Ears Herein we report a rare case of type B PDL in a white pregnant female, presenting with persistent lesions that occurred during the first trimester of pregnancy and continued even after 1-year postpartum. There are eight types of pigmentary demarcation lines. To the best of our knowledge, our case is unusual due to the unique distribution of type B PDL which involved not only the posterior portion of the lower extremities but also the anterior thigh and it is the second case that has so far been reported in the literature (Cho et al., 2012). Alopecia (hair loss) - an overview 6. Bonci A, Patrizi A. Pigmentary demarcation lines in pregnancy. Arms and legs The change from darker to lighter pigment occurs at the junction of the extensor to flexor surface of the arm. Accessibility
The medial borders of the pigmented areas were sharply demarcated while the lateral borders merged imperceptibly into the normal skin. So far, eight different types of PDL have been described (A - H).11. These lines may be present at birth, arise later in life, or occur during pregnancy.4. London. 
Mouth Face and neck Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. Eur J Dermatol.
Protection Policy, The Leading Dermatological Society for GPs, The differential areas of pigmentation appearing as lines, which are referred to as PDL, arise due to, In 1975 Selmanowitz and Krivo classified PDL in to five groups namely A to E, Group A - lines along the upper limb with variable trans-pectoral extension, Group C - lines on the chest and abdomen in the form of paired lines, median or paramedian, Group D - lines on the back, posteromedial demarcation, Group E - bilaterally symmetrical, obliquely oriented, hypopigmented macules on the chest, Subsequently, Somani et al. 3. 2. Analytical cookies are used to understand how visitors interact with the website. In a review by Nakama et al. .switcher .option a.selected {background:#fff;}
[5] The PDL and generalized cutaneous hyperemia in our patient could possibly be due to the progesterone therapy received during early pregnancy. Data
Dermatology 2000;200:85-6.
.switcher .selected a {border:1px solid #ccc;color:#666;padding:3px 5px;width:151px;} Successful use of Q-switched Alexandrite 755nm has been reported. Pigmentary demarcation lines are physiologically abrupt transition lines from areas of deeper pigmentation to less pigmented areas. 66. Some cases were accompanied or preceded by an overlapped erythematous component, and the fact that the erythema and pigmentation disappeared soon after delivery supports this hypothesis.33. Pigmentary demarcation lines over the face. Bukhari IA. Case: A 3-months pregnant multigravida white woman aged 34 presented to our dermatology clinic due to the presence of asymptomatic dark demarcation lines that appeared on her posterior legs. We could not come across a description of type B pigmentary demarcation line in the Indian literature. Its pathogenesis remains unknown. 2. 1. Anyhow, type B PDLs should be considered a physiological pigmentary alteration related to pregnancy.33. Pigmentary demarcation lines associated with pregnancy. [4], Five naturally occurring PDLs, labeled A-E, have been described:[1],[4], [5]. 2b). [3] We report a pregnant woman, who presented with type B pigmentary demarcation lines and generalized cutaneous hyperemia. diagnosis and management of common and important skin conditions. There is smooth lightening of the hyperchromia as it reaches the anterior aspect of the legs. Boils and folliculitis (including hid 11. Pigmentary Demarcation Lines (PDL), also known as Futchers or voigt lines, are abrupt physiological transition lines between the areas of darker pigmentation and the areas of lighter, normal pigmentation particularly seen in females and people with darker skin types (Kalasapura et al., 2014; Cho et al., 2012). images for use on the website.
Molluscum contagiosum 19. Referral pathways 2. We also use third-party cookies that help us analyze and understand how you use this website. health professionals, and the general public on skin Disclaimer: These citations have been automatically generated based on the information we have and it may not be 100% accurate. Happle (1993) also suggested that the familial pattern and female predominance led to the hypothesis of cutaneous mosaicism pigmentary pattern by paternal X chromosome lyonization. Itch 5. Web Design - Mode Ten Designs. Pigmentary demarcation lines are normal boundaries of the skin that represent a transition between levels of melanin pigment in the skin corresponding to dermatomal innervation. The pathogenesis of type B PDL is largely unknown. Yashar S, Haley J, Robinson-Bostom L, Reid N. Yashar S, & Haley J, & Robinson-Bostom L, & Reid N. Kelly A, & Taylor S.C., & Lim H.W., & Serrano A(Eds. The skin can provide diagnostic evidence of either local or systemic disease. Eczema - atopic (including facial ecz 12. 162.241.173.220 Seborrhoeic eczema 29. Pruritis ani 25. Eczema - atopic (including facial ecz 16. Type B PDL involve the posterior medial portion of the lower extremities and are more commonly associated with pregnancy and often show spontaneous resolution after delivery (Peck and Cusack, 2013). ownership. Perioral dermatitis 21. J Am Acad Dermatol 1984;11:438-40. conditions, Other useful tools for patients and Eczema - hand (and foot) 14. Aggravated by cold or heat Type B, which appear during pregnancy on the lower limbs and regress after delivery. Hair Travel acquired / worldwide infections Fourteen percent of black women have type B PDLs during pregnancy.22. solar keratosis), Fordyce Furthermore, type B PDLs may not appear in all of a woman's pregnancies and may be present only for a limited period of time during pregnancy, especially at the end. Erythema dyschromicum perstans is seen more often in people with skin of color. use, THE CUNLIFFE (TP) SKIN LESION DIAGNOSTIC TABLE, Trunk (chest, abdomen, back) / buttocks / axillae / groin, Leg & Other 2008;47:505-7. Dermatologist Specialization in Cosmetic and Dermatologic Surgery Clinics Hospital Federal University of Parana (Hospital de Clnicas Universidade Pigmentary demarcation lines. Type D, rare, postero-median lines along the spine. Other common types of PDL are; type A that mostly occurs in the lateral aspect of the upper anterior portion of the arms across the pectoral area and type C that consists of a vertical hypo pigmented line in the presternal and parasternal areas (Peck and Cusack, 2013; Gupta et al., 2005; Somani et al., 2004). Disclaimer - the author PCDS cannot accept responsibility for any misleading or incorrect statements, and the management of individual patients remains the direct responsibility of the individual doctor. dermatol. .l_name {float: none !important;margin: 0;} 2002;138:127-8.
