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The term "partial albinism" is properly used only of persons in whose skin the pigment content is universally reduced though not completely absent; "albinoidism" is the correct designation for patchy congenital leukoderma (piebald Negro). In the literature one finds references to "yellow" and "red" (xanthic) Negroes, and the connection of their abnormality with albinism is inferred from their family histories. In the 2 cases herein reported there is presented further evidence of the relationship between albinism and xanthism by the fact that both men had congenital nystagmus not referable to an absence of pigment from the eye. Such nystagmus is, of course, an integral part of the picture of albinism. XANTHISM Xanthism was originally described by Turner, 1 and it has been discussed by Pearson, Nettleship and Usher 2 and Stannus. 3 Strictly, the term is used of Negroes whose skin and hair have a reddish color, but

To the Editor.— Hypomelanosis from an antioxidant in polyethylene film was recently reported in theArchivesby Vollum ( 104 :70-72, 1971). Two Negro children were described who developed hypomelanosis associated with prolonged occlusive steroid therapy. The author indicates that the leukoderma was secondary to butylated hydroxytoluene (BHT) which Dr. Vollum admits is commonly used in plastics and edible fats but is not known to be a common sensitizer. The polyethylene film does not contain any hydroquinones or other depigmenting agents. An inconsistency appears when the author states that comparison of the two polyethylene formulas shows that BHT is not related chemically to monobenzone (a well-known depigmenting agent). "It seems likely, therefore, that BHT was responsible for the hypomelanosis." Patch tests were performed with 0.5%, 1%, and 5% BHT although the concentration of BHT in polyethylene film is only 0.02%. Despite the failure to reproduce the clinical picture, the author

The case to be described, which has been under my observation for about two years, presents certain abnormalities of pigmentation together with a mild degree of lichenification. In the present instance, the two conditions appear to be associated only, without any evident etiologic connection. As Lindberg 1 observed, an etiologic connection between leukoderma and many pathologic conditions has been implied, simply because the latter have been found in many patients presenting leukoderma. REPORT OF CASE History.— A stenographer, aged 18, of Canadian birth and parentage, first seen in April, 1926, complained of spots on the back of the neck and on the thorax which were discolored, rough and itchy. It was learned that since early childhood light-colored areas surrounded by skin of a deeper color than normal had been appearing on different parts. Some disappeared and others persisted. One of these which had been present for a long time was

Introduction Lightening pigmented blemishes with a bleaching agent has never been very satisfactory. This study was undertaken in an effort to develop a safe and effective bleaching cream. The unpredictability of bleaching coupled with the frequently alarming progression of the bleaching effect of monobenzylether of hydroquinone (MBH), even after applications have been discontinued, is now well established. 1,2 Even in much lower concentrations of MBH than is generally recommended, leukomelanoderma has been observed with significant frequency. 3 The complete loss of pigmentation in a therapeutically induced leukoderma after the use of MBH is especially traumatic to the patient, as well as being most disconcerting to the physician. The correction of these leukodermatous changes has proven to be particularly stubborn. 8-Methoxypsoralen (8-MOP) has been disappointing in its effectiveness as a treatment. 4 Methods This report is based on the results of a 21/2-year study of hydroquinone and 2 of its derivatives

In a Negro woman with long-standing leukoderma that followed a chemical burn, nine 1- and 2-mm diameter normal-skin autografts were transplanted into the leukodermic site. The grafts retained their pigment-forming capacity and showed temporary hyperpigmentation. The "pigment spread phenomenon" was evidenced by 1-mm wide zones of melanosis that developed around each autograft in the leukodermic skin. The melanotic annulus about the first autograft has thus far persisted for two years. The observations indicate donor autograft dominance in leukoderma in contradistinction to recipient site dominance in vitiligo.

