Contact leukoderma

What is contact? leukoderma?

Contact leukoderma is the loss of skin color (skin whitening) after contact with chemicals known to destroy the skin. pigment cells (melanocytes) It is usually due to chemicals found in the workplace, but can also follow the use of certain cosmetic products. It is also known as chemical leukoderma and can be spelled leucoderma.

Who gets contact leukoderma and why?

Contact leukoderma can develop in the context of pre-existing idiopathic vitiligo, suggesting a genetic predisposition. This genetic susceptibility may explain why only some people get leukoderma from coming into contact with certain chemicals. Liver and thyroid disease have been reported in some patients. However, in most patients, there is no personal or family history of vitiligo or other autoimmune disease.

The main chemicals known to cause contact leukoderma include aromatic or aliphatic derivatives of phenols and catechols. Hydroquinone monobenzyl ether (MBH) was the first chemical identified to cause leukoderma in leather manufacturing workers wearing MBH-cured rubber gloves. Other chemicals known to cause occupational leukoderma include the phenolic compounds, para-tertiary butylphenol, para-tertiary octylphenol, and para-tertiary butylphenolformaldehyde.

The most common cause of contact leukoderma from cosmetics is paraphenylenediamine (PPD) in hair dyes The hair dye may have been used by the patient, or it may have been applied to another person. Since PPD can also be found in black socks and footwear, leukoderma can also affect the feet. Sensitization to PPD may have followed the application of a temporary black henna tattoo, also leaving a white mark. Frequent use of hair dye has also been associated with an increased risk of developing vitiligo.

Contact leukoderma due to azo dyes has been reported with the use of facial cosmetics in the following products:

• Lipstick
• Lipstick
• Eyeliners.

Contact leukoderma can also be caused by para-tert-butyl-phenol (PTBP) in deodorants and spray-in perfumes.

A series of cases followed the use of skin lightening. cream containing hydroquinone monobenzyl ether in the hands. Hydroquinone monobenzyl ether has also been deliberately applied to pigmented areas to reduce the ugliness of extensive vitiligo.

A skin lightening cream containing rhododendrol (another phenolic compound) resulted in located contact leucoderma and extended vitiligo in approximately 18,000 users in Japan in 2013.

Methylphenidate patches (used to treat attention deficit / hyperactivity disorder) can rarely cause permanent loss of skin color at the application site.

Additionally, cultural practices, particularly in India, have been reported related to the use of high, an azo dye painted on the feet. The specific azo dye identified at discharge was solvent yellow 3. Contact leukoderma has also been reported in Asian women with a bindi adhesive, the colored spot applied to the forehead. The chemical associated with bindi leukoderma is PTBP in the adhesive.

What are the clinical features of contact leukoderma?

Contact leucoderma appears as a white patchskin (s), initially at the application site (s) but may extend beyond the known contact area in about a quarter of patients. A single injury occurs in approximately one third of patients; Multiple patches are more common.

Contact leukoderma is never present at birth.

Contact leukoderma due to cosmetics occurs most often on the face. The eyelids are particularly involved. Contact leukoderma due to hair dyes applied to the patient generally affects the hair margin rather than the skin of the scalp. Later it can lead to white spots in distant sites (vitiligo.

Usually there are small flat spots the size of confetti of white fur with a clearly defined margin seen under magnification. The skin is not scaly.

Wooden lamp Examination shows an accentuation of pigment loss, although this is not always as clear as in vitiligo.

Allergic previous contact dermatitis it does not occur in most cases. However, an itch is more commonly reported with contact leukoderma than with vitiligo.

How is contact leukoderma diagnosed?

Contact leukoderma must be distinguished from vitiligo. This can sometimes be difficult as they both show the same characteristics in histology of a skin biopsy with loss of melanocytes and melanin.

The following are suggested diagnostic criteria for contact leukoderma (Ghosh S, Mukhopadhyay S. 2009). A patient must have three of the four criteria.

• Acquired vitiligo-like depigmented lesions
• History of repeated exposure to specific chemicals.
• A flat vitiligo pattern macules at the site of exposure to the chemical
• Confetti machines

Patch test with cosmetic product and specific allergen it may cause new contact leukoderma patches and is not recommended.

What is the treatment for contact leukoderma?

Avoidance of the cosmetic product results in recovery of skin color in most cases, particularly if there was no history of pre-existing vitiligo. However, a greater spread of leukoderma has been reported despite strict avoidance of the chemical and this may indicate a genetic tendency to vitiligo. Current and systemic Corticosteroids have been reported to accelerate the recovery of skin color. Narrowband ultraviolet B phototherapy and PUVA photochemotherapy can also be used in some cases.