Clinical and Dermoscopic Features of Erythema Dyschromicum Perstans: A Case Series

Gökhan Kaya

doi:10.18621/eurj.1793048

Clinical and Dermoscopic Features of Erythema Dyschromicum Perstans: A Case Series

Abstract

Objectives: Erythema dyschromicum perstans (EDP) is a rare acquired dermal melanosis that clinically overlaps with lichen planus pigmentosus and Riehl’s melanosis. Its diagnosis relies on integrating clinical, dermoscopic, and histopathological features. To characterize the clinical, dermoscopic, and histopathological spectrum of EDP in a 14-patient case series and to highlight the diagnostic contribution of dermoscopy.

Methods: A retrospective review was conducted of 14 biopsy-proven EDP patients diagnosed between 2023 and 2025 at a secondary care dermatology center. Demographic data, clinical distribution, dermoscopic findings, histopathology, and treatments were systematically analyzed.

Results: Patients had a mean age of 41.4 years (range 21–69); 12 were female and 2 male, with Fitzpatrick skin types III–IV. Mean disease duration was 2.4 years (range 4 months–10 years). Lesions most often involved the trunk (71.4%), with additional sites including the face, upper arms, axillae, inframammary folds, and neck. Most patients were asymptomatic; two reported mild pruritus. Dermoscopy, available in ten cases, revealed a bluish-gray granular background in 90%, darker blotches in 40%, faint blurred vascular structures in 40%, and perifollicular accentuation in 20%; a diffuse cloud-like pattern was noted in one case. Histopathology consistently showed basal vacuolar alteration, pigment incontinence, and dermal melanophages, with Fontana–Masson confirming dermal melanin in selected specimens. Treatments included isotretinoin in four patients, dapsone in three, topical agents in four, while three remained untreated due to loss to follow-up.

Conclusions: This series documents both sexes and rarely reported sites of EDP, including a pregnancy-associated case, and highlights reproducible dermoscopic clues that support histopathologic confirmation and aid in distinguishing EDP from other acquired dermal melanoses. Larger prospective multicenter studies are warranted to clarify therapeutic approaches and long-term outcomes.

Keywords

Ethical Statement

This study was approved by the Bezmialem Vakıf University Scientific Research Ethics Committee (Decision No: 2025/347; date: 23.09.2025). All procedures were conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. Throughout the course of this study, we strictly adhered to the World Medical Association Declaration of Helsinki and Good Clinical and Laboratory Practice standards. All participants provided written informed consent before their inclusion in the study.

References

1. Ramirez CO. Los cenicientos problema clinico. In: Proceedingsof the First Central American Congress of Dermatology, San Salvador, 5–8 December, 1957. San Salvador: Central AmericanDermatological Society, 1957: 122–130.
2. Kumarasinghe SPW, Pandya A, Chandran V, et al. A global consensus statement on ashy dermatosis, erythema dyschromicum perstans, lichen planus pigmentosus, idiopathic eruptive macular pigmentation, and Riehl's melanosis. Int J Dermatol. 2019;58(3):263-272. doi: 10.1111/ijd.14189.
3. Numata T, Harada K, Tsuboi R, Mitsuhashi Y. Erythema Dyschromicum Perstans: Identical to Ashy Dermatosis or Not? Case Rep Dermatol. 2015;7(2):146-150. doi: 10.1159/000437414.
4. Knox JM, Dodge BG, Freeman RG. Erythema dyschromicum perstans. Arch Dermatol. 1968;97(3):262–272. doi: 10.1001/archderm.1968.01610090034006.
5. Ramirez CO. Ramirez CO. The ashy dermatosis (erythema dyschromicum perstans). Epidemiological study and report of 139 cases. Cutis. 1967;3:244-247.
6. Chang SE, Kim HW, Shin JM, et al. Clinical and histological aspect of erythema dyschromicum perstans in Korea: A review of 68 cases. J Dermatol. 2015;42(11):1053-1057. doi: 10.1111/1346-8138.13002.
7. Torrelo A, Zaballos P, Colmenero I, Mediero IG, de Prada I, Zambrano A. Erythema dyschromicum perstans in children: a report of 14 cases. J Eur Acad Dermatol Venereol. 2005;19(4):422-426. doi: 10.1111/j.1468-3083.2005.01203.x.
8. Banodkar DD, Banodkar P, Banodkar K, Banodkar PK. Erythema dyschromicum perstans (ashy dermatosis) and related disorders. In: Taylor SC, Kelly AP, Lim HW, Serrano A, editors. Taylor and Kelly's Dermatology for Skin of Color. 2nd ed. New York: McGraw-Hill Education; 2016.

