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Nuttaporn Nuntawisuttiwong,* Punyanut Yothachai,* Teerapat Paringkarn, Chayada Chaiyabutr, Chanisada Wongpraparut, Narumol Silpa-archa Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand*These authors contributed equally to this workCorrespondence: Narumol Silpa-archa, Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, Tel +66 2419 4333, Email doctornarumol@gmail.comBackground: The autologous non-cultured melanocyte–keratinocyte transplantation procedure (MKTP) has emerged as an effective treatment for various types of vitiligo and leukodermas. However, there is limited data on the long-term outcomes of the MKTP, especially in Thai patients.Objective: To assess the long-term efficacy and safety of the MKTP in patients with vitiligo and other leukodermas.Methods: This retrospective observational study analyzed data from 23 patients who underwent the MKTP for vitiligo and other leukodermas at the Siriraj MKTP Clinic, Thailand, and had a follow-up period exceeding 12 months. Clinical characteristics and MKTP specifics were evaluated. Repigmentation outcomes were assessed using the Vitiligo Area Scoring Index (VASI).Results: Of the 23 patients (24 treated lesions), 78.3% had segmental vitiligo, while the others had nevus depigmentosus, nonsegmental vitiligo, or piebaldism. Most lesions (70.8%) were located on the face. At the 12-month follow-up, repigmentation showed an 80.8% ± 19.3% VASI improvement, which was sustained over 84 months with an 80%– 90% VASI improvement. There was no statistically significant difference in repigmentation outcomes between facial and non-facial lesions.Conclusion: The MKTP demonstrated long-term efficacy and safety in treating vitiligo and other leukodermas, with sustained repigmentation over 84 months. These findings support the use of the MKTP as an effective treatment option for patients with refractory vitiligo and leukodermas, particularly within Thai populations.Keywords: autologous non-cultured epidermal suspension, melanocyte–keratinocyte transplantation procedure, nevus depigmentosus, piebaldism, repigmentation, vitiligo

Introduction: Non-vitiligo hypopigmented skin lesions may be close clinical mimickers of vitiligo, resulting in a diagnostic dilemma. Dermoscopic features of vitiligo have been studied, but those of other hypopigmentation disorders are not well-characterized. Objectives: We aimed to describe and compare the dermoscopic features of vitiligo and other hypopigmented skin lesions. Methods: A cross-sectional study including 105 vitiligo and 137 other hypopigmented skin lesions, including ash-leaf macules (n=17), nevus depigmentosus (n=16), post-inflammatory hypopigmentation (n=16), pityriasis alba (n=15), pityriasis versicolor (n=14), idiopathic guttate hypomelanosis (IGH) (n=14), lichen sclerosus (n=12), leprosy (n=9) and others. Dermoscopic findings were recorded by concordance of at least 2 qualified dermatologists. Results: Common dermoscopic findings in vitiligo were intermediate or ill-defined margins (96/105, 91.4%), and a complete absence of pigment network (70/105, 66.7%). Nevus depigmentosus lesions were mostly hypopigmented with a faint pigment network throughout the lesion. In 15/17 (88.2%) ash-leaf macules, a characteristic pattern of sharply demarcated areas of normal pigment network was seen within a depigmented lesion. Almost all lesions of IGH had a sharply defined margin with completely absent pigment network; discernible eccrine openings within the lesion were seen in 9/14 (64.3%). Dermoscopic findings of a complete absence of pigment network, perifollicular retention of pigment, presence of vascular pattern, loss of discernibility of eccrine openings within the lesion and lack of scaling were statistically significantly more common in vitiligo than other hypopigmented skin lesions (p

A nevus is characterized by collection of partially differentiated or well-differentiated cells normally found in the skin. Some nevi are associated with disorders such as autism, epilepsy, ophthalmogical disorders, intracranial abnormalities, and others. In this case series, we aim to analyze six cases with congenital nevus, matched our findings with case reports published and reviewed the literature, to come to a conclusion that would help the clinician to do focused clinical examination and investigations when they come across such nevi. Furthermore, as these sort of skin lesions cause psychological morbidity to both parents and patients, proper counseling is required along with dermatological therapy and treatment of comorbid conditions. As well as regular follow-up with monitoring of the lesions. The following are the cases: Case-1, is a case of congenital melanocytic nevi who presented with delayed milestone, epilepsy and neuroimaging revealed intracranial melanosis. Case-2 nevus of Ota on face with scleral nevus and glaucoma in the left eye. In Case-3: Nevus achromicus was present over the abdomen and scalp in a child who presented with status epilepticus and there was focal cortical dysplasia of left frontal cortex on imaging. Nevus sebaceous was present in case-4 who had seizure disorder but neuroimaging was normal. Case-5 child had nevus spilus over left frontal area with melanocytic satellite nevi who presented with febrile convulsion but normal neuroimaging. The sixth case is a 5-year-old male child with linear nevus without any other association.

