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February 2006

Diffuse Hypopigmented Macules—Diagnosis

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Copyright 2006 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2006

Arch Dermatol. 2006;142(2):235-240. doi:10.1001/archderm.142.2.235-e

Examination of the MART-1–stained skin biopsy specimen from the hypopigmented macule revealed a decreased density of melanocytes in the basal layer of the epidermis. A dermal infiltrate of lymphocytes and melanophages was observed. Notably, there was no evidence of acantholysis within the epidermis. Examination of the skin biopsy specimen from the hyperkeratotic papule showed focal suprabasilar acantholysis and areas of dyskeratotic cells (corps ronds and corps grains).

Guttate leukoderma is an unusual feature of Darier disease. Since its first description by Goodall and Richmond1 in 1965, fewer than 20 cases have been reported.2 The lesions of guttate leukoderma have been observed only in dark-skinned individuals of African or Japanese descent.25 All of the previously described patients had widespread hypopigmented macules that were distributed in a perifollicular pattern on the trunk and extremities.