2011; 21: 787-8. Int J Dermatol. .switcher a img {vertical-align:middle;display:inline;border:0;padding:0;margin:0;opacity:0.8;} We also noted a non-determined hypo-pigmentation on the anterior aspect of her left thigh (Fig. 2002;138:127-8. conditions. 2011;50:863-5. bras. Historically, the lack of recognition of benign variations in dark skin has led to unnecessary treatment and potentially poor results. Caused/aggravated by sunlight Indian J Dermatol Venereol Leprol 2004;70:336-41. James WD, Meltza MS, Giml MA, Berger TG, Rodman OG. There are six types of pigmentary demarcation lines based on anatomic location3 [Table 21-1]. They can be seen on the limbs, face, and sometimes the trunk. They neither correspond to the lines of Blaschko that mark the distribution of linear nevoid conditions, nor to the dermatomal lines. Type E, periareolar hypopigmented macules. Nose spots (syn. Genetic / rare conditions, Diagnosis based on predominant site 90% or more of body erythematous 2008;47:505-7. Physiologic pigmentation of the oral mucosa is commonly seen in patients with skin of color. They are considered to be associated with the distribution of cutaneous peripheral nerves and pigmentary differences due to neurogenic inflammation.
A 30 year-old Brazilian woman of skin phototype IV and pregnant for 35 weeks sought medical care for presenting hyperchromic lines on both legs for 5 weeks. Thank you. 2005;4:27-8. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. They have been considered as an atavistic remnant, where the dorsal skin is pigmented more than the ventral, providing better protection from the sun. Scalp Hyperchromia in the axillae and groin, which had appeared earlier in the pregnancy, were concurrent complaints. 1. Normal to low hormonal levels have been reported. Copyright 2022 Indian Journal of Dermatology, Venereology and Leprology All rights reserved.Published by Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL). described groups F, G, and H of PDL on the face in Indians, Group F - represents an inverted cone shaped area of hyperpigmentation over the lateral aspect of the face extending from the lateral orbital rim inferiorly or inferolaterally, Group G - occurs at a site similar to Group F, but with two inverted cones with a normal patch of skin in between, Group H - occurs on the lower face as a linear hyperpigmented band extending from the angle of mouth to the lateral aspect of the chin, PDL in pregnancy may regress spontaneously after delivery. Statement Policy (3). Arunachalam M, Bruscino N, Bassi A, Difonzo E. Type A and B pigmentary demarcation lines in a white, pregnant woman - a rare observation? Nail disorders 20. 1b) although she completely denied the presence of any post-inflammatory hypopigmentation. Type B pigmentary demarcation lines in a Chinese amenorrheic woman. Hyperpigmentation; Pigmentation disorders; Pregnancy. DIAGNOSTIC TABLE, Rash arises periodically lasting days-weeks, Macules (small flat lesions) / papules (small raised lesions), Patches / plaques (larger flat or flat-topped lesions), Pustules (small pus-filled lesions) / boils, Bullae (blisters) / vesicles (tiny blisters), Ulceration / necrosis (black non-viable skin), Skin Lesion Diagnostic Tool - how to and health professionals, Up to 30% of GP consultations have some element of skin, but yet there is limited Zhang R, Zhu W. Coexistence of pigmentary demarcation lines types C and E in one subject. .switcher .option a:hover {background:#fff;} This section provides a quick diagnostic and treatment guide in the It was her second pregnancy, and she denied similar alterations in the previous one. 2002;138:127-8. Rash arises periodically lasting days-weeks .switcher .option::-webkit-scrollbar {width:5px;} Int J Dermatol. [2] Subsequently, a few more patterns of pigmentary demarcation lines on the face, types F, G and H have also been described in Indian subjects. Bonci A, Patrizi A. Pigmentary demarcation lines in pregnancy. Bonci A, Patrizi A. Pigmentary demarcation lines in pregnancy. If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. Bonci A, Patrizi A. Pigmentary demarcation lines in pregnancy. The British Association of Dermatologists has released its latest position state General Dermatology Diagnostic Tool Int J Dermatol. 3. There is a female sex predilection and PDL are more common in pregnancy. (1993) suggested that pigmentary abnormality was caused by the compression of the peripheral nerves at S1 and S2 by an enlarged uterus during pregnancy. Eur J Dermatol. "Extremely helpful to have memory stick with notes of talks readers, especially in skin of colour: Copyright 1994 - 2021 The Primary Care Dermatology Society. Ozawa et al. Acne vulgaris 5. 