Background Nevus depigmentosus (ND) is one of the pigmentary conditions that is characterized by a hypopigmented patch with an irregular border. It is usually present at birth or shortly after birth. It is not a progressive condition, but it may increase in size in proportion to the growth of the body. Despite many treatment modalities, there is no effective treatment for this condition. Objective To review all articles about the treatment options for ND. Methods Pubmed database were searched for this study, and relative clinical trials were included in the review. Descriptive findings, including age, gender, and treatment modality and response, were reported. Results A total of 62 articles were identified, and 16 relevant articles were included in this review after screening and removing the duplicates. Conclusion In the literature, a limited number of treatment modalities have been employed for ND. Among these, surgical interventions and phototherapy have been the most commonly studied, but their efficacy has varied. Unfortunately, there is no definitive cure for ND, and recurrence of the lesion is not an uncommon occurrence even after complete clearance. Furthermore, there is a dearth of large-scale clinical studies that comprehensively analyze the different treatment modalities for ND.

A nevus is characterized by collection of partially differentiated or well-differentiated cells normally found in the skin. Some nevi are associated with disorders such as autism, epilepsy, ophthalmogical disorders, intracranial abnormalities, and others. In this case series, we aim to analyze six cases with congenital nevus, matched our findings with case reports published and reviewed the literature, to come to a conclusion that would help the clinician to do focused clinical examination and investigations when they come across such nevi. Furthermore, as these sort of skin lesions cause psychological morbidity to both parents and patients, proper counseling is required along with dermatological therapy and treatment of comorbid conditions. As well as regular follow-up with monitoring of the lesions. The following are the cases: Case-1, is a case of congenital melanocytic nevi who presented with delayed milestone, epilepsy and neuroimaging revealed intracranial melanosis. Case-2 nevus of Ota on face with scleral nevus and glaucoma in the left eye. In Case-3: Nevus achromicus was present over the abdomen and scalp in a child who presented with status epilepticus and there was focal cortical dysplasia of left frontal cortex on imaging. Nevus sebaceous was present in case-4 who had seizure disorder but neuroimaging was normal. Case-5 child had nevus spilus over left frontal area with melanocytic satellite nevi who presented with febrile convulsion but normal neuroimaging. The sixth case is a 5-year-old male child with linear nevus without any other association. [ABSTRACT FROM AUTHOR]

Nevus depigmentosus (ND) is one of the pigmentary conditions that is characterized by a hypopigmented patch with an irregular border. It is usually present at birth or shortly after birth. It is not a progressive condition, but it may increase in size in proportion to the growth of the body. Despite many treatment modalities, there is no effective treatment for this condition. To review all articles about the treatment options for ND. Pubmed database were searched for this study, and relative clinical trials were included in the review. Descriptive findings, including age, gender, and treatment modality and response, were reported. A total of 62 articles were identified, and 16 relevant articles were included in this review after screening and removing the duplicates. In the literature, a limited number of treatment modalities have been employed for ND. Among these, surgical interventions and phototherapy have been the most commonly studied, but their efficacy has varied. Unfortunately, there is no definitive cure for ND, and recurrence of the lesion is not an uncommon occurrence even after complete clearance. Furthermore, there is a dearth of large-scale clinical studies that comprehensively analyze the different treatment modalities for ND. [ABSTRACT FROM AUTHOR]

Waardenburg Syndrome (WS) is a condition characterized by pigmentary changes of the hair or skin, hearing loss, heterochromia iridis, and dystopia canthorum. There are four main types of WS, which can be commonly caused by mutations in the PAX3, MITF, EDNRB, EDN3, SNAI2, or SOX10 genes. Herein, we present a patient with Waardenburg Syndrome type 2 with no findings of mutations in the commonly associated genes.

