Acta Dermato-Venereologica 98-9CompleteContent | Page 25

QUIZ SECTION Disfiguring Leukoderma Caused by Banned Cosmetics: A Quiz Laura ATZORI 1 , Ramona ZANNIELLO 1 *, Giorgia SARAIS 2 , Viviana PIRAS 1 , Luca PILLONI 3 , Myriam ZUCCA 1 , Maria Angela BRUNDU 1 and Franco RONGIOLETTI 1 1 Section of Dermatology, Department of Medical Science and Public Health, 2 Department of Life and Environmental Sciences, and 3 Section of Pathology, Department of Surgery, University of Cagliari, IT-09124, Italy. *E-mail: [email protected] A 47-year-old African man was referred to our clinic for multiple, rapidly progressive, hypopigmented lesions, which first occurred on his face and later on his scalp and trunk. Dermatological examination showed whitish patches, either isolated in a confetti-like pattern, or confluent in larger hypopigmented areas with ill-defined margins (Fig. 1a, b). Examination under Wood’s lamp and direct microscopy for possible fungal infection were both negative. Otherwise healthy, the patient had no personal or family history of vitiligo and autoimmune diseases. Three days prior to onset of the hypopigmentation, he had begun application to his face of a “carrot extract and vitamin E cream”, a bleaching cream, named Skin Light ® (RODIS, Abidjan, Ivory Coast), which he had bought in an ethnic shop in Italy, It was the first-time the patient had used this specific product, but he had used other bleaching creams previously, with no complaints or skin reaction. The patient was precise about the name and composition of these cosmetics. He also reported a mild itching sensation and redness during first application of Skin Light ® , but only the appearance of the 914 pigmentation disorder led him to seek a dermatological consultation. In order to determine the composition of the cream, we conducted chemical and physical analysis in our university laboratory, including liquid chromatography and mass spectrometry. A biopsy was taken from the patient’s neck in order to investigate the type of pigmentation dis- order. Patch tests were performed with the baseline series recommended by the Società Italiana Dermatologia Al- lergologica Professionale ed Ambientale (SIDAPA) using Rapid Patch Test (RPT ® , F.I.R.M.A. SpA, Florence, Italy) and the commercial cream “as it is”, with an additional reading on day 4. A positive patch-test reaction developed exclusively to the cream (Fig. 1c, d). Vitiligo was excluded by histological examination, showing non-specific findings: mild orthohyperkeratosis (Fig. 1e), normally pigmented epidermal basal keratinocytes with Fontana-Masson stain (Fig. 1f), and uniform distribution of melanocytes on im- munohistochemistry (HMB-45; Melan-A) (Fig. 1g, h). What is your diagnosis? See next page for answer. Fig. 1. (a, b) Hypopigmented patches on the face and scalp (c, d) Patch test on day 4 with reaction only to the cream, (e) Histopathological imaging of a punch biopsy from the hypopigmented skin of the neck showed mild orthohyperkeratosis (×20 haematoxylin and eosin; H&E), (f ) basal pigmented keratinocytes in the epidermis (×20 Fontana- Masson stain). (g, h) Immunohistochemical studies for HMB-45 and Melan-A demonstrated melanocytes distributed in a uniform pattern. Written permission to publish these photographs has been provided by the patient. doi: 10.2340/00015555-2994 Acta Derm Venereol 2018; 98: 914–915 This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2018 Acta Dermato-Venereologica.