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Treatment of idiopathic guttate hypomelanosis with 5-fluorouracil tattooing using a handheld needle

Open AccessPublished:September 18, 2020DOI:https://doi.org/10.1016/j.jdin.2020.09.002

      Therapeutic challenge

      Idiopathic guttate hypomelanosis is a common acquired skin condition characterized by multiple discrete, round, porcelain-white macules on the extensor aspects of the extremities in the elderly population. Most patients are reassured of the benign nature of the condition and no treatment is recommended. Despite the benignity, many patients seek treatment because the condition is cosmetically displeasing. There are several topical, physical, and surgical modalities available for idiopathic guttate hypomelanosis, but the results are variable and unpredictable, and there is no standardization of the treatment regimens. Treatment modalities such as cryotherapy and spot peels are frequently associated with dyspigmentation, especially in darker skin types. We sought to develop a simple office-based procedure to treat idiopathic guttate hypomelanosis with minimal adverse effects, providing consistent results, and which can be performed by using readily available instruments (eg, needle) even in a remote or resource-poor setting.

      Solution

      Topical anesthesia (eutectic mixture of lignocaine 2.5% weight by weight and prilocaine 2.5% weight by weight cream) was applied on lesions for 45 minutes. A simple 24-gauge hypodermic needle was dipped in a vial containing a solution of 5-fluorouracil at 50 mg/mL. The needle was filled by capillary action and the tip of the needle was later inserted in the lesion to create mild pinpoint bleeding under aseptic conditions. 5-Fluorouracil invokes a regulatory response within the fibroblasts of the papillary dermis, which causes regulation of melanocytes.
      • Wambier C.G.
      • Wambier SPdF.
      • Pereira Soares M.T.
      • Breunig J.
      • Cappel M.A.
      • Landau M.
      5-Fluorouracil tattooing for idiopathic guttate hypomelanosis.
      ,
      • Arbache S.
      • Roth D.
      • Steiner D.
      • et al.
      Activation of melanocytes in idiopathic guttate hypomelanosis after 5-flourouracil infusion using a randomized, split-body, single blinded, placebo controlled clinical trial.
      5-Fluorouracil makes a long-lasting favorable microenvironment for the melanocyte migration and subsequent pigment spread. We conducted a total of 2 sittings 1 month apart, which yielded complete uniform repigmentation (Fig 1, A and B). No treatment-related adverse effects were observed during or after the procedure.
      Figure thumbnail gr1
      Fig 1Idiopathic guttate hypomelanosis before (A) and follow-up after (B) a single needling sitting.
      We tried a simple cost-effective treatment that can be easily performed and obviates the need for any high-end or complex equipment or instruments to treat idiopathic guttate hypomelanosis. This is an off-label use of 5-fluorouracil and the safety and efficacy remain unknown. The novelty of our pearl is that the previously reported description used an actual tattooing device, but we are simply using a needle available in any office.

      References

        • Wambier C.G.
        • Wambier SPdF.
        • Pereira Soares M.T.
        • Breunig J.
        • Cappel M.A.
        • Landau M.
        5-Fluorouracil tattooing for idiopathic guttate hypomelanosis.
        J Am Acad Dermatol. 2018; 78: e81-e82
        • Arbache S.
        • Roth D.
        • Steiner D.
        • et al.
        Activation of melanocytes in idiopathic guttate hypomelanosis after 5-flourouracil infusion using a randomized, split-body, single blinded, placebo controlled clinical trial.
        J Am Acad Dermatol. 2018; 78: 212-215

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