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
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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.