Dermal melanophages: Does quantitative assessment play a role in the diagnosis of inflammatory skin diseases?

Dermal melanophages are ubiquitous, present in a number of inflammatory and noninflammatory dermatoses. Dermal pigment incontinence is a result of effete keratinocytes or pigment-laden melanocytes (either naturally senescent or destroyed as a result of inflammation), dropping down into the papillary dermis. Subsequent mopping up of the melanin by dermal macrophages result in melanophages. The identification of the occasional melanophage in the dermis is nondiagnostic, as they represent mopping up of incidental senescent epidermal keratinocytes or melanocytes. A number of inflammatory dermatoses (including psoriasiform and spongiotic) result in dermal melanophages, though this is not well documented. This paper is the first to have attempted to confirm and quantify the presence of melanophages in diseases traditionally not associated with clinical pigmentation[1] (such as psoriasis, etc.). It is however common knowledge that psoriasis in Indian skin is usually pigmented.!