A 27-year-old woman came on postpartum day 4 with hyperpigmentation on the posterior aspect of both lower limbs and outer aspect of upper limbs. She started noticing these changes during the last trimester of pregnancy and it became more prominent after her delivery. Her antenatal period was uneventful except for hyperemesis gravidarum and intake of medroxyprogesterone tablets for 1 week during the initial part of pregnancy. The baby was delivered vaginally in occipitoposterior position. On examination, there were well-demarcated areas of hyperpigmentation on the flexoral aspect of both lower limbs which were diagnosed as Type B PDL []. Similar well-demarcated pigmentation was noticed on the anterolateral aspects of both arms suggestive of Type A PDL [].\nType B PDL are reported commonly in association with pregnancy. Type B is the most common type of PDL in pregnancy.[] These lines are very common in blacks. Seventy-nine percent of black female adults have at least one type of pigmentary demarcation line, with types A and B being present in over 50% of the cases.[] There are also many reports of Type B PDL in Japanese and Caucasians.[] Gupta et al. reported a pregnant woman from India, who presented with Type B PDL and generalized cutaneous hyperemia.[] Kumari et al. reported a case with Type A PDL alone and another case with Type B PDL alone in pregnancy.[] To the best of our knowledge, ours is the first report of a case having both Type A and Type B PDL in pregnancy from India. There are only few previous reports of concomitant occurrence of Type A and Type B PDL in pregnancy from outside India.[]\nMiura described PDL to correspond to axial lines of Sherrington. These virtual lines, well studied by neurologists, correspond to a subset of lines of Voigt, which separate dermatomes arising from nonconsecutive dorsal roots.[] Pigmentation has neural control and differences in pigmentation noted across these lines may correspond to the absence of overlap between neural territories controlled by different homoeobox genes.[] As per the axial–neural theory by Maleville, PDL may become apparent only when subtle variation in pigmentation is apparent between two contiguous dermatomes originating from noncontiguous dorsal roots. The prominence of these embryonic demarcated lines in different areas may be influenced by neural, hormonal and genetic factors. In pregnancy, increase in hormones such as melanocyte-stimulating hormone may trigger the inconspicuous melanocytes more in some of these demarcated areas supplied by specific peripheral nerves leading to prominence of PDL (including Type A and B as in our case).[]\nSince prominence of Type B PDL is more associated with pregnancy, local factors in the pelvis like compression and neurogenic inflammation of nerve roots S1 and S2 by enlarging uterus may be a significant contributing factor for Type B PDL as reported by previous authors.[] We are postulating that sacral nerve root compression which is more common in occipitoposterior deliveries might have added to aggravation of PDL on lower limbs in our patient after delivery. PDL on the face are fairly common in the Indian population especially among the females.[] We speculate that Type B PDL also may not be rare in Indian skin type and large population-based surveys are required.
We report the case of a 27-year-old healthy male who presented with an area of curlier and thinner hair than the rest of his scalp localized on the right parietal area. He referred that just at that location, his hair had been different since childhood, curlier than the rest. Physical examination revealed a plaque with shorter and curlier hair on an area of 10 cm in diameter on the right parietal area of the scalp. A decreased density of hair was observed. The skin on the patch was apparently healthy. There were not exclamation mark hairs or miniaturization of hair follicles. A hair pull test was negative []. A skin biopsy showed a mild perifollicular lymphocytic infiltrate, telangiectatic capillaries in the superficial dermis and several terminal hair follicles emerged in the same dilated follicular infundibulum. Interestingly, an excessive amount of normal apocrine glands were found in the deep reticular dermis. Counting of hair follicles was normal [Figure –]. Based on clinical appearance and histopathologic studies, a diagnosis of WHN was established.