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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 1  |  Issue : 1  |  Page : 23-24

Persistent type B pigmentary demarcation lines in pregnancy


Department of Skin and Venereal Diseases, Government Medical College, Kota, Rajasthan, India

Date of Web Publication26-Jun-2014

Correspondence Address:
Raghavendra Kalasapura
Department of Skin and VD, Government Medical College, Kota, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2349-5847.135435

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  Abstract 

Pigmentary demarcation lines (PDLs) are abrupt demarcation lines between the areas of light and dark pigmentation and also called as Futcher's or Voigt lines. These lines are most commonly seen in upper and lower limbs but can also be seen in other body parts. They occur almost in all races, but the incidence is more in Japanese, Caucasians and Negros. Treatment is not necessary because of transitory and asymptomatic nature of PDL. If at all required, it is due to cosmetic concerns only. We are reporting a rare case of type B PDL persisting even after 1 year postpartum.

Keywords: Futcher′s line, Pregnancy, Type B pigmentary demarcation lines


How to cite this article:
Kalasapura R, Kumar A, Yadav DK, Jain SK. Persistent type B pigmentary demarcation lines in pregnancy. Pigment Int 2014;1:23-4

How to cite this URL:
Kalasapura R, Kumar A, Yadav DK, Jain SK. Persistent type B pigmentary demarcation lines in pregnancy. Pigment Int [serial online] 2014 [cited 2019 May 21];1:23-4. Available from: http://www.pigmentinternational.com/text.asp?2014/1/1/23/135435


  Introduction Top


Pigmentary demarcation lines (PDL), also known as Futcher's or voigt lines, usually occur in upper and lower limbs. These are abrupt demarcation lines between light to dark pigmentation area and considered to be a physiological phenomenon. The incidence is more among Negroes and Japanese races of females but reported in Indian patients also. [1] Based on the site of occurrence, they are classified into type A to H [2],[3],[4] [Table 1]. Among them, most commonly seen subtypes are Type A and B. Type B PDL is almost always associated with pregnancy. They are self-resolving in nature, but sometimes may persist throughout the life. However, there are very few case reports about their persistence after 6 months postpartum. [5] We are reporting a rare case of type B PDL in a pregnant female who presented to us with persistent PDL even after 1-year postpartum.
Table 1: Classification of PDL based on the pattern and location[1-4]


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  Case Report Top


A 24-year-old female presented with asymptomatic dark demarcation lines in the posterior aspect of lower limbs since 1-year. Initially, patient noticed dark lines during her second trimester. They were asymptomatic, and she was least concerned. However, after delivery the lines persisted. There was no history of any medications or family members having similar complaints. On cutaneous examination a curvilinear, hyper pigmented, well-demarcated pigmentary lines were extending from ankle to buttocks, situated on the posterior-medial aspect of the lower limbs [Figure 1] with no scales or any discontinuity. On doing diascopy, there was no blanching or exaggeration of the lesions. Based on the history and clinical examination, diagnosis of type B PDL was made.
Figure 1: Curvilinear hyper pigmented well-demarcated line extending from ankle to buttocks situated on the posterior-medial aspect of lower limb

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  Discussion Top


Pigmentary demarcation lines presents as an abrupt transition between areas of light and dark pigmentation, most commonly on the trunk and lower extremities than in any other part of the body. [5] The first case was described in Japanese patients by Matzumoto, [6] Subsequently, Futcher described the same condition in the black population in 1938. [7] PDLs are the most frequent in Black and Japanese populations, fairly common in East Indians, and rare in Caucasians. [8] It has been proposed that the various PDLs are dominantly inherited among the family members of Japanese and Negroes. [9] The occurrence of PDL among females more compared to males. According to Somani et al. [4] the number of male patients with demarcation lines was negligible (0.74%) when compared with the number of females (8.3%). The cause for PDLs is still an enigma. According Selmanowitz and Krivo [1] PDLs are streaks of melanocyte accumulation along the embryological axial line, but not along the blaschko lines as in type A PDLs. The familial pattern and female predominance lead to the hypothesis of cutaneous mosaciasm pigmentary pattern by paternal X chromosome  Lyonization More Details. [10] The pathogenesis of PDLs in pregnancy is still unknown. According to Delmonte et al., [11] PDL lesions are associated with the distribution of the cutaneous peripheral nerves and the pigmentary differences result from neurogenic inflammation. Some other hypothesis mentions that compression of peripheral nerves at S1 and S2 by an enlarging uterus in pregnancy results in the pigmentary abnormality, [12] due to increased vascularity during pregnancy or a local trigger factor coupled with high levels of estrogen, progesterone, and melanocyte-stimulating hormone may offer possible explanations. [8] In a survey of the population, James et al. have reported that out of 75 patients of PDL, 14% developed type B lines during pregnancy only. [13] Actually the PDLs are a minor cosmetic disfigurement and usually self-resolving after pregnancy. Nakama et al. [14] reviewed 19 cases of pregnancy-associated type B PDLs, all of which resolved within a year of delivery. Although Type B PDLs are transitory, but in some cases they may persist [15] as seen in our case. The persistence of type B PDL may be due to unmasking or exaggerations of congenital demarcation lines during pregnancy because of hormonal changes, but still the reason is not known. Various therapeutic modalities have been tried that is Kligman regimen, sun protection, glycolic acid peels and alexandrite lasers, but the response is variable.

