Idiopathic Guttate Hypomelanosis
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Idiopathic guttate hypomelanosis (IGH) is an acquired, benign leukoderma of unknown etiology. Idiopathic guttate hypomelanosis is most commonly a complaint of middle-aged, light-skinned women, but it is increasingly seen in both sexes and older dark-skinned people with a history of long-term sun exposure. See the image below.
Idiopathic guttate hypomelanosis is a benign condition. The cause is not known, but it appears to be related to the effect of the sun on melanocytes, which makes them effete.
A variety of therapeutic methods, including topical steroids, topical retinoids, dermabrasion, cryotherapy, and minigrafting, have been used for idiopathic guttate hypomelanosis with variable success. [1]
Because pigmentation of the skin is due to an integration of melanocyte and keratinocyte function, an acquired defect of the epidermal melanin unit results in the observed hypopigmentation in idiopathic guttate hypomelanosis patients. Significantly fewer dopa oxidase-positive, KIT+, and melanocytes are seen in the lesions. [2, 3] In 1967, Hamada and Saito found a 50% reduction in melanocytes.
United States
Idiopathic guttate hypomelanosis is a very common condition to the point of being almost universal in elderly fair-skinned individuals. In 2002, a case control study of 47 renal transplant patients demonstrated a significant positive association between HLA-DQ3 and the development of idiopathic guttate hypomelanosis and a significant negative association between HLA-DR8 and the development of idiopathic guttate hypomelanosis.
International
Idiopathic guttate hypomelanosis is most common in countries with fair-skinned populations having a high degree of sun exposure.
Idiopathic guttate hypomelanosis affects fair-skinned people at a younger age.
Idiopathic guttate hypomelanosis is seen far more frequently in women, beginning around the age of 30 years. However, with increasing age and sun exposure, it is found almost equally in elderly men and women. Why idiopathic guttate hypomelanosis occurs earlier in young women than in young men is unknown.
Idiopathic guttate hypomelanosis is related to the lack of pigmentary protection from the sun and sun exposure rather than to age. Fair-skinned women develop this condition first; later, with increasing age and exposure to sun, both sexes seem to be equally affected.
Idiopathic guttate hypomelanosis is cosmetic alone, albeit, it is indicative of cumulative sun exposure. Idiopathic guttate hypomelanosis progresses with increasing sun exposure and, to a lesser degree, with age.
Progress in preventing idiopathic guttate hypomelanosis can be made by educating young women not to tan their legs.
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Laosakul K, Juntongjin P. Efficacy of tip cryotherapy in the treatment of idiopathic guttate hypomelanosis (IGH): a randomized, controlled, evaluator-blinded study. J Dermatolog Treat. 2017 May. 28 (3):271-275. [Medline].
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Gordon JR, Reed KE, Sebastian KR, Ahmed AM. Excimer Light Treatment for Idiopathic Guttate Hypomelanosis: A Pilot Study. Dermatol Surg. 2017 Apr. 43 (4):553-557. [Medline].
Ravikiran SP, Sacchidanand S, Leelavathy B. Therapeutic wounding – 88% phenol in idiopathic guttate hypomelanosis. Indian Dermatol Online J. 2014 Jan. 5 (1):14-8. [Medline].
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Christopher R Gorman, MD Avenues Dermatology, Private Practice
Christopher R Gorman, MD is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.
Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society
Disclosure: Nothing to disclose.
William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine
William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology
Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD.
Daniel Mark Siegel, MD, MS Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate Medical Center
Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Association for Physician Leadership, American Society for Dermatologic Surgery, American Society for MOHS Surgery, International Society for Dermatologic Surgery
Disclosure: Nothing to disclose.
Acknowledgments
Medscape Drugs & Diseases wishes to recognize Stephen W White, MD† for his original contributions to this article.
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