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June 2006, Vol 142, No. 6 >

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Correspondence | June 2006

Speckled Posttraumatic Hyperpigmentation by Foreign Bodies on the Lower Legs After Welding

Erika Richtig, MD; Bernd Leinweber, MD; Yassar Ghanimi, PhD; Peter Pölt, PhD; Alessandro DiStefani, MD; Rainer Hofmann-Wellenhof, MD
Arch Dermatol. 2006;142(6):781-798. doi:10.1001/archderm.142.6.790.
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Hyperpigmentation of the lower legs, caused either by hemosiderin deposits in the dermis or by increased melanin within the epidermis or upper dermis, is frequently found in the white population. In most patients, hyperpigmentation in this location is due to chronic venous insufficiency. Other causes of postinflammatory hyperpigmentation1- 2 include lichen planus, lichen simplex, eczematous dermatitis, and adverse reactions to cutaneous drugs.1 We describe a patient with an unusual persistent speckled hyperpigmentation on the anterior of both lower legs.
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Figure 1.

Clinical picture of the left leg.

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Figure 2.

Dermatoscopic examination (original magnification ×10) showing multiple, focally confluent macules, with a gray to bluish homogeneous coloration and a glassy appearance.

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Figure 3.

Histopathologic findings (hematoxylin-eosin, original magnification ×200). The arrow points to a roundish (in polarized light birefringent) foreign body with a surrounding moderate fibrosis and several siderophages in the dermis.

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Figure 4.

Image from scanning electron microscopy (Quanta 600 FEG; FEI, Hillsboro, Ore) of a cross section of one of the macules. Particle labeled 1 is metallic; all other bright particles are erythrocytes. HV indicates high voltage; Det, detector type; SSD, solid state detector; and WD, working distance.

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Figure 5.

Spectrum from an energy-dispersive x-ray spectrometer (Vantage; Thermo Electron Corp, Middleton, Wis) of the particle labeled 1 in Figure 4, which consists mainly of molybdenum, with additional small amounts of vanadium, silicon, and possibly oxygen. Because the analysis volume is greater than the particle, the carbon peak and at least part of the oxygen peak are originating from the dermis. Except for the carbon peak, all peaks are shown in full height. The carbon peak, by far the highest one, has been cut off by stretching the spectrum in the direction of the y-axis to give a better impression of the peak-background ratio of the other elements, which are the decisive ones for the composition of the particles.

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