Case of the Month

What is going on with this man’s chest? Dr. Crutchfield’s Case of the Month

Diagnosis: Futcher’s (or Voigt’s) Pigmentary Demarcation Lines, Type C and E. (Sometimes also referred to as Midline Hypopigmentation or Ito’s Pigmentary Demarcation Lines)

Futcher’s lines, also known as pigmentary demarcation lines or Voigt lines (sometimes spelled as Voight lines), or even more rarely, Ito's lines, is a normal skin pigmentation variant found in approximately 50% of black women and 33% of black men. Hispanics have the next highest incidence, followed by Asians and occasionally whites. The prevalence seems to be directly proportional to the degree of pigmentation. Futcher’s lines usually appear in early childhood and are often present at birth. There seems to be a slight female predominance. The current theory is that the purpose of the more heavily pigmented dorsal skin is increased sun protection; however, the darker side seems to be where more hair follicles are located. Five types of pigmentary demarcation lines (designated A to E) have been described, with Futcher’s lines (Type A) being most common. Type B lines represent an abrupt transition from the darker lateral skin to the medial lighter skin on the posterior legs. Type C lines represent a vertical line of hypopigmentation in the presternal or parasternal areas. They are present in approximately 30% of black adults. Type D lines are found on the posteromedial area of the spine. They are the least common, occurring in less than 10% of black adults. Type E lines represent well-defined patches, most often running from the medial third of the clavicle to the peri-areolar skin. They are present in approximately 15% of black adults.

In this particular case, the patient has mostly Futcher's/Voigt's type "C" pigmentary demarcation lines with a touch of type "E" pigmentary demarcation lines near his clavicles.

Reference:

Futcher Lines
Paul Kelly MD, Lowell A. Goldsmith MD, MPH, Lynn McKinley-Grant MD, Aída Lugo-Somolinos MD, Sarah Stein MD, Karen Wiss MD, Sheila Galbraith MD, Craig N. Burkhart MD, Dean Morrell MD, Lynn Garfunkel MD, and Nancy Esterly MD www.VisualDx.com