INTRODUCTION
Dyschromia is often the result of an external or internal insult to the skin.1 It is a concern for many patients, especially persons of color.2,3 In black patients, dyschromia is a common diagnosis and substantially affects their quality of life.2-4 Current literature focuses on post-inflammatory hyperpigmentation and treatment options. However, literature on etiologies of secondary hypopigmentation and depigmentation is sparse.1 Hypopigmentation and depigmentation can affect all skin tones; they are more apparent in darker skin.1 Literature suggests several diseases that may present with hypopigmentation and/or depigmentation despite this not being a major criterion for these conditions.5-11 Inflammation associated with atopic dermatitis (AD) may result in hypopigmented change and has been reported in several cases.5-7 There have been three reports of lichen planus (LP) presenting in skin of color as hypopigmented macules.8 Hypopigmentation is unusual for LP as it presents classically with hyperpigmentation.8 Discoid lupus erythematosus (DLE) often presents with erythema, induration, and follicular plugging.9 Presentation of DLE as depigmentation has been reported in seven cases and remains a rarely reported occurrence.9-11 Similarly, scleroderma-associated depigmentation has also been reported.12-15 Here, we present three cases of atypical dyschromia in skin of color to highlight the underlying hypo- and depigmentation that may present with active disease and persist despite appropriate treatment.
Report of a Case of Depigmentation From AD
Report of a Case of Depigmentation From AD
A 66-year-old African American woman presented to our clinic for a complete body examination of AD. She reports that her AD started around age 52 at menopause, with itching on the legs. Her AD worsened in the past 2-3 years and was particularly bothersome in the summer. She had been treated previously at an outside dermatology office and had tried Dupilumab for a short time; she developed a rash and stopped this medication. She had also tried ultrapotent topical steroids, and topical calcineurin inhibitors, none of which controlled her pruritus or outbreaks.
Pertinent findings on skin exam included lichenified scaling hyperpigmented plaques on the upper arms from the upper arm to the wrists. The anterior shins showed severe lichenification and hypopigmented linear vertical plaques. Her presentation was consistent with severe atopic dermatitis. She was started on Methotrexate systemically which gave her improved control of her pruritus and atopic flares. On subsequent visits, depigmentation was persistent on her shins despite improved control of her disease (Figure 1).
