title: Contact leukomelanosis induced by the leaves of Piper betle L. (Piperaceae): a clinical and histopathologic survey.
abstract: BACKGROUND
  In April 1997, an unusual pigmentary disorder was noticed by dermatologists in Taiwan. All patients had a history of using facial dressings with steamed leaves of Piper betle L. (Piperaceae).
  
  
  OBJECTIVE
  Our purpose was to clarify the evolution and the origin of this unique leukomelanosis.
  
  
  METHODS
  Fifteen patients with an unusual pigmentary disorder, who visited our clinic in September and October 1997, were asked to complete a questionnaire designed to elicit the history related to the disorder. Eight of these 15 patients underwent skin biopsies: 6 on the mottled hyperpigmented area (group A) and 2 on the hypopigmented area (group B). All 8 specimens were prepared with hematoxylin-eosin, Masson-Fontana, and S-100 stains.
  
  
  RESULTS
  The results of the questionnaire revealed that these patients had all experienced a temporary erythematous reaction in the first few days of the use of the facial dressing, and 9 of them also complained of an accompanying stinging sensation. A bleaching effect became noticeable approximately 1 week to 1 month later. Eight patients reported that the hyperpigmentation and confetti-like hypopigmentation occurred after overexposure to the sun. In both groups, histopathologic examination revealed some melanophages in the dermis. Masson-Fontana staining of specimens from group A showed local interspersed depigmentation and hyperpigmentation in the basal epidermis and pigmentary incontinence in the dermis. This picture was different from the homogeneous depigmentation within basal epidermis in specimens from group B. In both groups, S-100 staining was negative for melanocytes in the depigmented area.
  
  
  CONCLUSIONS
  The clinical course and histopathologic findings suggest that the evolution of this pigmentary disorder can be divided into 3 stages. The first stage is the immediate bleaching stage, when an irritant reaction is usually conspicuous. The second stage consists of prominent hyperpigmentation visible both grossly and microscopically. The final stage is characterized by confetti-like depigmentation. It may be induced by chemicals in the betel leaves such as phenol, catechol, and benzene derivatives, perhaps through inhibition of melanin synthesis or melanocytotoxicity.
authors: Department of Dermatology, Provincial Taoyuan Hospital, Taiwan, ROC.
authors: Y L
authors: YL
authors: Liao
authors: Y C
authors: YC
authors: Chiang
authors: T F
authors: TF
authors: Tsai
authors: R F
authors: RF
authors: Lee
authors: Y C
authors: YC
authors: Chan
authors: C H
authors: CH
authors: Hsiao
mesh_terms: D000328:Adult; D001114:Areca / Q000009:adverse effects*; D001458:Bandages; D001706:Biopsy; D003877:Dermatitis, Contact / Q000473:pathology*; D017453:Dermatitis, Irritant / Q000473:pathology; D017484:Dermatitis, Phototoxic / Q000473:pathology; D003879:Dermatologic Agents / Q000009:adverse effects*; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D005148:Facial Dermatoses / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D010859:Pigmentation Disorders / Q000139:chemically induced* / Q000473:pathology; D018515:Plant Leaves; D010946:Plants, Medicinal; D012867:Skin / Q000187:drug effects / Q000473:pathology; D013624:Taiwan
chemical_list: D003879:Dermatologic Agents; D004365:Drugs, Chinese Herbal