Document Detail


Contact leukomelanosis induced by the leaves of Piper betle L. (Piperaceae): a clinical and histopathologic survey.
MedLine Citation:
PMID:  10188678     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In April 1997, an unusual pigmentary disorder was noticed by dermatologists in Taiwan. All patients had a history of using facial dressings with steamed leaves of Piper betle L. (Piperaceae). OBJECTIVE: Our purpose was to clarify the evolution and the origin of this unique leukomelanosis. METHODS: Fifteen patients with an unusual pigmentary disorder, who visited our clinic in September and October 1997, were asked to complete a questionnaire designed to elicit the history related to the disorder. Eight of these 15 patients underwent skin biopsies: 6 on the mottled hyperpigmented area (group A) and 2 on the hypopigmented area (group B). All 8 specimens were prepared with hematoxylin-eosin, Masson-Fontana, and S-100 stains. RESULTS: The results of the questionnaire revealed that these patients had all experienced a temporary erythematous reaction in the first few days of the use of the facial dressing, and 9 of them also complained of an accompanying stinging sensation. A bleaching effect became noticeable approximately 1 week to 1 month later. Eight patients reported that the hyperpigmentation and confetti-like hypopigmentation occurred after overexposure to the sun. In both groups, histopathologic examination revealed some melanophages in the dermis. Masson-Fontana staining of specimens from group A showed local interspersed depigmentation and hyperpigmentation in the basal epidermis and pigmentary incontinence in the dermis. This picture was different from the homogeneous depigmentation within basal epidermis in specimens from group B. In both groups, S-100 staining was negative for melanocytes in the depigmented area. CONCLUSION: The clinical course and histopathologic findings suggest that the evolution of this pigmentary disorder can be divided into 3 stages. The first stage is the immediate bleaching stage, when an irritant reaction is usually conspicuous. The second stage consists of prominent hyperpigmentation visible both grossly and microscopically. The final stage is characterized by confetti-like depigmentation. It may be induced by chemicals in the betel leaves such as phenol, catechol, and benzene derivatives, perhaps through inhibition of melanin synthesis or melanocytotoxicity.
Authors:
Y L Liao; Y C Chiang; T F Tsai; R F Lee; Y C Chan; C H Hsiao
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American Academy of Dermatology     Volume:  40     ISSN:  0190-9622     ISO Abbreviation:  J. Am. Acad. Dermatol.     Publication Date:  1999 Apr 
Date Detail:
Created Date:  1999-04-15     Completed Date:  1999-04-15     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7907132     Medline TA:  J Am Acad Dermatol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  583-9     Citation Subset:  IM    
Affiliation:
Department of Dermatology, Provincial Taoyuan Hospital, Taiwan, ROC.
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MeSH Terms
Descriptor/Qualifier:
Adult
Areca / adverse effects*
Bandages
Biopsy
Dermatitis, Contact / pathology*
Dermatitis, Irritant / pathology
Dermatitis, Phototoxic / pathology
Dermatologic Agents / adverse effects*
Drugs, Chinese Herbal / adverse effects*
Facial Dermatoses / chemically induced*,  pathology
Female
Humans
Middle Aged
Pigmentation Disorders / chemically induced*,  pathology
Plant Leaves
Plants, Medicinal*
Skin / drug effects,  pathology
Taiwan
Chemical
Reg. No./Substance:
0/Dermatologic Agents; 0/Drugs, Chinese Herbal

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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