Blossom Jessin, Altmayer Stewart, Jones David M, Slominski Andrzej, Carlson J Andrew
Division of Dermatology, Albany Medical College MC-81, 47 New Scotland Avenue, Albany, NY 12208, USA.
Am J Dermatopathol. 2008 Dec;30(6):612-9. doi: 10.1097/DAD.0b013e318184bc57.
Volar melanotic macules are asymptomatic, tan-brown to brownish-black macules found on the palms, fingers, soles, and/or toes of dark-skinned individuals and are infrequently reported in light-skinned individuals. Herein, we report the acquisition of multiple, brownish-black volar digital macules in a 63-year-old white woman and avid gardener that were noted after the onset of pruritic, chronic hand dermatitis over a 10-month period. She was healthy without any medical conditions or medications. No family history of intestinal polyposis or mucosal melanosis existed. At presentation, she had less than 20 brownish-black, 2- to 10-mm irregular macules over the volar aspect of the thumbs and index fingers, left greater than right hand, associated with erythema, scale, and a negative potassium hydroxide examination. In addition, she had melanotic macules of her lips, buccal mucosa, and conjuctiva. No nail or anogenital macules were found. Biopsy demonstrated a region of epidermal hyperplasia, hyperkeratosis, and interface dermatitis associated with melanophages and sparse lymphocytic infiltrate. Melanin staining revealed diffuse pan-epidermal hypermelanization, dermal melanin, and dendritic melanocytes, which expressed HMB-45. After 1-year follow-up and treatment with topical corticosteroid, the volar macules have faded to tan brown. Based on the location, avocation, and coexisting mucosal melanotic macules, an irritant phytodermatitis with postinflammatory hyperpigmentation was diagnosed in the setting of Laugier-Hunziker syndrome-a disorder denoted by macular hyperpigmentation of nail, volar, and/or mucosal surfaces in healthy adults. Volar melanotic macules can also complicate 5-flourouracil therapy, tinea pedis, and other inflammatory disorders; be associated with acral melanomas; or represent a cutaneous manifestation of systemic disease such as Addison disease, Peutz-Jegher syndrome, Leopard syndrome, Carney syndrome, AIDS, and neurofibromatosis.
掌部黑素沉着斑无症状，为棕褐色至棕黑色斑，见于深色皮肤个体的手掌、手指、足底和/或足趾，在浅色皮肤个体中鲜有报道。在此，我们报告一名63岁的白人女性，她是一名园艺爱好者，在10个月内出现瘙痒性慢性手部皮炎后，手部出现多个棕黑色掌部指端斑。她身体健康，无任何疾病或正在服用药物。无肠道息肉病或黏膜黑素沉着症家族史。就诊时，她双手拇指和示指掌侧有不到20个棕黑色、2至10毫米不规则斑，左手多于右手，伴有红斑、鳞屑，氢氧化钾检查阴性。此外，她的嘴唇、颊黏膜和结膜有黑素沉着斑。未发现甲部或肛门生殖器斑。活检显示表皮增生、角化过度及界面性皮炎区域，伴有噬黑素细胞和稀疏淋巴细胞浸润。黑色素染色显示弥漫性全表皮色素沉着增加、真皮黑色素及表达HMB-45的树突状黑素细胞。经过1年随访及外用糖皮质激素治疗后，掌部斑已退为棕褐色。基于病变部位、职业及并存的黏膜黑素沉着斑，在Laugier-Hunziker综合征背景下诊断为刺激性植物性皮炎伴炎症后色素沉着，该综合征表现为健康成年人甲部、掌部和/或黏膜表面出现斑状色素沉着。掌部黑素沉着斑也可使5-氟尿嘧啶治疗、足癣及其他炎症性疾病复杂化；与肢端黑色素瘤相关；或代表系统性疾病如艾迪生病、黑斑息肉综合征、豹皮综合征、卡尼综合征、艾滋病和神经纤维瘤病的皮肤表现。
