We report a 76-year-old man who had four depigmented macules in the genital area as the sole manifestation of extramammary Paget's disease (EMP). Histologically, many scattered, dissociated, plump Paget cells, and small intraepidermal nests of these cells were seen in all four lesions. The distribution of Paget cells extended beyond the margin of the depigmented areas into adjacent normally pigmented skin. Fontana-Masson staining revealed a reduction in, or absence of, melanin deposition along the basal layer of the depigmented lesions, in contrast with an abundance of melanin along the basal layer of the adjacent normal skin. Pigment-blockade melanocytes and melanophages were seen within or below the affected epidermis. The depigmentation in this case could have been caused by a symbiotic disorder between melanocytes and keratinocytes (including melanocyte destruction), and by a disorder in melanosome transmission to the keratinocytes. This case illustrates that a depigmented macule may be a diagnostic feature of EMP. Moreover, depigmentation is probably one of the earliest clinical features of EMP, and not a neighbouring secondary change such as occurs in the Sutton's halo naevus phenomenon.

We herein report a case of zinc deficiency in a 5-month-old Japanese girl. Red crusted papules were observed on the periorificial areas, feet, and buttocks. Although there was no hair loss, the zinc concentration in the infant's serum was 24 ~g/dl, which was increased by an oral zinc supplement. Scanning electron microscopic (SEM) observation revealed that the scalp hair had an irregularly shaped cuticle and was unusually small and thin in diameter. These changes occurred before the onset of cutaneous symptoms, and remained after the skin manifestations had disappeared. The hair cuticle pattern and hair thickness returned to normal 2 months after zinc administration, while the skin eruptions disappeared more rapidly. It is suggested that damage to scalp hair in patients with mild acquired zinc deficiency takes place before the appearance of skin eruptions and persists after its disappearance, and that recovery from damage to the scalp hair takes place more slowly than that from a skin eruption.