A 19-year-old female presented with off-white colored depigmented macules over her laft fore arm. A clinical diagnosis of nevus depigentosus was made. As the patient had cosmetic concern regarding that lesion, she was treated with noncultured epidermal suspension technique. She had more than 90% repigmentation after 6 months of the procedure and the pigment was retained at 1-year follow-up. We also discussed briefly regarding the available literature on surgical treatment options. [ABSTRACT FROM AUTHOR]

Melanocyte-keratinocyte transplantation procedure (MKTP) is an effective surgical technique for restoring skin pigmentation in all types of vitiligo and leukoderma patients who are unresponsive to medical and/or phototherapy treatment. Data specific to the outcomes of MKTP among Thai vitiligo and nevus depigmentosus patients are currently scarce. To evaluate the efficacy and safety of MKTP in patients with vitiligo or nevus depigmentosus at the short-term (≤6 months) and long-term (≥12 months) follow-up. A retrospective review of the medical records of vitiligo or nevus depigmentosus patients who underwent MKTP at the Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during 2016 to 2019 was conducted. Repigmentation outcomes were evaluated by Vitiligo Area Scoring Index (VASI). Twenty-five patients had 27 MKTP surgeries on 32 anatomically-based lesions. The mean age was 32.4 years, the mean age at onset was 25.5 years, and 19 patients were male. Segmental vitiligo, non-segmental vitiligo, and nevus depigmentosus had significantly improved VASI scores at the short-term follow-up (−74.2% ± 23.2%, −100%, and −62.5% ± 17.6%, respectively) and the long-term follow-up (−81% ± 27.7%, −95.0% ± 7.0%, and −83.3% ± 14.4%, respectively). MKTP is a safe and effective method for treating refractory vitiligo and nevus depigmentosus in Thai patients. [ABSTRACT FROM AUTHOR]

Progressive cribriform and zosteriform hyperpigmentation (PCZH) is an uncommon disorder of pigmentation that is believed to be a result of pigmentary mosaicism. In this report, we describe a child with congenital nevus depigmentosus and low intelligence who later developed PCZH by the age of 5 years.

Primary care providers often encounter different types of pigmentary disorders such as vitiligo. This article arms the provider with the most common vitiligo differential diagnoses, with key findings and tips to identify specific hypopigmentary diseases. Readers will be better-prepared to provide safe and effective care and recommend referrals to appropriate specialties. Primary care providers often encounter different types of pigmentary disorders such as vitiligo. This article arms the provider with the most common vitiligo differential diagnoses, with key findings and tips to identify specific hypopigmentary diseases. Readers will be better prepared to provide safe and effective care and recommend referrals to appropriate specialties. [ABSTRACT FROM AUTHOR]

Here, we present a rare case of a patient who developed multiple primary melanomas within the boundaries of two nevi depigmentosa. The melanomas were excised, and as a preventive measure, the remainder of the nevi depigmentosa were removed. We performed whole‐exome sequencing on excised tissue from the nevus depigmentosus, adjacent normal skin, and saliva to explain this intriguing phenomenon. We also performed a GeneTrails Comprehensive Solid Tumor Panel analysis on one of the melanoma tissues. Genetic analysis revealed germline MC1R V92M and TYR R402Q polymorphisms and a MET E168D germline mutation that may have increased the risk of melanoma development. This genetic predisposition, combined with a patient‐reported history of substantial sun exposure and sunburns, which were more severe within the boundaries of the nevi depigmentosa due to the lack of photoprotective melanin, produced numerous somatic mutations in the melanocytes of the nevi depigmentosa. Fitting with this paradigm for melanoma development in chronically sun‐damaged skin, the patient's melanomas harbored somatic mutations in CDKN2A (splice site), NF1, and ATRX and had a tumor mutation burden in the 90–95th percentile for melanoma. [ABSTRACT FROM AUTHOR]

Progressive cribriform and zosteriform hyperpigmentation (PCZH) is an uncommon disorder of pigmentation that is believed to be a result of pigmentary mosaicism. In this report, we describe a child with congenital nevus depigmentosus and low intelligence who later developed PCZH by the age of 5 years. [ABSTRACT FROM AUTHOR]

Hypomelanosis of ito (HI) is a multisystemic disorder characterized by cutaneous, neurologic disorder, and musculoskeletal disorder. However, there may be isolated cutaneous manifestation, resulting in diagnostic overlap with other hypopigmentary lesions such as nevus depigmentosus and hypopigmentation along the lines of Blaschko. Therefore, there is the need for generally acceptable diagnostic criteria avoiding these ambiguities. Hence, the case of a 4-year-old female child with isolated hypopigmentations characterized as whorls on the torso and as linear distribution along the lines of Blaschko is reported.

