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Erythema dyschromicum perstans
Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports
Erythema dyschromicum perstans (EDP) is an acquired, generalized dermal hypermelanosis of unknown etiology. Clinically it presents as asymptomatic, ashen-gray-blue macules of varying sizes, most commonly on the trunk and proximal extremities. Variable components include erythema and papulation. It has been reported most frequently in dark-skinned Latin American people, although all racial groups can be affected. EDP has similarities to lichen planus pigmentosus and the ‘ashy dermatosis’ of Ramirez (which many consider to be synonymous with EDP), although the precise relationship of these conditions remains uncertain.
Management Strategy
Histology reveals vacuolar degeneration of the basal layer associated with pigmentary incontinence. Dermal vessels are surrounded with an infiltrate of lymphocytes and histiocytes, and many melanophages are present.
EDP may need to be differentiated from the late stage of pinta. Dark-field examination and serologic tests for syphilis should be carried out to exclude this treponematosis in suspected cases. Idiopathic eruptive macular pigmentation is a similar condition. Histology demonstrates that the pigment is located in the basal layer of the epidermis and the lichenoid inflammation characteristic of EDP is not present.
Although EDP may persist for many years, there have been reports of spontaneous resolution, making a conservative approach reasonable. Treatment is based on anecdotal evidence. Data suggests the use of tacrolimus ointment , either as monotherapy or in combination with other treatment modalities (i.e., topical steroids, light therapy, or laser ), as effective. Some systemic treatments ( steroids, isotretinoin, dapsone, and clofazimine ) have also shown efficacy.
Erythema dyschromicum perstans in children: a report of 14 cases
Torrelo A, Zaballos P, Colmenero I, et al. J Eur Acad Dermatol Venereol 2005; 19: 422–6.
No treatment was used. In six of these cases the eruption cleared or improved during follow-up ranging from 1 to 5 years.
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