Ashy dermatosis : A case of cinderella

We report the case of a 20-years old female, who presented an asymptomatic  grayish macules affecting the neck, trunk and roots of legs (Panel A). Histopathologic examination showed  an increased dermal melanophages (Panel B) and a vacuolization of basal cell layer (Panel C), evoking an ashy dermatosis (AD). Paraclinical assessment didn't find any related  disease. Multiple therapy was proposed such as corticosteroids and phototherapy. Evolution was marked by the extension of  lesions in members at five years of follow-up. AD was first described by Ramirez. He called the patients «Los cenicientos». The Spanish term cenicienta means Cinderella, because of this folklore character's close association with ashes from sitting at  home alone by the fireplace. Most cases present  gray–brown macules which are commonly found on the face, arms, neck, and trunk. Histopathologic findings are nonspecific and include vacuolization of the basal layer, pigmentary incontinence and perivascular inflammatory infiltrate. The etiology of AD is unknown. Some authors reported associations with ammonium nitrate, whipworm infestation and HIV seroconversions. Many treatments was proposed such as corticosteroids, dapsone, clofazimine and phototherapy, but the results are not satisfactory. Such as basic research on the pathogenesis and treatment of hypermelanosis continuous, we look for more answers to the questions raised by this case.