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Dermatopathia pigmentosa reticularis in Adult
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Dermatopathia pigmentosa reticularis in Adult

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Contributors: Sepideh Ashrafzadeh, Susan Burgin MD
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Synopsis

Dermatopathia pigmentosa reticularis (DPR) is an extremely rare, autosomal-dominant condition that presents with the triad of reticulate hyperpigmentation, noncicatricial alopecia, and onychodystrophy. Cases have been reported from the United States, Europe, India, South Korea, and Malaysia.

Generalized reticulate hyperpigmentation presents at birth or develops by the age of 2. It persists throughout life without fading. Over time, there is progressive alopecia affecting the scalp, eyelashes, eyebrows, and axillae. Mild onychodystrophy may progress to include pterygium formation, also by the age of 2. Other findings include absent dermatoglyphics, a punctate keratoderma of palms and soles, and hypo- or hyperhidrosis. Nonscarring acral bullae, mucosal pigmentation (oral or bulbar conjunctiva), and darkly pigmented areolae have been reported less frequently. The disease does not cause any life-threatening complications and patients are often otherwise healthy.

DPR is caused by missense mutations in the keratin 14 protein (KRT14), which maps onto chromosome region 17q11.2-q21. The KRT14 mutations reduce the amount of functional junction proteins in keratinocytes, leading to increased apoptosis of epidermal cells in the basal layer. The consequent decreased structural integrity of ectodermal tissues is hypothesized to cause skin and nail abnormalities such as blistering, adermatoglyphia, and nail dystrophy. The cause of hyperpigmentation in the condition is less clear, but is suspected to be either melanosome trafficking or pigmentary incontinence from increased keratinocyte apoptosis.

Codes

ICD10CM:
Q82.9 – Congenital malformation of skin, unspecified

SNOMEDCT:
239088003 – Dermatopathia pigmentosa reticularis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

The differential diagnosis for DPR includes the conditions below, which can be differentiated by their pattern of pigmentary distribution, histopathology, leukokeratosis, onset and duration of pigmentation, and associated symptoms.

Best Tests

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Management Pearls

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Therapy

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Last Reviewed: 09/25/2017
Last Updated: 10/12/2017
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Dermatopathia pigmentosa reticularis in Adult
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Dermatopathia pigmentosa reticularis : Trunk, Non-scarring alopecia
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