|SPOT THE DIAGNOSIS
|Year : 2015 | Volume
| Issue : 1 | Page : 62-63
Multiple eruptive pigmented plaques in a child
Keshavamurthy Vinay1, Davinder Parsad1, Debajyoti Chatterjee2
1 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||26-Jun-2015|
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Vinay K, Parsad D, Chatterjee D. Multiple eruptive pigmented plaques in a child. Pigment Int 2015;2:62-3
An 11-year-old boy presented to us with complains of multiple asymptomatic pigmented skin lesions for past 8 months. The lesions initially appeared over the trunk and were progressively increasing in number and size. There was no history of any drug intake prior to the onset of these lesions. On examination, multiple discrete round to oval, blackish-brown hyperpigmented plaques with accentuated skin markings were noted [Figure 1]a and b. The lesions were distributed predominantly over the trunk and back with occasional lesions on the neck and extremities. Lesional Darier's sign was negative. A punch skin biopsy was taken from one of the lesion and submitted for histopathological examination.
|Figure 1: Multiple discrete blackish-brown, round to oval plaques distributed over the trunk and proximal extremities (a). Close-up examination showing the velvety surface with accentuated skin markings (b)|
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| Diagnosis and Clinical Course|| |
Skin biopsy showed acanthosis, papillomatosis increased basal layer pigmentation and dermal melanophages [Figure 2]. There was no basal cell vacuolization or increase in mast cell count. Based on these features, a diagnosis of idiopathic eruptive macular pigmentation (IEMP) with papillomatosis was made. Patient was treated with oral isotretinoin 10 mg/day. With this, the progression of disease was stabilized. However, improvement of existing lesions was minimal.
|Figure 2: Microphotograph of skin biopsy showing acanthosis, papillomatosis, increased basal layer pigmentation and dermal melanophages (H and Eosin, ×200)|
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| Discussion|| |
Idiopathic eruptive macular pigmentation is an uncommon, idiopathic, pigmentary disorder commonly affecting the children and adolescents. Sanz de Galdeano et al.  first described this entity in English literature and laid out its diagnostic criteria: (1) Eruption of brownish nonconfluent asymptomatic macules involving the trunk, neck, and proximal aspect of the extremities in children or adolescents (2) absence of preceding inflammatory lesions (3) no previous drug exposure (4) histologic examination showing basal cell layer hyperpigmentation of the epidermis and prominent dermal melanophages without visible basal layer damage or lichenoid inflammatory infiltrate and (5) normal mast cell count. Later Joshi  highlighted the velvety nature of the lesion and reported the clinically and histological similarities with acanthosis nigricans. The presence of velvety raised surface with accentuated skin markings and pigmented papillomatosis on histopathology are common to acanthosis nigricans and IEMP. , He hypothesized IEMP to be an eruptive form of acanthosis nigricans though the typical flexural involvement of acanthosis nigricans is not seen in IEMP.  Similar to the series reported by Joshi,  our patient satisfied the diagnostic criteria of IEMP and in addition had velvety surface clinically and pigmented papillomatosis histopathologically.
Idiopathic eruptive macular pigmentation can clinically resemble urticaria pigmentosa, fixed drug eruption, lichen planus pigmentosus and erythema dyschromia perstans, but can be excluded by histopathological examination.  IEMP generally does not require any active intervention since it is self-limiting and usually undergoes spontaneous remission within months. Rarely the condition may be persistent and recurrent.  Trials with topical steroids and de-pigmenting agents, when used, have not been very successful.  We tried isotretinoin in our patient to speed up the resolution and to study its usefulness in the treatment of IEMP, however, no significant improvement was seen. We report this case for the rareness of the disease and to create awareness among the fellow dermatologist.
| References|| |
Sanz de Galdeano C, Léauté-Labrèze C, Bioulac-Sage P, Nikolic M, Taïeb A. Idiopathic eruptive macular pigmentation: Report of five patients. Pediatr Dermatol 1996;13:274-7.
Joshi R. Idiopathic eruptive macular pigmentation with papillomatosis: Report of nine cases. Indian J Dermatol Venereol Leprol 2007;73:402-5.
Chiu MW, Suh KY, Pirouzmanesh A, Landau JW. Multiple brown patches on the trunk. Idiopathic eruptive macular pigmentation with papillomatosis (IEMP). Arch Dermatol 2010;146:1301-6.
Mehta S, Aasi S, Cole R, Chu P, Weinberg JM. Idiopathic eruptive macular pigmentation: A case of 21 years' duration. J Am Acad Dermatol 2003;49:S280-2.
Herd TJ, Wright TS. Idiopathic eruptive macular pigmentation involving the distal extremities: A case report. Pediatr Dermatol 2014;31:e52-4.
[Figure 1], [Figure 2]