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Abstract

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  2. Abstract
  3. Case Report
  4. References

Abstract:  Wood's lamp evaluation is used to diagnose pigmentary disorders. For example, vitiligio typically demonstrates lesional enhancement under Wood's lamp evaluation. Numerous false positive enhancing lesions can be noted in the skin. We describe a 5-year-old Hispanic boy who had painted his face with highlighter, producing enhancing lesions under Wood's lamp. Physicians who use Wood's lamp should be aware that the appearance of markers and highlighter can mimic that of true clinical illnesses.

A Wood’s lamp is used to differentiate between vitiligo vulgaris and hypopigmenting disorders based upon the enhancement of vitiliginous lesions with this ultraviolet light source (1). We want to make pediatric dermatologists aware of a specific mimic of enhancement that we see commonly in children. The following case illustrates this issue.

Case Report

  1. Top of page
  2. Abstract
  3. Case Report
  4. References

A 5-year-old Hispanic boy presented with perinasal and periorificial hypopigmentation (Fig. 1A) of a few days duration. On Wood’s lamp examination (Fig. 1B), an enhancing lesion was noted over the left eyebrow, which resolved with alcohol swab. The child had been playing with magic markers but denied drawing on his face.

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Figure 1.  Hispanic boy: (A) side view, (B) under Wood’s lamp demonstrating lesion invisible to the naked eye.

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A similar lesion was induced with pink highlighter (Papermate W20) to the forearm of an adult volunteer (Fig. 2). Pink highlighter glows orange, and yellow highlighter glows yellow-green under a Wood’s lamp, mimicking erythrasma and vitiligo, respectively (1). The highlighter-induced exogenous lesions are bright and well demarcated and will clear with alcohol swabs. Medical usage of highlighters to outline patch test sites has been described (2). Standard markers are usually more noticeable on standard examination with lack of enhancement. Table 1 lists lesions that may enhance or alter under a Wood’s lamp. Practitioners should consider that marker usage is common in small children and may need to be cleaned off when evaluating for hypopigmentation in childhood.

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Figure 2.  Exogenously induced lesion created with pink highlighter.

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Table 1. Lesions That Alter with Wood’s Lamp
  1. Table modified from reference (1).

Pigmentary disorders (Blue-white fluorescence)
 Vitiligo
 Ash leaf macules of Tuberous sclerosis
 Hypopigmented Mycosis fungoides
Infection (type, color of fluorescence)
 Pseudomonas, Green
 Corynebacterium minutissimum, Coral-red
 Propionibacterium acnes, Orange-red, Yellowish-white
  Pityriasis versicolor, Yellowish-white, Copper-orange
 Pityrosporum folliculitis, Bluish-white follicular
 Microsporum (audouinii, canis, ferrugineum, distortum), Blue-green
 M. gypseum (some variants), Dull-yellow
Porphyrias, fluorescent source, usually red-pink
 Erythropoietic porphyria RBC, urine, teeth
 Erythropoietic protoporphyria RBC, feces, gall stones
 Hepatoerythropoietic porphyria RBC, feces, urine
 Porphyria cutanea tarda urine, feces
 Variegate porphyria urine, feces
False positives
 Colored markers, especially highlighters
 Dried soap and laundry detergents with optical brighteners
 Hyperkeratotic scale
 Invisible ink
 Lemon juice
 Lint
 Natural secretions: semen, serum, saliva, milk
 Select cosmetics and hair dyes
 Selected sunscreens and ointments
 Wet ear wax

References

  1. Top of page
  2. Abstract
  3. Case Report
  4. References