 
  References Top

1.Selmanowitz VJ, Krivo JM. Pigmentary demarcation lines. Comparison of Negroes with Japanese. Br J Dermatol 1975;93:371-7.  Back to cited text no. 1
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2.Gupta LK, Kuldeep CM, Mittal A, Paliwal V, Singhal H, Agarwal K, et al. Pigmentary demarcation lines in pregnancy. Indian J Dermatol Venereol Leprol 2005;71:292-3.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Malakar S, Dhar S. Pigmentary demarcation lines over the face. Dermatology 2000;200:85-6.  Back to cited text no. 3
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4.Somani VK, Razvi F, Sita VN. Pigmentary demarcation lines over the face. Indian J Dermatol Venereol Leprol 2004;70:336-41.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.Peck JW, Cusack CA. Futcher lines: A case report in pregnancy and literature review. Cutis 2013;92:100-1.  Back to cited text no. 5
    
6.Matzumoto SH. Uber eine eigentumliche pig-mentverteilung an den voigtschen linien. Arch Dermatol Syph 1913;118:157-64.  Back to cited text no. 6
    
7.Futcher PH. A peculiarity of pigmentation of the upper arm of Negroes. Science 1938;88:570-1.  Back to cited text no. 7
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8.Bonci A, Patrizi A. Pigmentary demarcation lines in pregnancy. Arch Dermatol 2002;138:127-8.  Back to cited text no. 8
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9.Weary PE, Behlen CH 2 nd . Unusual familial hypopigmentary anomaly. Arch Dermatol 1965;92:54-5.  Back to cited text no. 9
    
10.Happle R. Pigmentary patterns associated with human mosaicism: A proposed classification. Eur J Dermatol 1993;3:170-4.  Back to cited text no. 10
    
11.Delmonte S, Parodi A, Rebora A. Pigmentary demarcation lines Type B in a white non-pregnant woman. Acta Derm Venereol 1997;77:82.  Back to cited text no. 11
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12.Ozawa H, Rokugo M, Aoyama H. Pigmentary demarcation lines of pregnancy with erythema. Dermatology 1993;187:134-6.  Back to cited text no. 12
    
13.James WD, Carter JM, Rodman OG. Pigmentary demarcation lines: A population survey. J Am Acad Dermatol 1987;16:584-90.  Back to cited text no. 13
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14.Nakama T, Hashikawa K, Higuchi M, Ishii N, Miyasato M, Hamada T, et al. Pigmentary demarcation lines associated with pregnancy. Clin Exp Dermatol 2009;34:e573-6.  Back to cited text no. 14
    
15.Ruiz-Villaverde R, Blasco Melguizo J, Naranjo-Sintes R. Pigmentary demarcation lines in a pregnant Caucasian woman. Int J Dermatol 2004;43:911-2.  Back to cited text no. 15
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    Figures

  [Figure 1]
 
 
    Tables

  [Table 1]


This article has been cited by
1 Case of Recurrent Type B Pigmentary Demarcation Lines in a Pregnant Woman
Pelin Ustuner,Recep Bedir
Asian Journal of Dermatology. 2015; 7(1): 13
[Pubmed] | [DOI]



 

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