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LETTER TO EDITOR
Year : 2016  |  Volume : 36  |  Issue : 1  |  Page : 26-27

Dyschromatosis universalis hereditaria with sensorineural hearing loss


Sudhaa Skin Centre, Jammu, Jammu and Kashmir, India

Date of Submission21-May-2016
Date of Acceptance12-Jun-2016
Date of Web Publication22-Nov-2016

Correspondence Address:
Mrinal Gupta
Sudhaa Skin Centre, 35-A, Lane No-7, Tawi Vihar, Sidhra, Jammu 180019, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-6530.194160

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How to cite this article:
Gupta M. Dyschromatosis universalis hereditaria with sensorineural hearing loss. Egypt J Dermatol Venerol 2016;36:26-7

How to cite this URL:
Gupta M. Dyschromatosis universalis hereditaria with sensorineural hearing loss. Egypt J Dermatol Venerol [serial online] 2016 [cited 2020 May 31];36:26-7. Available from: http://www.ejdv.eg.net/text.asp?2016/36/1/26/194160

Dear Sir,

Dyschromatosis universalis hereditaria (DUH) is a rare genodermatosis clinically manifesting as hyperpigmented and hypopigmented macules forming a reticulate pattern in a generalized distribution. Although initially it has been reported mostly in Japan, subsequent cases have been reported from other countries. Systemic associations and abnormalities of hair and nails have also been reported [1]. We report a case of DUH with associated nail changes and sensorineural hearing loss (SNHL) since birth.

A 60-year-old man, born of nonconsanguineous parents, presented to us with asymptomatic hypopigmented macules, which started appearing when he was 5 years of age over the trunk and gradually progressed to involve the whole body, palms, and soles. In due course, there was also appearance of numerous hyperpigmented macules, which also appeared initially over the trunk and then gradually progressed to involve the whole body. There was associated history of complete hearing loss in the right ear and partial hearing loss in the left ear since birth, which was nonprogressive. There was no history of any preceding dermatoses, drug intake, systemic illness, or exposure to chemicals. Developmental milestones were normal, and family history was unremarkable.

Cutaneous examination revealed symmetrically distributed, reticulated, hyperpigmented and hypopigmented macules, varying in size from 2–20 mm, over the whole body, with sparing of the face [Figure 1]. There was no associated erythema, telengiectasias, or atrophy. His palms and soles showed numerous hyperpigmented macules, and his were dystrophic with trachyonychia and pitting [Figure 2]. His mucosae and hair were normal. Audiological examination revealed complete SNHL in the right ear and partial SNHL in the left ear. Rest of the systemic examination did not reveal any abnormality. All the routine hematological, hepatic, and renal investigations were normal. Chest radiography and ultrasonogram of the abdomen also revealed no abnormality. On the basis of these findings, a diagnosis of DUH with SNHL was made.
Figure 1: Generalized symmetrically distributed hyperpigmented and hypopigmented lesions on the trunk.

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Figure 2: Nail involvement in the form of trachyonychia and pitting.

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DUH is a rare genodermatosis, first described by Toyamo in 1929. Although the majority of cases show autosomal dominant distribution, a few cases with autosomal recessive inheritance have also been reported, and genetic loci over 6q24.2–q25.2 and 12q21–q23 have been mapped as well [1]. The etiology of DUH is still unclear, but it has been hypothesized to be a disorder of melanosome production and distribution in epidermal melanin units rather than a disorder of melanocyte number [2]. Clinically, it is characterized by numerous hyperpigmented and hypopigmented macules of varying sizes on the trunk and limbs. In most of the affected individuals, the lesions manifest by the age of 6 years, but late-onset manifestation has also been reported [1],[3]. Facial lesions are seen in up to 50% of the affected individuals, and involvement of the palms and soles is unusual. Associated cutaneous features such as hyperhidrosis, hypohidrosis, absent dermatoglyphics, mucosal changes such as leukokeratosis, and nail changes such as onychodystrophy have also been commonly reported [1],[3],[4].

A large number of systemic associations have been reported with DUH including tuberous sclerosis, X-linked ocular albinism, grand mal epilepsy, glaucoma, cataract, learning difficulties, insulin-dependent diabetes mellitus, teeth abnormalities, and small stature [1]. Ryrcroft et al. [5] reported a case of universal dyschromatosis associated with small stature and high-tone deafness in a 6-year-old girl born to consanguineous parents. Our case had similar associated SNHL in both ears since birth but there was absence of consanguinity, short stature, and other systemic features. These associations may indicate genetic linkage, and further genetic studies are required to precisely determine the various associations of DUH.There are no conflicts of interest.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Al Hawsawi K, Al Aboud K, Ramesh V, Al Aboud D. Dyschromatosis universalis hereditaria: report of a case and review of the literature. Pediatr Dermatol 2002;19:523–526.  Back to cited text no. 1
    
2.
Kim NS, Im S, Kim SC. Dyschromatosis universalis hereditaria: an electron microscopic examination. J Dermatol 1997;24:161–164.  Back to cited text no. 2
    
3.
Wu CY, Huang WH. Two Taiwanese siblings with dyschromatosis universalis hereditaria. Clin Exp Dermatol 2009;34:666–669.  Back to cited text no. 3
    
4.
Kumar S, Bhoyar P, Mahajan BB. A case of dyschromatosis universalis hereditaria with adermatoglyphia: a rare association. Indian Dermatol Online J 2015;6:105–109.  Back to cited text no. 4
    
5.
Rycroft RJ, Calnan CD, Wells RS. Universal dyschromatosis, small stature and high-tone deafness. Clin Exp Dermatol 1977;2:45–48.  Back to cited text no. 5
    


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