The presence of vitiligo in association with leukoderma centrifugum acquisitum (Sutton Sr.) is very uncommon, 1 and might be attributed to more than a mere coincidence. The following case is reported because of the rarity of vitiligo with leukoderma centrifugum acquisitum and to further stimulate our interest in the broad field of melanogenesis and leukoderma. Report of a Case Child, aged 10 years, white. Parents have been aware of a pigmented nevus on her right scapular area as well as smaller pigmented nevi on her chest and left thigh all of her life. However, since May, 1956, the "mole" on the right scapular area began to enlarge, became pink in color and crusted, and was surrounded by a gradual enlarging area of leukoderma (Fig. 1). Coincidentally a small halo of leukoderma appeared over the small pigmented nevus on her mid left thigh posteriorly. Since August, 1956, new lesions of

IN 1916 Sutton 1 called attention to a leukopigmentary anomaly which he named leukoderma acquisitum centrifugum. Hyde 2 is credited by Sutton in his textbook with first recognizing the disease when he presented a case before the Chicago Dermatologic Society in 1906 under the title "Vitiligo With a Central Mole." However, Hebra and Kaposi 3 mentioned the phenomenon in their textbook as early as 1874. In a general discussion of vitiligo they spoke casually of vitiligo that formed around preexisting nevi, and they cited other authors as to the causal role of injury, pressure, burns and constitutional disease in depigmentations. In 1910 Rolleston 4 noted and recorded the anomaly in a patient who was suffering from abdominal carcinomatosis. This patient was jaundiced, and the vitiliginous area surrounding the nevus was observed to take the yellow discoloration. In 1915 Almkvist 5 described a case of this sort, but called the achromic

To the Editor: D. E. Vander Ploeg and J. J. Stagnone describe inArch Derm90:172, 1964, two cases in which alopecia of the eyebrows was present without associated syphilitic skin or mucous membrane lesions. In the old days this was much more common than now. To the French syphilologists this sign was very well known and they called it Signe d'Omnibus . 1 It is unfortunate that the authors do not mention whether any leukoderma was present or whether any pathological findings could be traced in the cerebrospinal fluid (which is common in these cases). From the author's photos I could not determine whether any alopecia of the eyelashes was present (they do not mention anything in their paper). Alopecia of the cilia is much rarer but very characteristic. Ordinarily the eyelashes of the upper eyelids are affected. Felix Pinkus 2 in a monograph describes the syphilitic alopecia of the

A 9-year-old mentally retarded girl had a systematized leukoderma in the configuration of whorls and streaks that began during the first year of life. No other family members were affected. Histologic examination of a hypopigmented area revealed decreased amount and patchy distribution of melanin in the basal layer of the epidermis. There was no loss of pigment into the underlying dermis. The clinical and histologic features of this case correspond to those previously reported in the Japanese and European literature as incontinentia pigmenti achromians (Ito). Although certain clinical features of this rare syndrome are similar to those found in incontinentia pigmenti (Bloch-Sulzberger), the relationship between the two remains unproved. At present it seems best to consider incontinentia pigmenti achromians as a variant of hypochromic nevus even as Ito did in describing the original case.

Anal Chancre. Presented by Dr. Parounagian. P. K., a man, a Greek, aged 31, was seen at the Bellevue Clinic for the first time on the day of presentation. He gave a history of penile chancre three years previously, for which he had been treated with twelve injections of arsphenamine. There had not been any further manifestations of the disease until two months before presentation, when a generalized roseola occurred. A hard, elevated, round lesion, the size of a dime, was detected near the anal orifice. The patient admitted sodomy three or four months previously. The glands below Poupart's ligament were markedly swollen, and there was an unusually pronounced general adenopathy. The patient indulged freely in alcohol and complained of severe headaches. The case was presented as one of possible reinfection with syphilis. Leukoderma Syphiliticum. Presented by Dr. Parounagian. W. W., a colored man, aged 33, was admitted to the

DERMATITIS due to use of synthetic rubber gloves is infrequent. For patients with so-called "housewife's" eczema of the hands, dermatologists frequently recommend the use of cotton or fabric-lined rubber gloves for household chores. A recent experience suggests that this recommendation carries with it added risks as well as safeguards, and the following case is reported to emphasize the risk. REPORT OF CASE G. T., a 40 year old white housewife, was seen on Sept. 27, 1949, complaining of an extremely pruritic dermatitis of the forearms and wrists of 10 days' duration. Examination revealed a patchy, erythematous, edematous, vesicular dermatitis of the lower two thirds of the flexor aspects of both forearms, the wrists and the dorsal surfaces of several fingers of both hands. Since the distribution of the eruption was suggestive of a contact dermatitis, the patient was questioned in detail regarding possible contact factors. It was learned that the