9. Tlougan BE, Gonzalez ME, Mandal RV, Kundu RV, Skopicki DL. Erythema dyschromicum perstans. Dermatol Online J. 2010;16(11):17. doi:10.5070/D39218v6bn.
10. Schmidt JD. Erythema dyschromicum perstans. J Dermatol Nurses Assoc. 2011;3(4):223-224. doi: 10.1097/JDN.0b013e31821c4736.
11. Muñoz C, Chang AL. A case of Cinderella: erythema dyschromicum perstans (ashy dermatosis or dermatosis cinecienta). Skinmed. 2011;9(1):63–64.
12. Melo CR, Sá MC, Carvalho S. Erythema dyschromicum perstans in a child following an enteroviral meningitis. An Bras Dermatol. 2017;92(1):137-138. doi: 10.1590/abd1806-4841.201745144.
13. Ankad BS, Drago NR, Koti VR, Nikam BP. Dermoscopic approach to hyperpigmented lesions in skin of color. Clin Dermatol Rev. 2020;4(2):84-91. doi: 10.4103/CDR.CDR_74_20.
14. Rutnin S, Udompanich S, Pratumchart N, Harnchoowong S, Vachiramon V. Ashy Dermatosis and Lichen Planus Pigmentosus: The Histopathological Differences. Biomed Res Int. 2019;2019:5829185. doi: 10.1155/2019/5829185.
15. Mahajan VK, Chauhan PS, Mehta KS, Sharma AL. Erythema Dyschromicum Perstans: Response to Topical Tacrolimus. Indian J Dermatol. 2015;60(5):525. doi: 10.4103/0019-5154.164452.
16. Bahadir S, Cobanoglu U, Cimsit G, Yayli S, Alpay K. Erythema dyschromicum perstans: response to dapsone therapy. Int J Dermatol. 2004;43(3):220-222. doi: 10.1111/j.1365-4632.2004.01984.x.
17. Schwartz RA. Erythema dyschromicum perstans: the continuing enigma of Cinderella or ashy dermatosis. Int J Dermatol. 2004;43(3):230-232. doi: 10.1111/j.1365-4632.2004.02001.x.
18. Leung N, Oliveira M, Selim MA, McKinley-Grant L, Lesesky E. Erythema dyschromicum perstans: A case report and systematic review of histologic presentation and treatment. Int J Womens Dermatol. 2018;4(4):216-222. doi: 10.1016/j.ijwd.2018.08.003.
19. Antonov NK, Braverman I, Subtil A, Halasz CL. Erythema dyschromicum perstans showing resolution in an adult. JAAD Case Rep. 2015;1(4):185-187. doi: 10.1016/j.jdcr.2015.04.011.
20. Ozdemir I, Tamer F, Ogut B, Erdem O. Coexistence of erythema dyschromicum perstans, frontal fibrosing alopecia, and facial papules. Our Dermatol Online. 2024;15(1):88-89. doi: 10.7241/ourd.20241.22.
21. Özuguz P, Doğruk Kacar S, Karaca S, Değer A. Gebeliğin Tetiklediği Eritema Diskromikum Perstans Olgusu [A Case of Erythema Perstans Dyschromicum Induced Pregnancy]. Kocatepe Tıp Dergisi. 2016;17(1):41-43. doi: 10.18229/ktd.44806. [Article in Turkish]
22. Akça HM, Bayramoğlu Z. Hyperpigmentation–Ashy dermatosis. J Exp Clin Med. 2022;39(2):579–580. doi: 10.52142/omujecm.39.2.57.
23. Çevirgen Cemil B, Canpolat F, Ataş H, Köybaşıoğlu FF, Şaşmaz R. Erythema Dyschromicum Perstans in A 10-Year-Old Girl. J Turk Acad Dermatol. 2015;9(1):1591c6. doi: 10.6003/jtad.1591c6.
24. Vásquez-Ochoa LA, Isaza-Guzmán DM, Orozco-Mora B, Restrepo-Molina R, Trujillo-Perez J, Tapia FJ. Immunopathologic study of erythema dyschromicum perstans (ashy dermatosis). Int J Dermatol. 2006 Aug;45(8):937-941. doi: 10.1111/j.1365-4632.2006.02893.x.
25. Muskat A, Hoffman L, Kost Y, Mattis DM, Amin B, McLellan BN. A rare case of erythema dyschromicum perstans arising in the setting of a third-generation tyrosine kinase inhibitor. Acta Oncol. 2022;61(7):830-832. doi: 10.1080/0284186X.2022.2082258.
26. Hamid A, Turner K, Elbuluk N. Research Landscape of Acquired Dermal Macular Hyperpigmentation: A Bibliometric Analysis. Dermatol Res Pract. 2025;2025:8871423. doi: 10.1155/drp/8871423.
27. Krueger L, Saizan A, Stein JA, Elbuluk N. Dermoscopy of acquired pigmentary disorders: a comprehensive review. Int J Dermatol. 2022;61(1):7-19. doi: 10.1111/ijd.15741.
28. Poojary S, Rongioletti F. Acquired hyperpigmentation disorders of uncertain etiology. In: Rongioletti F, Smoller BR, editors. New and Emerging Entities in Dermatology and Dermatopathology. Cham: Springer. 2021: p. 197-213. doi: 10.1007/978-3-030-80027-7_16.
29. Elmas ÖF, Acar EM, Kilitçi A. Dermoscopic Diagnosis of Ashy Dermatosis: A Retrospective Study. Indian Dermatol Online J. 2019;10(6):639-643. doi: 10.4103/idoj.IDOJ_517_18.
30. Tomii K, Fujimoto A, Yokoyama R, et al. Erythema dyschromicum perstans with a Wagyu beef-like appearance on dermoscopy. J Eur Acad Dermatol Venereol. 2020;34(3):e141-e142. doi: 10.1111/jdv.16096.
31. Sandhu S, Neema S, Radhakrishnan S. Dermoscopy of disorders of hyperpigmentation. Pigment Int. 2021;8(1):14-24. doi: 10.4103/Pigmentinternational.Pigmentinternational_40_20.
32. Kotekar S, Thappa DM. Facial dyschromias: a review of clinical and dermoscopic features. CosmoDerma. 2024;4:130. doi: 10.25259/CSDM_156_2024.
33. Ankad BS, Nikam BP, Drago NR, Narkhede N. Hyperpigmentary disorders. In: Ankad BS, Mukherjee SS, Nikam BP, editors. Dermoscopy–Histopathology Correlation: A Conspectus in the Skin of Colour. Singapore: Springer; 2021: p. 145-183. doi: 10.1007/978-981-33-4638-3_6.
34. Sasidharanpillai S, Govindan A, Ajithkumar KY, et al. Histological Evaluation of Acquired Dermal Macular Hyperpigmentation. Indian Dermatol Online J. 2019;10(5):542-546. doi: 10.4103/idoj.IDOJ_426_18.
35. Wang F, Zhao YK, Wang Z, Liu JH, Luo DQ. Erythema Dyschromicum Perstans Response to Isotretinoin. JAMA Dermatol. 2016;152(7):841-842. doi: 10.1001/jamadermatol.2015.6185.
36. Abbott J, Kowalski EH, Klein S, DeShazo R, Hull CM. Iatrogenic calcinosis cutis secondary to calcium chloride successfully treated with topical sodium thiosulfate. JAAD Case Rep. 2020;6(3):181-183. doi: 10.1016/j.jdcr.2019.12.017.
37. Srinivasan D, Gottlieb A. Successful Management of Erythema Dyschromicum Perstans Following Topical Ruxolitinib Therapy. J Drugs Dermatol. 2023;22(3):297-299. doi: 10.36849/JDD.7156.

Details

Primary Language

English

Subjects

Dermatology

Journal Section

Research Article

Authors

Gökhan Kaya ^*
0000-0002-9651-4115
Türkiye

Early Pub Date

December 27, 2025

Publication Date

December 27, 2025

Submission Date

September 29, 2025

Acceptance Date

November 28, 2025

Published in Issue

Year 2026 Number: Advanced Online Publication

DOI

https://doi.org/10.18621/eurj.1793048

IZ

https://izlik.org/JA74JB68EE

Cite

RIS / Bibtex

APA

Kaya, G. (2025). Clinical and Dermoscopic Features of Erythema Dyschromicum Perstans: A Case Series. The European Research Journal, Advanced Online Publication, 1-12. https://doi.org/10.18621/eurj.1793048

AMA

1.Kaya G. Clinical and Dermoscopic Features of Erythema Dyschromicum Perstans: A Case Series. Eur Res J. 2025;(Advanced Online Publication):1-12. doi:10.18621/eurj.1793048

Chicago

Kaya, Gökhan. 2025. “Clinical and Dermoscopic Features of Erythema Dyschromicum Perstans: A Case Series”. The European Research Journal, no. Advanced Online Publication: 1-12. https://doi.org/10.18621/eurj.1793048.

EndNote

Kaya G (December 1, 2025) Clinical and Dermoscopic Features of Erythema Dyschromicum Perstans: A Case Series. The European Research Journal Advanced Online Publication 1–12.

IEEE

[1]G. Kaya, “Clinical and Dermoscopic Features of Erythema Dyschromicum Perstans: A Case Series”, Eur Res J, no. Advanced Online Publication, pp. 1–12, Dec. 2025, doi: 10.18621/eurj.1793048.

ISNAD

Kaya, Gökhan. “Clinical and Dermoscopic Features of Erythema Dyschromicum Perstans: A Case Series”. The European Research Journal. Advanced Online Publication (December 1, 2025): 1-12. https://doi.org/10.18621/eurj.1793048.

JAMA

1.Kaya G. Clinical and Dermoscopic Features of Erythema Dyschromicum Perstans: A Case Series. Eur Res J. 2025;:1–12.

MLA

Kaya, Gökhan. “Clinical and Dermoscopic Features of Erythema Dyschromicum Perstans: A Case Series”. The European Research Journal, no. Advanced Online Publication, Dec. 2025, pp. 1-12, doi:10.18621/eurj.1793048.

Vancouver

1.Gökhan Kaya. Clinical and Dermoscopic Features of Erythema Dyschromicum Perstans: A Case Series. Eur Res J. 2025 Dec. 1;(Advanced Online Publication):1-12. doi:10.18621/eurj.1793048