Pigment International

THE CLINICAL PICTURE
Year
: 2014  |  Volume : 1  |  Issue : 1  |  Page : 31-

Punctate leukoderma


Shraddha Uprety, Keshavamurthy Vinay, Muthu Sendhil Kumaran 
 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Muthu Sendhil Kumaran
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160 012
India




How to cite this article:
Uprety S, Vinay K, Kumaran MS. Punctate leukoderma.Pigment Int 2014;1:31-31


How to cite this URL:
Uprety S, Vinay K, Kumaran MS. Punctate leukoderma. Pigment Int [serial online] 2014 [cited 2022 May 28 ];1:31-31
Available from: https://www.pigmentinternational.com/text.asp?2014/1/1/31/135439


Full Text

A 40-year-old male patient with acrofacial vitiligo, presented with multiple punctate, well-defined depigmented macules, over chest, back, and proximal extremities [Figure 1] and [Figure 2]. They appeared 6 months after psoralen plus ultraviolet A (PUVA) sol (psoralen + sunlight) treatment. Based on history and clinical findings a diagnosis of punctate leukoderma was made.{Figure 1}{Figure 2}

Punctate leukoderma is an adverse effect of PUVA therapy, characterized by multiple discrete, hypopigmented or achromic, round to oval macules distributed over extremities, chest, and back. It is attributed to nuclear damage of both the keratinocytes and melanocytes caused by the formation of psoralen photo adducts. Histopathology demonstrates decrease, but not absence of melanocytes and melanin pigment. Ultrastructural studies have shown cellular damage with vacuolar degeneration of both keratinocytes and melanocytes.

The other clinical mimics of punctate leukoderma include vitiligo itself, tuberous sclerosis, chemical leukoderma, tinea versicolor and idiopathic guttate hypomelanosis. Idiopathic guttate hypomelanosis is a disease of advanced age in the pigmented races. The lesions are small, achromic, angulated macules distributed predominantly over extremities. The ultrastructural changes as seen in PUVA induced punctate leukoderma are not present. Vitiligo histopathologically shows absence of melanocytes and melanin pigment. Absence of fine scales and a negative KOH scraping can exclude the diagnosis of tinea versicolor.