ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferencesView all Images (14)
Chemical leukoderma
Other Resources UpToDate PubMed

Chemical leukoderma

Contributors: Caroline M. West MD, Bethany K. H. Lewis MD, MPH, Martin Agyei MD, Jason E. Hawkes MD, Amanda Truong BS, Douglas L. Powell MD, Jamie L. Woodcock MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Chemical leukoderma (also known as contact leukoderma or occupational vitiligo) is an acquired depigmenting dermatosis caused by repeated or sometimes a single exposure to specific chemicals. These substances may be toxic to melanocytes, or may compete with tyrosine for hydroxylation by tyrosinase, thereby impeding synthesis of melanin in melanocytes.

The following set of diagnostic criteria has been proposed (3 of 4 criteria must be present for the diagnosis):
  • Acquired depigmented macules and patches that resemble vitiligo
  • A history of repeat exposure to a causative chemical
  • Depigmentation occurs at sites of exposure
  • The presence of confetti macules
Chemicals in the phenol and catechol families are the most widely recognized causative agents, including monobenzyl ether of hydroquinone found in some "acid-cured" rubber gloves, germicides such as para-tertiary butylphenol (PTBP), and pyrethroid insecticides. An adhesive (hexamethylenetetramine) has also been implicated. Other causative toxins include mercurials, arsenics, sulfhydryls, azo dyes, and paraphenylenediamine (PPD). Exposure to these types of agents typically occurs in an industrial setting. Additionally, they can be found in many common household materials, including wallets, decorative coloring agents for skin, footwear, watchstraps, hearing aids, deodorants, hair treatments, cosmetics, eyewear, and detergents.

Chemical leukoderma is common in developing countries where manufacture of consumer products often is not strictly regulated. In developed countries, exposure to causative agents more commonly takes place in industrial occupations.

Chemical leukoderma can affect any age group but is far more prevalent in adults; however, pediatric cases have been reported in developing countries, where children have repeated exposure to common household objects containing the chemical agent.

Individuals with a personal or family history of vitiligo have a higher risk of developing chemical leukoderma on exposure to causative chemicals.

Related topic: drug-induced hypopigmentation

Codes

ICD10CM:
L81.9 – Disorder of pigmentation, unspecified

SNOMEDCT:
280962005 – Chemically-induced hypomelanosis

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

Subscription Required

References

Subscription Required

Last Reviewed:02/19/2020
Last Updated:03/02/2020
Copyright © 2021 VisualDx®. All rights reserved.
Chemical leukoderma
Chemical leukoderma
Clinical image of Chemical leukoderma
Depigmented patches with a pinkish hue on the dorsal hands and fingers, secondary to a phenolic detergent. Note the confetti macules at the proximal patch edges.
Copyright © 2021 VisualDx®. All rights reserved.