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CASE REPORT
Year : 2010  |  Volume : 55  |  Issue : 3  |  Page : 277-278
Idiopathic eruptive macular pigmentation: Report on two cases


Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India

Date of Web Publication25-Sep-2010

Correspondence Address:
Sanjiv Grover
Department of Dermatology, Armed Forces Medical College Pune, Maharashtra
India
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DOI: 10.4103/0019-5154.70698

PMID: 21063525

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   Abstract 

Idiopathic eruptive macular pigmentation (IEMP) is a rather under-reported condition of unknown etiology. Clinically consisting of benign hyperpigmented macules, the condition is characterized histopathologically by dermal melanization. It must be differentiated from lichen planus pigmentosus, erythema dyschromicum perstans, fixed drug eruption and mastocytosis.


Keywords: Idiopathic, eruptive, macular pigmentation


How to cite this article:
Grover S, Basu A. Idiopathic eruptive macular pigmentation: Report on two cases. Indian J Dermatol 2010;55:277-8

How to cite this URL:
Grover S, Basu A. Idiopathic eruptive macular pigmentation: Report on two cases. Indian J Dermatol [serial online] 2010 [cited 2014 Nov 24];55:277-8. Available from: http://www.e-ijd.org/text.asp?2010/55/3/277/70698



   Introduction Top


Idiopathic Eruptive Macular Pigmentation (IEMP) is a rather under-reported condition of unknown etiology first reported three decades ago. [1] Awareness of its existence is low and details of its clinico-pathological features are not very well known. We report two such cases of this little known condition.


   Case Report Top


The details of the cases are illustrated in [Table 1]. Both the cases were asymptomatic; the lesions appearing insidiously and progressing gradually to involve the affected areas. There was no history of inflammatory lesions or topical applications predating the onset of lesions, systemic drug intake or itching. There was no personal or family history of atopy and the antenatal history was unremarkable. General physical and systemic examination was normal. Dermatological examination revealed multiple, discrete, ill-defined, gray-black pigmented, smooth, non-scaly, non-atrophic, non-alopecic, normesthetic, oval macules measuring app 5mm to 15 mm in size over the involved areas [Figure 1]. Darier's sign was negative. Hair, nails, mucosae, palms and soles were normal. Hematological and biochemical investigations were normal. Histopathology of the hyper pigmented macule revealed mild papillomatosis, increased basal layer melanin and dermal melanophages. There was absence of parakeratosis and dermal inflammatory/lichenoid infiltrate [Figure 2].
Figure 1: Multiple, discrete, ill-defined, gray-black pigmented macules on trunk [Panel a], face and limbs [Panel b]

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Figure 2: Mild papillomatosis, increased basal layer melanin and dermal melanophages [H and E; ×100 (Panel a), ×400 (Panel b)]:

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Table 1: Brief clinical summary of cases


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   Discussion Top


Less than 30 cases of IEMP have been reported in literature so far, reflecting unfamiliarity with the entity. While majority of the cases have been reported in children and adolescents, it has also been reported in a 31-year-old female. [2] Criteria have been established for diagnosis of IEMP, [3] namely: (a) eruption of brownish, non-confluent, asymptomatic macules involving the trunk, neck and proximal extremities in children and adolescents (b) absence of preceding inflammatory lesions (c) no previous drug exposure (d) basal layer hyperpigmentation of the epidermis and prominent dermal melanophages without visible basal layer damage or lichenoid inflammatory infiltrate (e) normal mast cell count. Our cases fulfilled all these criteria for diagnosis of the entity.

IEMP must be differentiated from lichen planus pigmentosus, erythema dyschromicum perstans, fixed drug eruption and mastocytosis. Absence of basal cell degeneration, colloid bodies, lichenoid infiltrate or excess dermal mast cell population may rule out these disorders. In a series of nine cases, an additional histopathological finding of pigmented papillomatosis has been reported. [4] However, in this series, some lesions were reported to have clinically a velvety surface and these correlated with the peculiar histopathological finding. Otherwise, IEMP is an epidermal hypermelanotic condition with basal cell melanization. The condition is self-limiting and has been reported to disappear spontaneously in months to years. [5] However, a solitary report of a case of IEMP has been reported for 21 years duration with one recurrence. [6]

The cases are reported for rarity in literature and to underscore the clinical suspicion of this entity in differential diagnosis of pigmented lesions, especially in the first two decades of life.

 
   References Top

1.Degos R, Civatte J, Belaοch S. Idiopathic eruptive macular pigmentation (author's transl). Ann Dermatol Venereol 1978;105:177-82.  Back to cited text no. 1      
2.Milobratovic D, Djordjevic S, Vukicevic J, Bogdanovic Z. Idiopathic eruptive macular pigmentation associated with pregnancy and Hashimoto thyroiditis. J Am Acad Dermatol 2005;52:919-21.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Sanz de Galdeano C, Lιautι-Labrθze C, Bioulac-Sage P, Nikolic M, Taοeb A. Idiopathic eruptive macular pigmentation: report of five patients. Pediatr Dermatol 1996;13:274-7.  Back to cited text no. 3      
4.Joshi R. Idiopathic eruptive macular pigmentation with papillomatosis: Report of nine cases. Indian J Dermatol Venereol Leprol 2007;73:402-5.  Back to cited text no. 4  [PUBMED]  Medknow Journal  
5.Jang KA, Choi JH, Sung KS, Moon KC, Koh JK. Idiopathic eruptive macular pigmentation: report of 10 cases. J Am Acad Dermatol 2001;44:351-3.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  
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;49:280-2.  Back to cited text no. 6      


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]

This article has been cited by
1 Case report: Idiopathic eruptive macular hyperpigmentation. A rare cause of hyper-pigmented macules | [Casereport: Ldiopathische eruptieve maculaire hyperpigmentatie. Een zeldzame oorzaak van hypergepigmenteerde maculae]
Vermander, E., Suys, E.
Nederlands Tijdschrift voor Dermatologie en Venereologie. 2011; 21(8): 428-431
[Pubmed]



 

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    Abstract
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