Background: Hypopigmentary disorders are common group of dermatoses in pediatric age group. Aim: To study the frequency and patterns of hypopigmentary disorders in children. Materials and Methods: This study was a descriptive clinical study spanning over a period of 23 months. A total of 113 children (61 boys and 52 girls) were included in this study. Results: The frequency of hypopigmentary disorders among children was 3.28 per 1000 children attending the dermatology out patient department. The mean age of the children was 7.2 years. The mean of age of onset was 7.36 years. Most common hypopigmentary disorder in our study was pityriasis alba (24.7%), followed by vitiligo (20.4%), leprosy (11.5%), nevus depigmentosus (10.18%), and tinea versicolor (6.2%). Others were hypomelanosis of Ito (5), post-inflammatory hypopigmentation (5), pityriasis rosea (4), steroid-induced hypopigmentation (4), lichen sclerosus et atrophicus (3), pityriasis lichenoides chronica (3), lichen striatus (2), oculocutaneous albinism (2), tuberous sclerosis complex (2), pigmentary mosaicism (1), and Griscelli syndrome (1). Conclusion: Pityriasis alba, vitiligo, leprosy, nevus depigmentosus and tinea versicolor are the five most common hypopigmentary disorders in children.

Hypomelanosis of ito (HI) is a multisystemic disorder characterized by cutaneous, neurologic disorder, and musculoskeletal disorder. However, there may be isolated cutaneous manifestation, resulting in diagnostic overlap with other hypopigmentary lesions such as nevus depigmentosus and hypopigmentation along the lines of Blaschko. Therefore, there is the need for generally acceptable diagnostic criteria avoiding these ambiguities. Hence, the case of a 4-year-old female child with isolated hypopigmentations characterized as whorls on the torso and as linear distribution along the lines of Blaschko is reported. [ABSTRACT FROM AUTHOR]

The article presents abstracts of poster presentations on dermatology, including topics on newborn skin disorders in a dermatology outpatient clinic in Turkey, influence of neonatal and maternal factors on the prevalence of salmon patch, and treatment of diffuse cutaneous mastocytosis with imatinib mesylate.

Background: Hypopigmentary disorders are common group of dermatoses in pediatric age group. Aim: To study thefrequency and patterns of hypopigmentary disorders in children. Materials and Methods: This study was a descriptive clinical study spanning over a period of 23 months. A total of 113 children (61 boys and 52 girls) were included in this study. Results: The frequency of hypopigmentary disorders among children was 3.28 per 1000 children attending the dermatology out patient department. The mean age of the children was 7.2 years. The mean of age of onset was 7.36 years. Most common hypopigmentary disorder in our study was pityriasis alba (24.7%), followed by vitiligo (20.4%), leprosy (11.5%), nevus depigmentosus (10.18%), and tinea versicolor (6.2%). Others were hypomelanosis of Ito (5), post-inflammatory hypopigmentation (5), pityriasis rosea (4), steroid-induced hypopigmentation (4), lichen sclerosus et atrophicus (3), pityriasis lichenoides chronica (3), lichen striatus (2), oculocutaneous albinism (2), tuberous sclerosis complex (2), pigmentary mosaicism (1), and Griscelli syndrome (1). Conclusion: Pityriasis alba, vitiligo, leprosy, nevus depigmentosus and tinea versicolor are the five most common hypopigmentary disorders in children. [ABSTRACT FROM AUTHOR]

