Dear Editor,
Patients with facial melanosis comprise a major group in all dermatology clinics. It causes cosmetic disfigurement with marked psychosocial impact. Facial pigment demarcation lines (FPDLs) are one of the causes of facial melanosis. These are physiological, abrupt transitions from deeper-pigmented skin to lighter-pigmented skin, and are more common in females. These lines can be seen on face, trunk, and limbs. Groups F, G, and H of PDLs have been described on the faces of Indians (FPDL). Pigment demarcation line (PDL) group F represents an inverted cone or V-shaped area of hyperpigmentation over the lateral aspect of the face between the temple and malar area. PDL Group G occurs at a site similar to group F, but with two inverted cones with a normal patch of skin in between two inverted cones forming letter “W”; PDL Group H occurs on the lower face as a linear hyperpigmented band extending from the angle of the mouth to the lateral aspect of the chin.[1]
FPDLs can often be misdiagnosed as melasma, post-inflammatory pigmentation, and nevus of ota. PDL needs to be differentiated from these other causes of facial melanosis as it is more resistant to treatment.
Dermoscopy is a non-invasive technique widely used in cases of facial melanosis to define and ascertain certain differentials. Dermoscopy improves the diagnosis and management. Various dermoscopic findings described in FPDL are clear borders of abrupt transition between more and less pigmented areas, along with darker thicker brown curved lines in more pigmented areas, blotchy, and granular patterns of pigmentation.[2,3]
We report a case of FPDL with new dermoscopic finding of white clods. The patient was a 23-years-old female who reported to dermatology outpatient department for pigmentation around the eyes and on cheek area. On examination, brownish discoloration was seen between the temple and malar area with clear demarcation between pigmented and non-pigmented areas. Dermoscopy was done, and clear borders of abrupt transition, accentuation of the pseudoreticular pattern of pigmentation, dots, and clods in granular pattern were noted [Figure 1]. Based on clinical and dermoscopic features, a diagnosis of FPDL was considered. In addition, we have noted a novel finding of white clods, which, to the best of our knowledge, has not been described in the literature.
Figure 1.
Clinical and dermoscopic picture of patient with PDL. (a) Pigment demarcation lines (b). Dermoscopy showing perifollicular sparing (brown arrow), White clods (blue arrow), dots (green arrow) with abrupt area of transition to hyperpigmented area (Dermlite 4, 10x)
Dermoscopy has proved to be a boon to dermatologists assisting in clinical diagnosis, and even in some cases overcoming the need for histopathology studies, forbidding the traumatic and economic burden on patients. This new finding of a white clod may be an additional dermoscopic feature of FPDL. However, the same needs to be confirmed in a larger series.
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References
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