Bilateral areas of persistent leukoderma1-4(Fig. 1) resulting from the clinical evaluation of 1% to 10% monobenzyl ether of hydroquinone (MBH) offered an ideal control study for evaluating the effectiveness of 8-methoxypsoralen (8-MOP)*in restoring pigmentation. Nine Negro male subjects with extensive areas of leukoderma on the flexoral surfaces of both forearms, persisting 21/2 years after MBH, were treated for a total of 8 months. For the first 4 months a 5-day weekly schedule of 30 mg. of 8-MOP was followed after 2 hours by exposure with ultraviolet light (Burdick hot quartz Hospital Model LA640) to the flexoral surface of the right forearm. A target distance of 10 inches with a 10-minute exposure was maintained after the first 2 weeks. For the next 4 months the flexoral surface of the left forearm was exposed to ultraviolet light 5 days weekly in the same manner but without the preceding dose

The term morphea 1 was used as an appellation for areas of leukoderma and maculo-anesthetic leprosy in the seventeenth and early eighteenth centuries. Erasmus Wilson was the first to restrict the term to plaques of tallow-like hardening of the skin, which he believed were vestigial evidences of true leprosy, 2 distinguishing two types, morphoea alba lardacea and morphoea alba atrophica. The earliest reported case of generalized hardening of the skin was one described by Carlo Curzio 3a in 1753 as an instance of ichthyosis corii, which occurred in a patient at his clinic in the Royal Hospital for Incurables at Naples. This case was reported in English by William and Robert Watson 4 in 1754, the latter having seen Curzio's patient. Curzio's monograph was translated into French 3b in 1755. Willan had never observed generalized scleroderma, but he referred to Curzio's case in his textbook on cutaneous diseases (1808)

A patient had multiple congenital giant nevocellular nevi all of which had halos but none of which regressed. This unusual phenomenon was studied histochemically and ultrastructurally in an attempt to compare this process with ordinary halo nevi and other known leukodermatous disorders. Histochemical studies demonstrated a decrease in melanin and tyrosinase activity in the area of the halo. Although the relative frequency of clear cells in the halo remained normal, electron microscopy revealed an increased density of Langerhans cells in the hypochromic zone and a variable deficit in the number of melanocytes. Ultrastructurally these melanocytes were markedly deficient in melanized melanosomes. These results suggest that either we may be dealing with an unusual form of leukoderma acquisitum centrifugum or a variant of one of the other congenital leukodermatous diseases.

In a review of the literature we have found reports of leukoderma following many dermatologic conditions, 1 but so far as we were able to search, there is no recorded case following dermatitis venenata. REPORT OF CASE H. W., a man, white, aged 30, a salesman, born in the United States, was referred to us on Aug. 20, 1924, for treatment of his skin condition. On June 15, the patient developed "ivy poisoning," at which time he consulted his family physician, Dr. Paul Baurberger, Yonkers, N. Y. At this time the patient had a characteristic eruption of dermatitis venenata involving the face, neck, arms and hands. He was treated with wet dressings for twelve hours. The following day the condition was so much improved that further treatment was suspended. In a short time all the lesions healed completely and left no visible traces. (The patient believed that he had had

Modern textbooks are nearly unanimous in asserting that no form of therapy has any effect on vitiligo. Andrews1bluntly states: "No treatment has the slightest effect upon leukoderma." Pusey2asserts that "treatment is ineffective." Stelwagon3questions how far treatment influences the course of the disease and thinks that the outlook for recovery is not encouraging. Sequeira4believes that the disease is little influenced by treatment. In the past several years articles have appeared that offer hope for a cure of vitiligo. Lindsay5reported excellent results with the use of gold sodium thiosulphate injected intravenously. Nadel6cured a patient by intravenous and oral administration of acridine dyes followed by exposures to ultraviolet rays. He based his treatment on the ability of the acridine dyes to sensitize persons to sunlight. Riviere7suggested that ultraviolet rays enlarge the small blood vessels and facilitate the diapedesis of

In November, 1916, Sutton 1 reported two cases of a peculiar form of depigmentation to which he gave the name leukoderma acquisitum centrifugum. This modification of vitiligo consisted in an oval or circular depigmented lesion, having at its center "a minute rounded, slightly elevated brownish maculopapule which resembled a small pigmentary nevus, which the patient said had been present only since the onset of the attack. The hyperpigmented areola commonly found in vitiligo was absent. The lesion had developed slowly and has never given rise to subjective symptoms of any kind." On histologic examination, Sutton believed that he recognized a collection of endothelial cells in the derma, which he interpreted as an infiltration. Treatment for one year was without effect. Sutton's report aroused my interest, and during the last six years I have been on the lookout for similar cases with a view to defining more sharply the histologic and

