What are the other Names for this Condition? (Also known as/Synonyms)

• Ashy Dermatosis of Ramirez
• EDP (Erythema Dyschromicum Perstans)
• Erythema Chronicum Figuratum Melano Dermicum

What is Erythema Dyschromicum Perstans? (Definition/Background Information)

• Erythema Dyschromicum Perstans (EDP) is a benign, but uncommon skin condition, resulting in grey-colored and well-defined patches, commonly on the head and neck region. EDP is observed in children and adults
• The cause of the condition is unknown, but numerous risk factors for Erythema Dyschromicum Perstans have been identified. These include the use of certain chemicals, pesticides, medications, and in some cases, a positive family history of EDP
• Apart from the discolored skin patches, no other symptoms are generally noted. However, scratching the itchy lesions may result in secondary infections. In some individuals, Erythema Dyschromicum Perstans may present cosmetic issues
• When required, Erythema Dyschromicum Perstans may be treated using topical creams and gels. If the condition is severe, laser therapy may be provided. In general, the prognosis is good with appropriate treatment. However, some cases are known to resist treatment and remain for years

Who gets Erythema Dyschromicum Perstans? (Age and Sex Distribution)

• Erythema Dyschromicum Perstans may occur at any age, although most cases are observed before age 40 years
• Both males and females may be affected. However, females are affected more than males
• Individuals of all racial and ethnic background can be affected. But, the condition affects darker-skinned individuals, such as Indians (belonging to the Indian subcontinent) and South Americans, more

What are the Risk Factors for Erythema Dyschromicum Perstans? (Predisposing Factors)

The risk factors for Erythema Dyschromicum Perstans may include the following:

• A family history of the condition
• Ingestion of certain fertilizers, such as ammonium nitrate, and pesticides. Thus, plantation workers, farmers, and agriculture workers have a higher risk
• Certain elements and chemicals such as cobalt and barium sulfate
• Contrast material used in radiographic procedures
• Use of certain medications such as penicillin, benzodiazepine, and omeprazole

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Erythema Dyschromicum Perstans? (Etiology)

The exact cause of development of Erythema Dyschromicum Perstans (EDP) is unknown.

• According to some studies, abnormal cell-mediated immunity may be responsible for EDP development
• Having HLA-DR4 genotype is known to increase the risk
• Some researchers report that it may be a type of lichen planus

It is important to note that Erythema Dyschromicum Perstans is non-contagious and it cannot be transmitted from one individual to another.

What are the Signs and Symptoms of Erythema Dyschromicum Perstans?

The signs and symptoms of Erythema Dyschromicum Perstans (EDP) include:

• The benign lesions appear as slightly elevated, well-circumscribed patches
• Multiple patches of size varying from 5 mm to over 3 cm may be observed
• They are typically ash or grey in color; hence, they are also known as Ashy Dermatosis. Some are of bluish-brown discoloration
• The lesions may itch leading to scratching and bleeding; the itch may be mild in many cases
• Burning sensation may be noted
• EDP commonly affects the head and neck region; uncommonly, it may be present on the trunk, arms and legs too
• One side of the body may be involved, sometimes, both sides with a symmetrical presentation pattern
• Usually, EDP does not involve the mucus membranes, scalp, hands and feet
• No other associated signs and symptoms are noted

How is Erythema Dyschromicum Perstans Diagnosed?

A diagnosis of Erythema Dyschromicum Perstans may involve the following:

• A thorough medical history assessment and complete physical examination
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
• A differential diagnosis may be considered to eliminate the following conditions:
  • Drug eruptions
  • Leprosy
  • Lichen planus pigmentosus
  • Pinta
  • Skin pigmentation disorders that include urticaria pigmentosa, incontinentia pigmenti, etc.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Erythema Dyschromicum Perstans?

Erythema Dyschromicum Perstans is a benign condition that does not cause any significant complications. However in some individuals, the following complications may be noted:

• Cosmetic issues resulting in emotional stress
• Secondary bacterial and fungal infection: Continuous itching and scaling of the skin will create skin moistness, providing a suitable environment for bacteria and fungi to grow and thrive

How is Erythema Dyschromicum Perstans Treated?

It is often difficult to treat Erythema Dyschromicum Perstans (EDP), which lasts for years in some individuals. In others, especially in children, it may disappear without treatment. The following treatment measures may be attempted for EDP:

• Use of topical steroid creams
• Ultraviolet light therapy
• Chemical skin peels
• Laser excision
• Use of medications such as clofazimine, dapsone, and isoniazid
• Administration of antifungal or antibiotic medication, if necessary

Follow-up care with regular screening and check-ups are important and encouraged.

How can Erythema Dyschromicum Perstans be Prevented?

Currently, it may not be possible to prevent Erythema Dyschromicum Perstans. However, one may lower the risk for the skin condition by considering the following factors:

• Take adequate protective measures, such as use of face masks and hand gloves, while using chemicals, fertilizers, and insecticides
• Inform your physician if you are allergic to certain drugs and to contrast materials used in certain imaging studies
• Undertake routine screening of individuals working in environment where exposure to hazardous chemicals may be evident

What is the Prognosis of Erythema Dyschromicum Perstans? (Outcomes/Resolutions)

• The prognosis for Erythema Dyschromicum Perstans is usually good in a majority of cases, since it is a benign condition that may only present some cosmetic issues
• In many children, the condition is self-limiting and may disappear after a certain period. However, in some adults, it may not respond well to treatment and may persist for many years

Additional and Relevant Useful Information for Erythema Dyschromicum Perstans:

• Do not pick or pop the blisters, for doing so can affect the healing process and may result in secondary infections
• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse