Erworbene retikuläre Pigmentdermatosen

Die klinischen Differenzialdiagnosen erworbener Hyperpigmentierungen der Haut sind vielfältig. Seltenheit und unscharfe Abgrenzungen zwischen den verschiedenen Entitäten auf der einen und auch vermeintliche Unbedeutsamkeit und Harmlosigkeit der Dermatosen auf der anderen Seite verzögern oft eine zügige Diagnose im klinischen Alltag. In der vorliegenden Arbeit sollen die wichtigsten klinischen Differenzialdiagnosen erläutert werden.

Abstract

Clinical differential diagnoses of acquired hyperpigmentation of the skin are manifold. The rarity and fuzzy demarcation between various entities on the one hand and the alleged insignificance and harmlessness of the dermatoses on the other hand often delay a rapid diagnosis in everyday clinical practice. In the present work the most important clinical differential diagnoses are reviewed. Acquired reticular pigment dermatoses (RPD) of the skin sui generis include Dowling-Degos disease (DDD), Galli-Galli disease (GGD). Further diseases rarely found in Europe are Kitamura disease (RKD), reticular acropigmentation Dohi (RAD) and Haber syndrome (HS). Other acquired more frequent hyperpigmentation of the skin, which may also have a reticular pattern, include acanthosis nigricans, papillomatosis confluens et reticularis Gougerot carteaud, diabetic dermatopathy, and postinflammatory hyperpigmentation. Some of these diseases are particularly indicative of endocrinopathies. In particular, childhood acanthosis nigricans is of great importance in diabetes mellitus screening. Histopathological examination with the clinical problem of acquired hyperpigmentation can be difficult and requires close clinical-pathological correlation.

Kernaussagen

• Diverse entzündliche und infektiöse Erkrankungen führen zu teils auch retikulären Hyperpigmentierungen an der Haut.

• Von den retikulären Pigmentdermatosen sui generis kommen der Morbus Dowling-Degos und der Morbus Galli-Galli am häufigsten vor.

• Differenzialdiagnostisch müssen erregerbedingte Dermatosen, wie die Pityriasis versicolor, von postinflammatorischen Hyperpigmentierungen abgegrenzt werden, nach Akne, Ekzem, Lichen planus u. a. m.

• Die erworbenen Hyperpigmentierungen der großen Körperfalten, Akanthosis nigricans und Papillomatosis confluens et reticularis Gougerot Carteaud, sind häufig mit Stoffwechselerkrankungen assoziiert und können u. a. eine (latente/subklinische) diabetische Stoffwechsellage anzeigen.

• Die Papillomatosis confluens et reticularis Gougerot Carteaud scheint durch eine Besiedelung mit dem Bakterium Dietzia papillomatosis assoziiert zu sein und wird mit Minozyklin oft erfolgreich behandelt.

• Biopsien dienen der Ausschlussidagnostik und sollten zusammen mit ausführlichem klinischem Befund, Anamnesedaten und am besten einer Fotodokumentation eingesendet werden.

Schlüsselwörter

erworbene Hyperpigmentierungen - Hypopigmentierungen - Pilzinfektionen - Genodermatose - Histopathologie

Keywords

acquired hyperpigmentation - hypopigmentation - mycotic infectious diseases - histopathology - genodermatoses

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