Ashy dermatosis. An apoptotic disease?

Of nine patients with ashy dermatosis, eight were women; most were young adults when the dermatosis began. The incidences of atopy (five patients) and thyroid disease (three patients) were striking. Although some of the patients were clinically atypical, histologic study in all cases showed basal cell vacuolation, Civatte bodies, pigmentary incontinence, and a mild perivascular lymphohistiocytic infiltrate. Direct immunofluorescence microscopy, performed in four cases, showed igM cytoid bodies. We hypothesize that the postinflammatory hyperpigmentation in ashy dermatosis and, perhaps, in other dermatoses may occur on the basis of basal cell apoptosis.