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:

Observation Letter
88 (
6
); 812-813
doi:
10.25259/IJDVL_1202_2021
pmid:
35962515

Supraventine sparing of salt-and-pepper pigmentation in a patient with systemic sclerosis

Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India

Corresponding Author: Dr. Vishal Gupta, Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India. doctor.vishalgupta@gmail.com

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Sindhuja T, Danish M, Gupta V. Supraventine sparing of salt-and-pepper pigmentation in a patient with systemic sclerosis. Indian J Dermatol Venereol Leprol 2022;88:812-3.

Sir,

A 13-year-old Indian girl presented with a nine-month history of progressive binding down of the skin on the face, trunk and distal extremities including fingers. There were depigmented macules interspersed with areas of normal pigmentation around the follicles suggestive of salt-and-pepper pigmentation, over the forehead and legs [Figure 1]. There was a striking sparing of depigmentation along the course of the superficial veins on her forehead and frontal scalp [Figure 2]. She also had Raynaud’s phenomenon, dysphagia to solid food, exertional dyspnea and symmetric proximal muscle weakness. Nail fold capillaroscopy demonstrated a few giant capillaries. Laboratory investigations were significant for a positive indirect immunofluorescence test for antinuclear antibody (4+, 1:100, fine speckled pattern), a positive line immunoblot assay for Scl-70 antibodies and an elevated serum creatine kinase (1441 U/L; normal 55–135 U/L). Anti-centromere, antimitochondrial M2, Jo-1, PM-Scl, Mi-2 and Ku antibodies were negative. Pulmonary function tests showed a restrictive pattern (forced vital capacity 78%, forced expiratory volume in 1 second 66%) and high resolution computerized tomographic scan of the chest revealed basal and subpleural predominant reticular opacities and traction bronchiectasis suggestive of interstitial lung disease. Barium swallow showed poor oesophageal motility and 2-D echocardiography showed a large pericardial effusion without an impending cardiac tamponade. Based on these clinical and investigative findings, a diagnosis of diffuse cutaneous systemic sclerosis with inflammatory myopathy was made. During the hospital stay, she was treated with intravenous dexamethasone (50 mg) pulse for three days, daily nifedipine 10 mg/day, torsemide 5 mg/day, sildenafil 10 mg thrice a day and mosapride 5 mg twice a day, along with cold protection measures. There was symptomatic improvement in muscle weakness and a reduction in the size of the pericardial effusion on repeat 2-D echocardiography and the patient was discharged in a stable condition. Unfortunately, she passed away two weeks later at home and the cause of death could not be ascertained.

Salt-and-pepper pigmentation over bilateral legs
Figure 1:
Salt-and-pepper pigmentation over bilateral legs
Sparing of depigmentation over the course of superficial veins within areas of salt-and-pepper pigmentation on the forehead and scalp
Figure 2:
Sparing of depigmentation over the course of superficial veins within areas of salt-and-pepper pigmentation on the forehead and scalp

Salt-and-pepper pigmentation is a characteristic pigmentary change in patients with systemic sclerosis and is particularly common in patients with darker skin phototypes with a prevalence ranging from 51 to 94%.1 Patients with systemic sclerosis have an abnormal temperature response and the perifollicular sparing of the salt-and-pepper depigmentation is thought to be due to the rich capillary network around the hair follicles warming the perifollicular skin. Preservation of normal pigment overlying the superficial veins within the areas of salt-and-pepper pigmentation is quite rare and may be attributed to the warm skin overlying superficial veins.2

The thermographic examination has previously demonstrated a temperature difference of 0.5–1.5° C in the pigmented areas over the vessels compared to the surrounding depigmented skin.2

We came across only one earlier report of three patients with this distinctive pigmentary change; all had progressive systemic sclerosis, two of whom also had active myositis like our case.2 However, the clinical significance of this observation as a clue to more severe disease needs to be further explored.

Pigment retention overlying superficial veins within areas of depigmentation has rarely been seen in certain other dermatoses as well, such as vitiligo, dermatitides and dermatophytic infections.3 It is hypothesized that a significant inflammatory response may cause vasodilatation leading to increased vascular permeability and endothelial cell activation. Endothelial injury and subclinical-to-mild phlebitis may result in basal epidermal hyperpigmentation and dermal pigment incontinence.3

In addition, serpentine supravenous hyperpigmentation is also known to occur following intravenous infusion of certain chemotherapy agents, including 5-fluorouracil, docetaxel, cyclophosphamide, bleomycin and vinca alkaloids.3

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

Dr. Vishal Gupta is the Deputy Editor of the journal.

References

  1. , , , , . Salt-and-pepper appearance: A cutaneous clue for the diagnosis of systemic sclerosis. Indian J Dermatol. 2012;57:412-3.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , , . A new skin manifestation of progressive systemic sclerosis. J Am Acad Dermatol. 1984;11:265-8.
    [CrossRef] [PubMed] [Google Scholar]
  3. , . Serpentine supravenous hyperpigmentation – A rare cutaneous manifestation in non-neoplastic conditions. J Skin Sex Transm Dis. 2019;1:97-100.
    [CrossRef] [Google Scholar]

Fulltext Views
6,187

PDF downloads
2,440
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections