© 2004 The International Society of Dermatology International Journal of Dermatology 2004, 43, 911–912

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Blackwell Publishing Ltd.Oxford, UKIJDInternational Journal of Dermatology0011-9059Blackwell Publishing Ltd, 200345MorphologyMorphologyMorphologyMorphology

Pigmentary demarcation lines in a pregnant Caucasian woman

Dear Sir,Pigmentary demarcation lines (PDL) were first described by

Matzumoto1 on the upper and lower limbs of Japanese peoplein 1913, although its address has been attributed to Miura2 andDupré.3 Nowadays we can consider six specific patterns ofPDLs (Table 1). The best characterized are types A and C. Wepresent the case of a Caucasian woman with PDL extendingdown the posteromedial aspects of her legs (type B).

A 27-year-old Caucasian woman attended our Dermatol-ogy Unit with an asymptomatic pigmented maculae on thelower limbs that developed in the 6th month of her first preg-nancy. She had noticed no other areas of pigmentary change.No personal and familiar history was found. Physical exami-nation revealed well-demarcated hyperpigmented maculessymmetrically distributed all over the flexor aspects of herlower limbs (Figs 1, 2). These pigmentary patterns remainunchanged 9 months postpartum.

Pigmentary changes are seen in nearly 85% of pregnantwomen. Pigmentary demarcation lines are borders of abrupttransition between more deeply pigmented skin and that oflighter pigmentation. They do not correspond to Blaschko’slines or dermatomal lines. All are more frequently found infemales compared with males, however, this apparent differ-ence may be because of the greater cosmetic consciousnessamong females than males.

Some cases of pregnancy-associated PDL are accompaniedby an erythematous component, although it usually causes nosevere symptoms. Some authors point to the coincidence ofthe distribution of these lines and the cutaneous nerves of thearea affected, and have tried to hypothetize that the cause ofthis pattern is the result of the neurogenic inflammation pro-duced in the late period of pregnancy.4 Recently, Maleville5

concluded that the axial-neural theory is the most commonlyaccepted in opposition to that of pigmentary mosaicism asdefended by Krivo.6 Nevertheless further investigations are

needed to determine the etiology of this physiological eventand its relation with other pigmentary diseases.

Ricardo Ruiz-Villaverde Jose Blasco-Melguizo Ramón Naranjo-SintesDermatology Unit, Hospital Clínico San Cecilio, Granada, Spain

Table 1 Types of pigmentary demarcation lines

Patterns Sites

A Lateral aspect of upper anterior portion of the arms across the pectoral areaB Posteromedial portion of the lower limbC Vertical hypopigmented line in pre and parasternal areasD Posteromedial area of the spineE Bilateral aspect of the chest, from the mid-third of the clavicel to the periareolar skinF7 Straight or curved convex line sharply demarcating a relatively darker zone from a lighter area on the face

Figure 1 Pigmentary demarcation lines

International Journal of Dermatology 2004, 43, 911–912 © 2004 The International Society of Dermatology

912 Morphology

References1 Maztumoto S. Uber eine eigentümliche pigmentverteilung an

den Voigtschen linien. Arch Dermatol Syphilol 1913; 118: 157.

2 Miura O. On the demarcation lines of pigmentation observed among the Japanese, on inner sides of their extremities and on anteriorand posterior sides of their medial regions. Tohoku J Exp Med 1951; 54: 135.

3 Dupré A, Maleville J, Lassere J, et al. Axial dermatoses. Ann Dermatol Venereol 1977; 104: 304–308.

4 Ozawa H, Rokugo M, Aoyama H. Pigmentary demarcation lines of pregnancy with erythema. Dermatology 1993; 187: 134–136.

5 Maleville J, Taieb A. Pigmentary demarcation lines as markers of neural development. Arch Dermatol 1997; 133: 1559.

6 Krivo JM. How common is pigmentary mosaicism? Arch Dermatol 1997; 133: 527–528.

7 Malakar S, Dhar S. Pigmentary demarcation lines over the face. Dermatology 2000; 200: 85–86.

Figure 2 Cutaneous area affected in our patient