Background: Nevus depigmentosus is a congenital, nonprogressive hypopigmented disorder. Various therapeutic methods have been attempted to repigment nevus with variable results. Objective: The objective of this study is to report our experience of treatment of nevus depigmentosus with a combination of noncultured melanocyte-keratinocyte transplantation (MKTP) and excimer laser sessions. Materials and Methods: Six patients (male 1, female 5) of nevus depigmentosus were treated with a combination of noncultured melanocyte-keratinocyte transplantation and excimer laser. One patient was lost to follow-up. Remaining five patients were observed for a period ranging from 7 to 30 months. Results: Two patients responded poorly to MKTP. The remaining three patients responded with repigmentation ranging from 80% to 100% but the quality of repigmentation was unsatisfactory in two of them. Conclusion: Though repigmentation of nevus depigmentosus is possible by grafting techniques, the results are inconsistent and recurrence is possible. [ABSTRACT FROM AUTHOR]

The use of confocal laser scanning microscopy (CLSM) may be an eligible alternative for confirmation of the diagnosis of hypopigmented macules. Our purpose was to evaluate CLSM features for non-invasive imaging of vitiligo, nevus depigmentosus and postinflammatory hypopigmentation in vivo. A total of 68 patients with a clinical diagnosis of the aforementioned diseases were included in this study. CLSM was performed on lesional and adjacent normal appearing skin for all patients. In the active and stable phases of vitiligo, CLSM demonstrated a complete loss of melanin in lesional skin in 14 of 25 patients (56.0%) and 16 of 20 patients (80.0%), respectively. In 11 of 25 (44.0%) patients, the amount of melanin in lesional skin decreased in the active phase of vitiligo, but it is noteworthy to know that the melanin was distributed homogeneously in the dermal papillary rings. In four of 20 patients (20.0%), the dermal papillary rings disappeared completely, but some refractile granules and dendrites could be seen in the stable phase of vitiligo, which may indicate the start of vitiligo repigmentation. Although, in 20 of 20 patients (100%) with nevus depigmentosus, the dermal papillary rings lost their integrity and the content of melanin decreased obviously, there must have been melanin in the dermal papillary rings during its development in all patients. Simultaneously, the melanin was distributed heterogeneously in the dermal papillary rings. The content of melanin and dermal papillary rings in postinflammatory hypopigmentation probably depend on the depth and site of the inflammation; moreover, melanophages were observed in postinflammatory hypopigmentation but did not exist in vitiligo and nevus depigmentosus. In addition, the content of melanin and dermal papillary rings in adjacent normal appearing skin showed changes in the active phase of vitiligo but showed no changes in any of the patients in the stable phases of vitiligo, nevus depigmentosus and postinflammatory hypopigmentation. Differences based on CLSM in the aforementioned diseases were the content of melanin and its distribution pattern. CLSM may be useful to discriminate vitiligo, postinflammatory hypopigmentation and nevus depigmentosus in a non-invasive fashion. [ABSTRACT FROM AUTHOR]

Background/purpose: Vitiligo and nevus depigmentosus (ND) present similar hypopigmented macules with significantly different prognoses. Although the distinction between the two diseases is important, differential diagnosis relies on medical history and physical examination, which is far from decisive in some cases. The Mexameter® is an objective skin color-measuring device, and has been reported to provide a reproducible and sensitive means of quantifying small skin color differences. In this study, we investigated the usefulness of a Mexameter® for discriminating these diseases. Methods: A selection of 202 hypopigmented skin lesions (182 from vitiligo and 20 from ND) were the objects of this study. Using a Mexameter, MIs were obtained from lesions and symmetrically located control skin. RMIs, ratios of the MIs of lesional skins to control skins, were calculated. Results: The mean MIs and RMIs were significantly different for vitiligo and ND. The mean RMI of ND lesions was 74±13, which was significantly higher than that of vitiligo lesions (50±24). No ND lesion had an RMI of <50%. Conclusion: This study shows that the Mexameter®, an objective pigment-measuring device, can be used to achieve a more accurate diagnosis of hypopigmentary disorders, and that the relative melanin index (RMI), which represents the relative pigment levels, might be a more effective parameter than the melanin index (MI) itself for comparing pigmentation differences. [ABSTRACT FROM AUTHOR]

Nevus depigmentosus is a congenital hypomelanotic condition for which no effective treatments are available. The hypopigmentation is permanent and enlarges in proportion with growth in the person. Here, I report a patient of nevus depigmentosus on whom we performed suction blister grafting and the resultant pigmentation was satisfactory even at a follow-up after 10 years.