The diagnosis of APD is made on clinical grounds based on the characteristic presentation. During infancy or early childhood, multiple hyperpigmented and hypopigmented macules develop on the dorsal aspects of the hands and feet. In addition, multiple small hyperpigmented macules can be seen on the face (Urabe & Hori, 1997). The lesions tend to progressively increase in number and size until adolescence and then remain stable for life (Oyama et al., 1999). There is typically sparing of the palms, soles, and mucous membranes. Acropigmentation of Dohi is often isolated and not associated with systemic abnormalities. Because of the reduction in melanocytes within the hypopigmented areas (Urabe & Hori, 1997), they may appear chalky white under Wood’s light as seen in vitiligo. However, vitiligo is not usually associated with coexisting areas of hyperpigmentation within the affected skin sites, except when there is spontaneous repigmentation.
The hyperpigmented macules histologically show increased melanin in the stratum basale, whereas the hypopigmented areas show a reduction in melanocyte density (Urabe & Hori, 1997). The main entity in the differential diagnosis of APD is reticulate acropigmentation of Kitamura. Reticulate acropigmentation of Kitamura shares with APD the presence of hyperpigmented macules on distal extremities. Features that differentiate reticulate acropigmentation of Kitamura from APD include onset during the first two decades of life, reticulate pattern of hyperpigmentation, presence of atrophy, absence of hypopigmented macules, palmar pits, and breaks in the palmar epidermal rete ridge pattern (Sharma, Sharma, Radotra, & Kaur, 1989). Other diseases that should be considered in the differential diagnosis include dyschromatosis universalis hereditaria, mild xeroderma pigmentosum, dyspigmentation secondary to chemicals or radiation, and ephelides (Oyama et al., 1999; Urabe & Hori, 1997). Dyschromatosis universalis hereditaria is characterized by lesions similar to those seen in APD but in a more generalized distribution affecting the head and neck, trunk, and extremities including the palms and soles (Urabe & Hori, 1997).
There is no simple effective treatment that exists for the hypopigmented macules seen in APD. Treatments for vitiligo would not be expected to be effective for APD. Split thickness skin grafts have shown some efficacy in one case (Taki et al., 1986). The hyperpigmented macules can be effectively treated with different Q-switched lasers (Urabe & Hori, 1997). From the cosmetic standpoint, a camouflage make-up can be used to even out the skin tone. Sun avoidance and the use of sunscreens are recommended to decrease the visibility of the depigmented areas and avoid sunburns. The patient can be assured that this is not a condition that is known to be linked with other health issues. Reassurance can also be given that, after adolescence, the condition is generally stable.
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