Unique brown star shape on dermatoscopy of generalized Dowling-Degos disease

Abstract

CASE REPORTAn otherwise healthy 49-year-old woman presented with a 15-year history of a slowly extending rash and pigment changes particularly on the thighs and between the breasts. She described episodic pruritus, worse with heat, friction and perspiration. Her family history was unremarkable.Clinical examination revealed numerous generalized 2-4 mm brown and hypopigmented macules. Excoriated papules were seen over the thighs and intermammary skin (Fig. 1). There were pitted acneiform scars with hypo-and hyperpigmentation in the perioral area.Dermatoscopy of the papules consistently revealed an irregular star-shaped brown outline on a red-brown background (Fig. 2). Follicular plugging and inclusion cysts were seen centrally.Skin biopsies from papules on the thighs and chest revealed flattened epidermis centrally and on the periphery, adenoid proliferations of the rete ridges in a filiform pattern with basal hyperpigmentation, inclusion cysts and follicular plugging (Fig. 3). Parakeratosis was seen in some lesions, possibly due to excoriation. There were scattered melanophages in the upper papillary dermis. Acantholysis was not seen despite examination of multiple sections of multiple papules. S100, Melan A and HMB45 stains showed increased pigment especially at the periphery.The diagnosis of generalized Dowling-Degos disease was made on the clinical and histological findings. DISCUSSIONDowling-Degos disease is an autosomal dominant genodermatosis with variable penetrance, but is often sporadic, as in our patient.1 Localized and generalized forms have been recognised. 2 It typically presents as an acquired hyperpigmentation, particularly of the flexures, beginning in adult life.To our knowledge, the dermatoscopic features of Dowling-Degos disease have been reported in only one case of localized Dowling-Degos disease of the vulva.

Grover’s disease: dermoscopy, reflectance confocal microscopy and histopathological correlation

“…Dermoscopy of Grover’s disease has been described [3–5] showing similarities with Darier’s disease [6,7], papular Dowling–Degos disease [8], and solitary acantholytic dyskeratoma [3]. Common dermoscopy findings consist of polygonal, star-like shaped yellowish/brownish areas that histopathologically correspond to marked hyperparakeratosis and acanthosis, and a peripheral whitish halo that correlates with orthokeratosis and hypergranulosis.…”

Dermoscopic features of a case of transient acantholytic dermatosis

“…1 Giacomel and colleagues 2 reported that the dermoscopy of TAD and solitary acantholytic dyskeratoma are similar to the star-like brown pattern seen in Dowling-Degos disease. 3 This pattern reportedly corresponds to surface scaling and microfissures. Our patient also exhibited this star-like brown pattern, which seemed to correspond to parakeratotic dented areas.…”

Cutaneous tuberculosis simulating lymphocutaneous sporotrichosis

“…Cutaneous tuberculosis mimicking sporotrichosis may be observed in young people following a bacillus of Calmette-Guérin vaccination or the first inoculation of M. tuberculosis. [1][2][3] Similar cutaneous sporotrichoid lesions have been reported in elderly patients by the inoculation of Conflict of interest: none declared. other Mycobacterium spp.…”

“…Cutaneous tuberculosis simulating sporotrichosis has been sporadically reported. [1][2][3] Cutaneous inoculation from other Mycobacterium spp. (for example, M. kansasii or M. marinum) may also show a sporotrichoid appearance.…”