Gutierrez Paula, Gandhi Kushal, Amakiri Nnana, Garza John, Ventolini Gary
Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA.
The University of Texas Permian Basin, Odessa, TX, USA.
Case Rep Womens Health. 2020 Jun 22;27:e00234. doi: 10.1016/j.crwh.2020.e00234. eCollection 2020 Jul.
Post-inflammatory hypopigmentation (PIH) is an acquired partial or total loss of pigment that occurs as a result of cutaneous inflammation. Clinically, post-inflammatory hypopigmentation is recognized by a discoloration of the skin; however, proper diagnosis requires a skin biopsy. Although post-inflammatory hypopigmentation is similar in appearance to vitiligo, histopathological evaluation highlights the key differences in the presence of melanocytes and melanophages.
A 28-year-old woman presented with discoloration in the vulvovaginal area. Physical examination was within normal limits; however, a genital exam revealed a large, intensely white discoloration in an hourglass pattern involving the clitoris, labia majora, and perianal area. Pigmentation was observed at the base of the hair follicles, which is not consistent with vitiligo. The patient consented to a skin biopsy, which was performed without complication. The biopsy showed mild chronic vulvitis and pigment incontinence due to post-inflammatory hypopigmentation. The patient was prescribed a high-potency topical steroid and a significant reduction in lesion area was observed at 3-month follow-up.
Proper diagnosis via clinical examination and skin biopsy is essential in the treatment of pigment deficiencies. In cases of post-inflammatory hypopigmentation, the initial cause of inflammation must first be identified in order to provide an effective treatment regimen. When facing uncommon dermatological conditions such as post-inflammatory hypopigmentation, proper histopathological diagnosis, course of treatment, and follow-up are important in order to achieve patient satisfaction.
炎症后色素减退（PIH）是一种后天性的部分或全部色素脱失，由皮肤炎症引起。临床上，炎症后色素减退通过皮肤变色得以识别；然而，准确诊断需要进行皮肤活检。尽管炎症后色素减退在外观上与白癜风相似，但组织病理学评估突出了黑素细胞和噬黑素细胞存在方面的关键差异。
一名28岁女性因外阴阴道区域变色前来就诊。体格检查正常；然而，妇科检查发现阴蒂、大阴唇和肛周区域呈沙漏状出现大片明显的白色变色。在毛囊根部观察到色素沉着，这与白癜风不符。患者同意进行皮肤活检，活检过程顺利。活检显示为轻度慢性外阴炎以及炎症后色素减退所致的色素失禁。给患者开了强效外用类固醇药物，在3个月的随访中观察到皮损面积显著减小。
通过临床检查和皮肤活检进行准确诊断对于色素缺乏症的治疗至关重要。对于炎症后色素减退病例，必须首先确定炎症的初始原因，以便提供有效的治疗方案。面对炎症后色素减退等不常见的皮肤病时，正确的组织病理学诊断、治疗过程及随访对于让患者满意很重要。
