Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Net letter
2012:78:6;774-774
doi: 10.4103/0378-6323.102393
PMID: 23075658

Flagellate pigmentation and exacerbation of melasma following chikungunya fever: A less frequently reported finding

Rajat Kandhari1 , Niti Khunger2 , Avninder Singh3
1 Department of Dermatology and STD, V.M. Medical College and Safdarjang Hospital, New Delhi, India
2 V.M. Medical College and Safdarjang Hospital, New Delhi, India
3 National Institute of Pathology, ICMR, Safdarjung Hospital Campus, New Delhi, India

Correspondence Address:
Rajat Kandhari
Department of Dermatology and STD, V.M. Medical College and Safdarjang Hospital, New Delhi
India
How to cite this article:
Kandhari R, Khunger N, Singh A. Flagellate pigmentation and exacerbation of melasma following chikungunya fever: A less frequently reported finding. Indian J Dermatol Venereol Leprol 2012;78:774
Copyright: (C)2012 Indian Journal of Dermatology, Venereology, and Leprology

Sir

Reports have emerged in recent years describing the mucocutaneous manifestations of chikungunya fever. [1],[2],[3],[4] Chikungunya fever is an acute viral infection, characterised by fever,severe arthralgia, and constitutional symptoms. The most commonly encountered skin findings associated with chikungunya fever is a maculopapular rash, which may occur with the onset of the fever, during the course of the fever or after the fever has subsided. The rash usually lasts for a period of 1-7 days. [2],[5] Other mucocutaneous manifestations which may occur include hyperpigmentation, transient nasal erythema, generalized erythema, tenderness and edema of the hands and feet, multiple apthous-like ulcers, vesiculobullous lesions, purpuric or hemorrhagic lesions and vasculitic lesions. [1],[2],[3],[4],[6] Chikungunya fever may also be associated with exacerbation of certain pre-existing dermatosis such as psoriasis [1],[3],[7] and lichen planus [3] to name a few.

We report a case of a 35 year old, female patient with streaks of hyperpigmentation on the trunk and the extremities. On questioning, the patient revealed that the brownish coloured lesions appeared in association with a fever, which had occurred three weeks back. The fever was associated with severe joint pains, persistent in nature; fatigue and dryness of the skin. There was accentuation of the pre existing brownish discoloration on either side of her face, which occurred on subsidence of the fever. She also revealed the occurrence of blackish, lesions on the palms. Tests for malaria, dengue fever and typhoid were negative. Viral culture and isolation were not performed. A probable diagnosis of chikungunya fever was made on clinical grounds and exclusion of other possible causes of fever with joint pains. On examination, we found asymptomatic, centrofacial, brownish-black discoloration, which was predominant on the nose and the upper lip. Bilateral malar region showed a reticulate pattern of pigmentation, which was present for two years prior to the fever, but had exacerbated once the fever subsided. The upper extremities and the back, showed an irregular, flagellate or "whip-lash" pattern of brownish pigmentation. There was speckled, discrete, freckle-like pigmentation seen on the palmar aspect of both hands, along with blackish macules on the fingers. Generalised xerosis and scaling were noted all over the body [Figure - 1]a-d. Two skin biopsies were performed, one from the right side of the back and the other from the nose. The biopsy from the back showed increased intraepidermal melanin in the basal and suprabasal keratinocytes [Figure - 2], whereas the biopsy from the nose demonstrated superficial and deep melanophages in the dermis with less prominent epidermal pigmentation along with extensive solar elastosis, suggestive of melasma.

Figure 1: (a) speckled, discrete, freckle-like pigmentation on the palmar aspect of the hand along with blackish macules on the fingers, (b) brownish-black discoloration on the nose and the upper lip along reticulate pattern of pigmentation on bilateral malar region, (c) upper extremity showing brownish, with xerosis and scaling, (d) flagellate or "whip-lash" pattern of pigmentation on the trunk
Figure 2: Increased intraepidermal melanin in the basal and suprabasal keratinocytes (H and E, ×100)

In a study done by Inamdar et al. [1] in 145 "suspected cases" of chikungunya fever, hyperpigmentation was reported as the most common finding. They reported flagellate pigmentation in two cases and accentuation of melasma in one case. Riyaz et al. [4] in their study of 162 patients of chikungunya fever, reported flagellate pigmentation and exacerbation of pre existing psoriasis, lichen planus and unmasking of Hansens disease with type 1 reaction. They, however, did not mention the number of cases having the flagellate pattern of pigmentation. Prashant et al[3] reported flare up of pre existing dermatosis in ten patients out of their group of 115, wherein six patients had a flare up of psoriasis and four patients experienced a flare up of lichen planus. They however did not report any patient with flagellate pigmentation. In another study [7] of 75 suspect cases of chikungunya fever, exacerbation of pre existing dermatological disease was noted in 4 patients, of whom two had psoriasis and one each had eczema and erythroderma. The exact cause of the hypermelanosis following chikungunya fever remains a mystery, although it is primarily considered a post inflammatory response. It is proposed that the chikungunya virus may be triggering the intraepidermal melanin dispersion or retention. [1] The presence of melanophages seen on histology may be considered a cause for the persistence of the pigmentation. [4]

References
1.
Inamadar AC, Palit A, Sampagavi VV, Raghunath S, Deshmukh NS. Cutaneous manifestations of chikungunya fever: Observations made during a recent outbreak in south India. Int J Dermatol 2008;47:154-9.
[Google Scholar]
2.
Bandyopadhyay D, Ghosh SK. Mucocutaneous features of Chikungunya fever: A study from an outbreak in West Bengal, India. Int J Dermatol 2008;47:1148-52.
[Google Scholar]
3.
Prashant S, Kumar AS, Basheeruddin DD, Chowdhary TN, Madhu B. Cutaneous manifestations in patients suspected of Chikungunya disease. Indian J Dermatol 2009;54:128-31.
[Google Scholar]
4.
Riyaz N, Riyaz A, Rahima, Abdul Latheef EN, Anitha PM, Aravindan KP, et al. Cutaneous manifestations of chikungunya during a recent epidemic in Calicut, north Kerala, south India. Indian J Dermatol Venereol Leprol 2010;76:671-6.
[Google Scholar]
5.
Johnston RE, Peters CJ: Alphaviruses. In: Fields BN, Knipe DM, Howley PM, Chanock RM, Melnick JL, Monath TP, Roisman B, Straus SE editors. Fields Virology Volume 1, 3 rd ed. Philadelphia: Lippincott-Raven; 1996.p. 843-98.
[Google Scholar]
6.
Pakran J, George M, Riyaz N, Arakkal R, George S, Rajan U, et al. Purpuric macules with vesiculobullous lesions: A novel manifestation of Chikungunya. Int J Dermatol 2011;50:61-9.
[Google Scholar]
7.
Bhat RM, Rai Y, Ramesh A, Nandakishore B, Sukumar D, Martis J, et al. Mucocutaneous manifestations of chikungunya fever: A study from an epidemic in coastal Karnataka. Indian J Dermatol 2011;56:290-4.
[Google Scholar]

Fulltext Views
2,494

PDF downloads
1,647
Show Sections