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An 8-year-old boy with reticular erythematous mucinosis syndrome had erythematous plaques on his chest, face, and arms for three years. Sun exposure resulted in pruritus and increased lesions. Histologic examination revealed a perivascular mononuclear cell infiltrate with hematoxylin and eosin staining, positive staining material between the dermal collagen bundles with alcian blue (pH 2.5) staining, and granular basement membrane deposits of IgM with direct immunofluorescence staining. Results of all lupus erythematosus serologies and porphyrin studies were negative. Minimal erythema dose determinations to ultraviolet A and B were normal, and the lesions could not be induced with high doses of irradiation. Topical sunscreens, corticosteroid cream, and systemic beta-carotene produced no therapeutic benefit.

Full-thickness and epidermal autografts of normally pigmented skin were transplanted within hypopigmented areas in each of two patients with piebaldism. Full-thickness punch grafts 2 to 4 mm in size retained their pigmentation (donor dominance) and within 4 months pigment was found to have spread around them. Within a year, melanization covered roughly triple the diameter of the grafts (or 9 times their areas) and then came to a standstill. Epidermal grafts (about 12 mm in diameter) healed with no visible scars at either donor or recipient sites. These grafts, too, retained their pigmentation, but no pigment was seen to spread from them in 8 months of observation. Controls of hypopigmented, full-thickness autografts placed into comparable hypopigmented areas showed either no change or but slight pigmentation along the rim of the graft and no spread of pigment.

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