Correspondence 197

with special reference to the intercellular cement. JInvest Dermatol 1967;48:540-552.

10. Hashimoto K. Electron microscopy and histochemis-try of pemphigus and pemphigoid. Oral Surg 1972;30'206-219.

AMRINDER J. KANWAR, M.D.SANDIPAN DH.A.R, M.D., D.K.B.Chandigarh, India

POLYTHELIA: A MARKER OF FETALALCOHOL SYNDROME AND A CLUE FOR

FAMILLVL ETHILISM

To the EditorsWe read with great interest the article by Ber-

tucci and Krafchik on fetal alcohol syndrome (1994;11:178-180). It has suggested to us the followingconsiderations:

1. Polythelia, or supernumerary nipple, was notmentioned in the above paper but is reported tobe a further and notable cutaneous markeramong clinical manifestations of fetal alcoholsyndrome, mainly if the ethanol abuse is on themother's side (1).

2. Similarly, the occurrence of polythelia alone of-fers an important clue for both familial and per-sonal history of alcoholism, as described in a de-tailed survey by Konig et al (2).

3. However, in our recently performed case controlstudy investigating the backgrounds of acces-sory mammary tissue and its association withnephrourinary disorders, this observation wasnot correlated as statistically significant (3).

The causes of this strange association are still notelucidated. Nevertheless the dermatologist shouldalways be aware of the relationship linking chronicalcohol intake with supernumerary nipples (Fig. 1).

Familial alcoholism . polythelia . Personal alcoholism

Fetal alcohol syndrome <-

Figure 1. Chronic alcohol intake and polythelia.

REFERENCES

1. Grosshans E. Significance of polythelia [letter]. Der-matology 1993,186-240.

Konig P, Haller R, Dunser H. Polythelie bei Alcohol-kranken. Wien Med Wochenschr 1985;18:443-446.Urbani CE, Betti R. Accessory mammary tissue as-sociated with congenital and hereditarj' nephrouri-nary malformations: a clinical survey. Int J Dermatolin press.

CARLO ENRICO URBANI, M.D.ROBERTO BETTI, M.D.Milan, Italy

PIGMENTING PITYRIASIS ALBA

To the Editors:We read with great interest the article by DuToit

and Jordaan (1993;10:l-5) reporting a special typeof pityriasis alba (PA) characterized by central blu-ish pigmentation and mild scaling, and encircled bya narrow band of hypopigmentation. A patient re-cently seen by us had similar clinical features.

An 8-year-old boy had an asymptomatic, scaly,hypopigmented patch with central bluish pigmenta-tion on the right cheek of six months' duration. Thelesion started as a small macule and gradually in-creased in size. There was no personal or familyhistory of atopy. A general examination was nor-mal.

Cutaneous examination revealed a bluish hyper-pigmented, scaly patch measuring 3 x 3 cm on theright cheek. It was surrounded by a hypopigmentedhalo 3 to 4 mm in diameter. A few hypopigmented,scaly macules suggestive of PA were seen in the vi-cinity of the main patch. There was no sensory def-icit over the lesion. Examination of other parts ofthe body did not reveal any similar lesions. Exami-nations of hair, nails, and mucosa were noncontrib-utory. A diagnosis of pigmenting pityriasis alba(PPA) with PA was made. Scrapings from the lesionand the scalp did not reveal a dermatophyte. Thelesion cleared with topical clobetasone-17-butyrate(Eumosone) applied twice daily for 8 to 10 weeks.

Histopathologic examination of the skin from thecenter of the lesion showed mild acanthosis, spon-giosis, exocytosis, a sparse, perivascular lymph-omononuclear infiltrate and incontinence of pig-ment. The features were consistent with PPA.

A significant association between PPA and der-matophyte infection was found by DuToit and Jor-daan in their series of 20 patients with PPA, many ofwhom (64%) cleared with oral griseofulvin. How-ever, a careful search in our patient failed to findany evidence of dermatophyte infection. The lesion

198 Pediatric Dermatology Vol. 12 No. 2 June 1995

remained restricted to the face in our patient, as ob- feel that it is a marker for tinea capitis/dermato-served in 18 (90%) of 20 patients of DuToit and Jor- phj-te infection,daan. Our patient had PA, in addition. This was ob-served in one-third of patients with PPA by DuToit REFERENCESand Jordaan, also suggesting that PA and PPA are , , , . .«Trr> r̂ ,x,, i • u

.„ . r • 1 -̂ ,T 1- 1- Verhagen ARHB, Koten JW. Lichenoid melanoder-marufestations of a stngle entity. However, there ^ati,is BrJ Dermatol 1979;101:651-658.was no clinical or histopathologic resemblance to li-chenoid melanodermatitis (1). SANDIPAN DHAR, M.D., D.N.B.

T . . r.n A • J _. J . - . AMRINDER J. KANWAR, M.D.In our opmion PPA ts an underreported entity GOUTAM DAWN M D

and is perhaps a variant of PA. However, we do not Chandigarh, India