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Erythema dyschromicum perstans revisited

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Letter: Erythema dyschromicum perstans revisited
Mauricio Goihman-Yahr MD PhD
Dermatology Online Journal 17 (1): 14


The recent Dermatology Online Journal article entitled, “Erythema dyschromicum perstans,” is discussed to clarify the history of the disease and the contributions of those who have reported it.


I am writing about the article “Erythema dyschromicum perstans” by Tlougan et al that was published in Dermatology Online Journal, Volume 16, Number 11, in November of 2010.

This case report is clear and to the point and it might correspond to a case of erythema dyschromicum perstans (EDP). However, there are some omissions and errors that should be corrected.

1. Erythema dyschromicum perstans was indeed first described by Ramírez under the name, “Dermatosis Cenicienta” (Ashy dermatosis) [1]. This was a presentation at a Dermatological Congress and the case report appeared in the Proceedings from this conference. The name, “Erythema Dyschromicum Perstans,” was used by Convit, Kerdel-Vegas, and Rodríguez-Garcilazo in their publication in the Journal of Investigative Dermatology [2]. This was a full-fledged report with clinical and pathological features as well as a very detailed differential diagnosis. Dr. Sulzberger was not a coauthor but he suggested the Latin name as above when consulted by the authors about the entity. The original name given by Venezuelan authors was “pintoid,” because the disease does look very much like “pinta” or “carate.” Convit and his coworkers were not aware of the Ramírez presentation and thought this was a hitherto unknown entity. It should be noted that there were close personal ties between Francisco Kerdel-Vegas and Marion Sulzberger. Kerdel had been a resident under the latter and became afterwards a close personal friend. I may add that it was I (as a resident) who performed the physical examinations of the cases reported in the Journal of Investigative Dermatology, although my name does not appear as a coauthor as indeed it should not be.

2. No prospective randomized controlled studies are available to determine therapy; the disease is extremely uncommon and of long duration. Case reports (except for the original) are single case studies (similar to the one by Tlougan et al). The “small series” in which clofazimine treatment was studied contained 8 patients and is not really small if one considers the rarity of the condition [3].

3. In my experience sun or ultraviolet light therapies do not improve EDC. In general, patients get worse after sun exposure. It is well to report the experiences that a group may have had with a single case, but one cannot build up a whole body of inferences and theories of pathogenesis out of it.


1. Ramirez CO. Los cenicientos: problema clinica. In: Memoria del Primer Congresso Centroamericano de Dermatologica, December 5-8, 1957, San Salvador, El Salvador 1957: 122

2. Convit J, et al. Erythema dyschromicum perstans: a hitherto undescribed skin disease. J Invest Dermatol 1961; 36: 457

3. Piquero-Martin J, et al. Clinical trial with clofazimine for treating erythema dyschromicum perstans: evaluation of cell-mediated immunity. Int J Dermatol 1989; 28: 198 [PubMed]

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