nor to the dermatomal lines.
There is a female sex predilection and PDL are more common in pregnancy.
The dermatological examination revealed bilateral, symmetrical, well-demarcated, hypo and hyper-pigmented patches spreading from the inner aspects of the thighs down to the popliteal fossae and distal medial portion of the calves (Fig.
Alopecia (hair loss) - an overview 6. Intertrigo (inflammation in body fold 17. Increased hormonal levels and maintenance of hyperpigmentation with the use of estrogen pills after labor have also been reported.
Compression of peripheral nerves in the space between S1 and S2 by the enlarged uterus and the influence of sex hormones have also been proposed as causative mechanisms of these lines; however, the pathogenesis is unknown.33.
DIAGNOSTIC TABLE, Rash arises periodically lasting days-weeks, Macules (small flat lesions) / papules (small raised lesions), Patches / plaques (larger flat or flat-topped lesions), Pustules (small pus-filled lesions) / boils, Bullae (blisters) / vesicles (tiny blisters), Ulceration / necrosis (black non-viable skin), Skin Lesion Diagnostic Tool - how to
I shall book again and already shared with colleagues She was slightly concerned that she had experienced a similar temporary pigmentation during her previous pregnancy that spontaneously resolved 6 months after delivery. Arunachalam M, Bruscino N, Bassi A, Difonzo E. Type A and B pigmentary demarcation lines in a white, pregnant woman - a rare observation? Type B PDL involve the posterior medial portion of the lower extremities and are more commonly associated with pregnancy and often show spontaneous resolution after delivery (Peck and Cusack, 2013).
1.
Skin lesion algorithm - common benign 7. College of General Practitioners, The All These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc.
Eczema - hand (and foot) 14.
Bonci A, Patrizi A. Pigmentary demarcation lines in pregnancy. Data
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J Am Acad Dermatol.
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3. J Am Acad Dermatol 1984;11:438-40. Blistering (bullous) conditions 7.
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number of pharmaceutical companies.
66. Notice
Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. She had a history of gestational diabetes, which was been treated with NPH insulin since the 26th week of pregnancy and was under control.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Ozawa et al. 2011;50:863-5.
Bukhari IA. Sharona Yashar; Jennifer Haley; Leslie Robinson-Bostom; Nianda Reid.
Happle (1993) also suggested that the familial pattern and female predominance led to the hypothesis of cutaneous mosaicism pigmentary pattern by paternal X chromosome lyonization.
The medial borders of the pigmented areas were sharply demarcated while the lateral borders merged imperceptibly into the normal skin. UK Tel: 0333 939 0126 Email: pcds@pcds.org.uk, Website Privacy
She also had similar pigmentary abnormalities in her previous pregnancy.
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2011;50:863-5.
These lines disappeared completely one month after parturition. Somani VK, Razvi F, Sita VN.
Acne vulgaris 5. Patches / plaques (larger flat or flat-topped lesions) However, due to miscegenation, it is probable that PDLs are common in Brazil, but that they are underdiagnosed.
There is no Brazilian case reported in the indexed literature.
All named individuals and organisations maintain copyright for the relevant images. Arunachalam M, Bruscino N, Bassi A, Difonzo E. Type A and B pigmentary demarcation lines in a white, pregnant woman - a rare observation?
Furthermore, type B PDLs may not appear in all of a woman's pregnancies and may be present only for a limited period of time during pregnancy, especially at the end. .switcher .selected a:hover {background:#fff}
Expectant treatment is used, and good results have been reported with the use of Q-switched Alexandrite laser. Hyperhidrosis (excess sweating) 16. They can be seen on the limbs, face, and sometimes the trunk.
Herein we report a rare case of type B pigmentary demarcation lines in a white pregnant female presenting with persistent lesions that occurred during the first trimester and continued even 1-year postpartum. In a study involving 380 patients, although PDL were reported to occur typically during childhood which supports the former theory, seven of fifty black women (14%) were noted to have the new appearance of type B lines with pregnancy (James et al., 1987).
In one study, 79% of African American women and 75% of African American men had at least one pigmentary demarcation line.
Arms and legs Boils and folliculitis (including hid 8. Therefore, when evaluating pigmentation, it is important to understand and recognize normal variants.1 Knowledge of normal variations in skin is crucial in the evaluation and management of patients with skin of color because there are a number of skin lesions that represent physiologic variants. The hyper-pigmented (black arrow) and hypo-pigmented areas (red arrow) on the basal layer of the epidermis (H and E, original magnification x400) and (b) Basal hyperpigmentation (arrow black) and hypopigmentation (red arrow) (Masson Fontane x200), https://scialert.net/abstract/?doi=ajd.2015.13.16. 4.
Caused/aggravated by sunlight Effective treatment of Futcher's lines with Q-switched Alexandrite laser.
Rosacea 27. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. They are rare examples of streaks of melanocytes, otherwise inapparent. .switcher a img {vertical-align:middle;display:inline;border:0;padding:0;margin:0;opacity:0.8;}
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Longitudinal melanonychia is a normal pattern of nail pigmentation seen in patients with skin of color.
Bukhari IA.
Type B pigmentary demarcation lines in a Chinese amenorrheic woman.
Pigmentary demarcation lines associated with pregnancy.
