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Acquired dermal macular hyperpigmentation: an overview of the recent updates
Shikha Shah1, Narayanan Baskaran1, Keshavamurthy Vinay1
1Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Abstract:
Acquired dermal macular hyperpigmentation (ADMH), previously known as macular pigmentation of uncertain etiology (MPUE), is an umbrella concept that unifies the distinct but overlapping acquired dermal pigmentary disorders like lichen planus pigmentosus, ashy dermatosis, erythema dyschromicum perstans, Riehl's melanosis and pigmented contact dermatitis. All of these disorders usually lack a clinically apparent inflammatory phase, are characterised by dermal pigmentation clinically and histologically, and have a variable protracted disease course. Recently, a proposal has been made to classify these disorders into those with and without contact sensitisation. Dermoscopy is essentially similar across the spectrum of these disorders, and is useful for diagnosis and therapeutic response monitoring. Scoring system has been validated for the same. The treatment of ADMH remains challenging, with multiple topicals, oral therapies including mycophenolate mofetil, and lasers tried. Need of the hour is randomised controlled trials to enhance the therapeutic armamentarium.
Insights
Acquired dermal macular hyperpigmentation (ADMH) encompasses various skin pigment disorders. Current treatments are challenging, highlighting the need for more research and clinical trials to improve therapeutic options for these conditions.
Area of Science:
- Dermatology
- Pigmentary Disorders
Background:
- Acquired dermal macular hyperpigmentation (ADMH) unifies several distinct but overlapping acquired dermal pigmentary disorders.
- These conditions, including lichen planus pigmentosus and ashy dermatosis, share characteristics like dermal pigmentation and a protracted course, often lacking a clear inflammatory phase.
Purpose of the Study:
- To provide a comprehensive overview of Acquired Dermal Macular Hyperpigmentation (ADMH).
- To discuss diagnostic tools like dermoscopy and current therapeutic challenges.
- To emphasize the need for further research and randomized controlled trials.
Main Methods:
- Review of existing literature on ADMH and related disorders.
- Discussion of clinical and histological features.
- Analysis of current diagnostic and therapeutic approaches, including dermoscopy and scoring systems.
Main Results:
- ADMH is an umbrella term for disorders like lichen planus pigmentosus and ashy dermatosis.
- Dermoscopy shows similar patterns across these conditions and aids diagnosis and monitoring.
- Treatment remains challenging, with limited efficacy of current topical, oral, and laser therapies.
Conclusions:
- ADMH represents a spectrum of dermal pigmentary disorders requiring further investigation.
- Standardized diagnostic criteria and validated scoring systems are valuable.
- Randomized controlled trials are crucial to develop more effective treatments for ADMH.
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