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Review
. 2021 Aug 2;12(5):663-673.
doi: 10.4103/idoj.IDOJ_881_20. eCollection 2021 Sep-Oct.

Acquired Dermal Macular Hyperpigmentation: An Update

Keshavamurthy Vinay  1 , Anuradha Bishnoi  1 , Divya Kamat  1 , Debajyoti Chatterjee  2 , Muthu Sendhil Kumaran  1 , Davinder Parsad  1
Affiliations
Review

Acquired Dermal Macular Hyperpigmentation: An Update

Keshavamurthy Vinay et al. Indian Dermatol Online J. .

Abstract

Acquired dermal macular hyperpigmentation (ADMH) is an umbrella term that includes disorders clinically characterized by small and large pigmented macules/patches and histopathologically showing an evidence of current or resolved interface dermatitis with pigment incontinence, without clinically significant prior inflammatory phase. The term intends to include diseases previously described in the literature as lichen planus pigmentosus, Riehl's melanosis/pigmented cosmetic dermatitis and ashy dermatosis/erythema dyschromicum perstans. The nomenclature and origin of these disorders have always been a matter of discussion. These disorders share many clinicopathological similarities, are difficult to treat and adversely affect the quality of life. Recent consensus points towards the need for a unifying term to facilitate research and therapeutic trials. This article aims to provide a comprehensive review of the recent advances in ADMH.

Keywords: Acquired dermal macular hyperpigmentation; Reihl's melanosis; ashy dermatosis; erythema dyschromia perstans; lichen planus pigmentosus; pigmented cosmetic dermatitis.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a-c) A case of lichen planus pigmentosus typically showing photo-distributed lesions with involvement of the V area of the neck and upper back followed by an abrupt cut-off. Photo-protected areas, including the upper eyelids, infra-orbital area and chin, are relatively spared
Figure 2
Figure 2
(a) Flexural lichen planus pigmentosus involving the infra-mammary area (b) co-existing vitiligo with lichen planus pigmentosus (c) lichen planus pigmentosus associated with frontal fibrosing alopecia
Figure 3
Figure 3
Cases of Blaschkoidal lichen planus pigmentosus. (a) A middle-aged lady with classical lichen planus pigmentosus of upper back with Blaschkoidal lesion over lower back, which were extending to the right upper arm. She also had involvement of face and infra-mammary areas. (b) Blaschkoidal lichen planus pigmentosus over the chest
Figure 4
Figure 4
(a) Palmo-plantar involvement in lichen planus pigmentosus. (b) The patient also had typical lesions of lichen planus pigmentosus over face and axilla
Figure 5
Figure 5
(a) Case of lichen planus pigmentosus showing sparing of the ears (b) pigmented contact dermatitis to hair dye showing predominant involvement of helix of the ear and ear lobule
Figure 6
Figure 6
A case of pigmented contact dermatitis to mehendi. (a) Diffuse brownish-black discoloration with characteristic involvement of the lobule of the ear. Note can also be made of colored hair (b) Same patient showing patch-test positivity (2+) to para-phenylenediamine. Photo-patch test (right side) showing photo-aggravated contact dermatitis (3+)
Figure 7
Figure 7
(a and b) A case of erythema dyschromicum perstans showing discrete round to oval pigmented macules over trunk and proximal extremities. Subtle erythema surrounding the pigmented macules can be appreciated
Figure 8
Figure 8
Dermoscopic grades of acquired dermal macular hyperpigmentation. (a) Grade 1: Predominantly, pigment dots situated discreetly without any pattern arrangement (b) Grade 2: Pigment dots and globules coalescing with each other in a broken netlike/Chinese letter pattern (c) Grade 3: Pigment dots and globules showing well-formed netlike pattern (d) Grade 4: Diffuse involvement with pigment dots, globules and blotches, sparing just the eccrine and sebaceous gland openings
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References

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