The British journal of dermatology
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Case Reports
Unusual hyperpigmentation developing in congenital reticular ichthyosiform erythroderma (ichthyosis variegata).
We present an unusual new clinical feature which developed in a patient with congenital reticular ichthyosiform erythroderma. This rare ichthyotic disorder is characterized by erythematous ichthyotic skin surrounding slowly enlarging areas of normal skin, and by a pathognomonic ultrastructural pattern, namely perinuclear deposits of a filamentous material in vacuolized keratinocytes. At the age of 18 years, a 23-year-old woman developed several irregular hyperpigmented macules on her limbs, which were almost black in colour. ⋯ Electron microscopy and immunohistochemistry demonstrated that the lesions were strictly related to the ichthyotic skin and that their dark colour was especially due to melanosome accumulation in activated dendritic melanocytes. An unusual postinflammatory hyperpigmentation, in which the lack of pigment deposition in the keratinocytes is due to a transfer defect in pathological cells, is hypothesized. A characteristic hyperplastic stimulation of the epidermis is also taken into consideration to explain the lack of a similar picture in other erythrodermic ichthyotic disorders with a continuous inflammatory process.
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We examined the prevalence of depression (measured by the Carroll Rating Scale for Depression, CRSD), wishes to be dead and acute suicidal ideation among 480 patients with dermatological disorders that may be cosmetically disfiguring, i.e. non-cystic facial acne (n = 72; 5.6% suicidal ideation), alopecia areata (n = 45; 0% suicidal ideation), atopic dermatitis (n = 146; 2.1% suicidal ideation) and psoriasis (79 outpatients, 2.5% suicidal ideation and 138 inpatients, 7.2% suicidal ideation). Analysis of variance revealed that the severely affected psoriasis inpatients (mean +/- SD total body surface area affected: 52 +/- 23.4%) had the highest (P < 0.05) CRSD score, followed by the patients with mild to moderate acne; both scores were in the range for clinical depression (CRSD score > 10). The 5.6-7.2% prevalence of active suicidal ideation among the psoriasis and acne patients was higher than the 2.4-3.3% prevalence reported among general medical patients. Our findings highlight the importance of recognizing psychiatric comorbidity, especially depression, among dermatology patients and indicate that in some instances even clinically mild to moderate disease such as non-cystic facial acne can be associated with significant depression and suicidal ideation.