In 1916 Sutton reported two cases of a condition which he considered to be an unusual variety of vitiligo, and he named the disease leukoderma centrifugum acquisitum.1In one case there was one oval patch, in the exact center of which was a small round elevated brownish maculopapule. It resembled a small pigmented nevus and, according to the statement of the patient, had been there only since the onset of the attack, which dated back three years. There was no hyperpigmented areola surrounding the patch of vitiligo. The second patient had four lesions which were similar to the one described. Two of the lesions were faint and almost imperceptible; the mother of the patient stated that originally one of these patches was much more distinct but that it had gradually regained some of its color. On microscopic examination Sutton noted an increase of pigment in the basal layer

Although leukoderma acquisitum centrifugum has usually been described in association with pigmented nevi, a survey of the literature reveals that this condition occurs with psoriasis, 1 senile verruca, 2 fibroma, 3 papular sarcoid 1 and vascular nevus. 4 Feldman and Lashinsky 5 have recently reviewed the literature and reported five cases in which leukoderma acquisitum centrifugum occurred in association with moles. For this association they suggested the name halo nevus. No report could be found in the literature of the occurrence of leukoderma acquisitum centrifugum in association with lichen planus. The following case is therefore believed to be of interest: REPORT OF CASE Mrs. H. F., aged 48, consulted me because of a generalized itching eruption which, she stated, had appeared suddenly about two months previously on the trunk and the extremities and had gradually spread. The pruritus was severe at times and interfered with sleep. There was no history

A percentage of cases of leukoderma are secondary to fungous infections, to specific diseases such as syphilis and leprosy and to many scaly eruptions such as psoriasis and ringworm. It can also be produced in certain persons by contact with various irritants such as plants, chemicals or even the rays of the sun. Sun rays, therefore, may be accountable for the prevalence of the disease among the inhabitants of tropical regions. Altered photosensitivity plays a more important part in the production of leukoderma than would be ordinarily suspected. With relatively few exceptions, the exposed parts of the body represent the preponderance of areas involved in early cases of leukoderma. It is not unusual, however, to see spots of the disease on other parts of the body. Gupta1was of the opinion that the phenomenon is due to allergy. The disease has been known to occur from conditions that produce

A case is presented of a 9-year-old girl who developed a depigmented halo around a pigmented tumor of the skin on her shoulder. She also developed widespread metastases in the ipsilateral axillary lymph nodes, lungs, and, presumably, liver, and subsequently died of her disease. Histologic interpretations of the nature of the cutaneous tumor and axillary metastases are given and the suggestion made that the skin lesion was a malignant melanoma. Should this interpretation be correct, this case represents the first of its kind in which a lesion in a child with the clinical features of a halo nevus proved to be a fatal malignant melanoma.

Congenital leukoderma is described in all textbooks under the name of partial albinism. The condition consists of achromic patches, irregularly distributed and often symmetrically situated. These patches are milky white, closely resembling those of vitiligo. Congenital leukoderma differs from vitiligo in being present at birth, in being hereditary with approximately the same distribution in all subjects of the same family, in the absence of peripheral pigmentation and in being fixed, neither growing nor diminishing in size in later years. The cases reported were seen through the courtesy of Dr. J. A. Tremols of Havana. The patients were a mother and three children, 32, 4, 3 years and 8 months of age, respectively, all white, from direct Spanish ancestors, the possibility of any admixture of colored blood being carefully excluded. All of them presented extensive achromic patches over the chest, abdomen, legs and arms, of similar size and shape. In the

It has long been known that the darker-skinned races are sometimes affected with leukoderma. Such stories as the one occasionally heard of the "Negro who turned white" no doubt originated from the rare cases of extensive depigmentation. The following is apparently the first report of a case of complete leukoderma : A mulatto, aged 55, came to the medical service complaining of pain in both knees, following an old bilateral compound fracture of both legs with resultant bowing. His peculiar white appearance at first suggested an unusually severe anemia, although he was not weak or short of breath and the mucous membranes were of good color. The blood was reported to be normal, and the Hinton, Wassermann and Kahn tests were also negative. The patient then volunteered the following explanation for his whiteness: Until the age of 35, he had the ordinary brown skin of a mulatto. At that time, following a scratch on the