1987;16:584-90. Pigmentary demarcation lines (PDL), also known as Futchers lines or Voigts lines, are physiological abrupt transition lines from areas of deeper pigmentation to the area with less pigmentation. All rights reserved. Download, The 4. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. Hands Type B pigmentary demarcation lines have been reported over the legs during pregnancy, and regress after delivery. 1987;16:584-90. In a recent Indian study, three distinct patterns of pigmentary demarcation lines have been described on the face and have been designated as F, G and H types of PDL. Although type B PDL are transitory, they may persist in some patients as seen in our case. Compression of peripheral nerves in the space between S1 and S2 by the enlarged uterus and the influence of sex hormones have also been proposed as causative mechanisms of these lines; however, the pathogenesis is unknown.33. Dressings. This chapter, which provides a brief overview of PDL, is set out as follows: Please refer to notes on image rights at bottom of the page with regards to individual image 2011; 21: 787-8. 55. Delmonte et al. Type A lines, also termed Voigt (Futcher) lines, are sharply demarcated, frequently bilateral lines of pigmentation found at the anterolateral junction of the upper arms [Figure 21-1]. Eur J Dermatol. The lesions had developed around the 8th week of her pregnancy and gradually became more noticeable. Type B PDL occurs as a well demarcated line in the posterior aspect of the legs extending from the perineum to the ankles. Actinic (solar) keratosis 3. J Cosmet Dermatol. Thank you. training in dermatology. Effective treatment of Futcher's lines with Q-switched Alexandrite laser. The lesions persisted for a year after delivery. number of pharmaceutical companies. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. , 88 Regression occurs spontaneously from 6 to 12 months after delivery; hence, treatment is not required. Privacy Policy Comparision of Negroes with Japanese. 2002;138:127-8. Bonci A, Patrizi A. Pigmentary demarcation lines in pregnancy. Somani VK, Razvi F, Sita VN. Urticaria and angioedema 30. Another topic of discussion is the very early onset of PDL in this case before the 18th week which is commonly reported as the beginning time of lesions during pregnancy. Lability of pigment in the darker-skinned population causes dramatic changes in skin color after inflammatory processes of the skin. Bonci A, Patrizi A. Pigmentary demarcation lines in pregnancy. This site uses cookies to provide, maintain and improve your experience. in a long time. Palmar and Plantar Hyperpigmented Macules, Punctate Keratoses of the Palms and Soles, COMMON SKIN DISORDERS SEEN PREDOMINANTLY IN DARKER SKIN, Chest from midthird of clavicle to periareolar skin, Straight or curved convex line on the face. Nails .switcher {font-family:Arial;font-size:10pt;text-align:left;cursor:pointer;overflow:hidden;width:163px;line-height:17px;} It is important to differentiate normal nail pigmentation from malignant melanocytic proliferations and extraneous pigment deposition. PO Box 789, Rickmansworth, WD3 0NU. Gravidez; Hiperpigmentao; Transtornos da pigmentao. Type A (Futchers / Voigts lines), the most common lines, seen over the dorso-ventral aspect of the arms. Keloidal scarring is common in patients with skin of color. 1. J Am Acad Dermatol. 2002;138:127-8. 1a). She also had similar pigmentary abnormalities in her previous pregnancy. Skin lesion algorithm - common benign 4. The remaining types, F, G and H, are rarer variants of PDL that are seen on various facial areas. Ma HJ, Zhao G, Dang YP. This case was also remarkable since the patient reported to have had similar but temporary pigmentation in her previous pregnancy. Longitudinal melanonychia is a normal pattern of nail pigmentation seen in patients with skin of color. Work conducted at a Private Clinic - Curitiba (PR), Brazil. Zhang R, Zhu W. Coexistence of pigmentary demarcation lines types C and E in one subject. Terms of Use Scabies 28. (EN), An. She had also received progesterone injections for 3 months. Stay informed of issues for this journal through your RSS reader, Resumo Its distribution is bilateral and symmetrical and separates the more deeply pigmented skin of the outer surfaces from the lighter inner surfaces. 2002;138:127-8. conditions, Hyperpigmentation
.switcher .option a {color:#000;padding:3px 5px;} J Am Acad Dermatol 1987;16:584-90. I shall book again and already shared with colleagues 2005;4:27-8. Ulceration / necrosis (black non-viable skin) Eyelids Pregnancy-related She was slightly concerned that she had experienced a similar temporary pigmentation during her previous pregnancy that spontaneously resolved 6 months after delivery. O tratamento expectante com relato de bom resultado com Q-switchedAlexandrite laser. Our primary objective is to educate GPs, nurses, other