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.
eczema, Other guidelines - The British step-by-step treatment advice.
Arch Dermatol.
Hyperchromia in the axillae and groin, which had appeared earlier in the pregnancy, were concurrent complaints.
Pigmentary demarcation lines are abrupt demarcation lines between the light and dark pigmentation areas that usually occur on the upper and lower limbs.
carers, this Fordyce's granules), Adult Ma HJ, Zhao G, Dang YP.
Face and neck
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,
According to Selmanowitz and Krivo (1975), PDL are streaks of melanocyte accumulation along the embryological axial line but not along the Blaschkos lines as in type A PDL. Otherwise it is hidden from view.
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- of the face and neck, Actinic
(1997) found that some authors believed that these lesions are not always associated with pregnancy and they occur due to the distribution of cutaneous peripheral nerves that cause pigmentary differences due to neurogenic inflammation.
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Photosensitive rashes (rashes made wo 22.
Nails
Copyright 2022 Indian Journal of Dermatology, Venereology and Leprology All rights reserved.Published by Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL).
The unusual presence of a non-determined hypo-pigmentation on the anterior flexor aspect of the left thigh in this case indicated that this could possibly be a new subtype of type B PDL since the patient denied the occurrence of any following post-inflammatory hypopigmentation.
Some cases were accompanied or preceded by an overlapped erythematous component, and the fact that the erythema and pigmentation disappeared soon after delivery supports this hypothesis.33.
spots (syn.
There is smooth lightening of the hyperchromia as it reaches the anterior aspect of the legs.
right and good speakers. Eczema - atopic (including facial ecz 16. Erythema dyschromicum perstans is seen more often in people with skin of color.
Disclaimer: These citations have been automatically generated based on the information we have and it may not be 100% accurate. [3] The PDL were seen with a much higher frequency in women (9%) than in men (0.75%).
A 30 year-old Brazilian woman of skin phototype IV and pregnant for 35 weeks sought medical care for presenting hyperchromic lines on both legs for 5 weeks.
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Type D, rare, postero-median lines along the spine.
Child abuse / domestic violence
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Zhang R, Zhu W. Coexistence of pigmentary demarcation lines types C and E in one subject.
Accessibility https://dermatology.mhmedical.com/content.aspx?bookid=2585§ionid=211764446. PO Box 789, Rickmansworth, WD3 0NU. .switcher .option {position:relative;z-index:9998;border-left:1px solid #ccc;border-right:1px solid #ccc;border-bottom:1px solid #ccc;background-color:#eee;display:none;width:161px;max-height:198px;-webkit-box-sizing:content-box;-moz-box-sizing:content-box;box-sizing:content-box;overflow-y:auto;overflow-x:hidden;} If you would like to donate, please use this
Int J Dermatol.
Fungal infections (tinea) 15.
Hyperpigmentation; Pigmentation disorders; Pregnancy.
2002;138:127-8. .switcher .selected a {border:1px solid #ccc;color:#666;padding:3px 5px;width:151px;} Sua fisiopatogenia incerta. Delmonte et al. use, THE CUNLIFFE (TP) SKIN LESION DIAGNOSTIC TABLE, Trunk (chest, abdomen, back) / buttocks / axillae / groin, Leg & Other .switcher {font-family:Arial;font-size:10pt;text-align:left;cursor:pointer;overflow:hidden;width:163px;line-height:17px;} Type C, which are mid sternal, extending from the clavicle to the inferior border of the sternum. 2011; 21: 787-8.
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Br J Dermatol 1975;93:371-7.
Other common types of PDL are; type A that mostly occurs in the lateral aspect of the upper anterior portion of the arms across the pectoral area and type C that consists of a vertical hypo pigmented line in the presternal and parasternal areas (Peck and Cusack, 2013; Gupta et al., 2005; Somani et al., 2004).
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Aggravated by cold or heat Historically, the lack of recognition of benign variations in dark skin has led to unnecessary treatment and potentially poor results.
J Am Acad Dermatol.
55. Pigmentary demarcation lines (PDL), also known as Futchers lines or Voigts lines, are physiological abrupt transition lines from areas of deeper pigmentation to the area with less pigmentation. Arch Dermatol. Charity No.
email the declaration of consent form with the images to pcds@pcds.org.uk. described groups F, G, and H of PDL on the face in Indians, Group F - represents an inverted cone shaped area of hyperpigmentation over the lateral aspect of the face extending from the lateral orbital rim inferiorly or inferolaterally, Group G - occurs at a site similar to Group F, but with two inverted cones with a normal patch of skin in between, Group H - occurs on the lower face as a linear hyperpigmented band extending from the angle of mouth to the lateral aspect of the chin, PDL in pregnancy may regress spontaneously after delivery. 2005;4:27-8.
Protection Policy, The Leading Dermatological Society for GPs, The differential areas of pigmentation appearing as lines, which are referred to as PDL, arise due to, In 1975 Selmanowitz and Krivo classified PDL in to five groups namely A to E, Group A - lines along the upper limb with variable trans-pectoral extension, Group C - lines on the chest and abdomen in the form of paired lines, median or paramedian, Group D - lines on the back, posteromedial demarcation, Group E - bilaterally symmetrical, obliquely oriented, hypopigmented macules on the chest, Subsequently, Somani et al.
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