Examining Physiologic Volar Macules in Diverse Populations - AMJ

Examining Physiologic Volar Macules in Diverse Populations

PHYSIOLOGIC volar melanotic macules (P-VMM) are underexplored, particularly in individuals with skin of color. Historically, trauma has been suggested as a possible cause, but limited research has been conducted in recent decades. This study aimed to assess the clinical, historical, and dermoscopic features of P-VMM in adults with skin of color.

A cross-sectional study enrolled 200 adults from Jamaica and Massachusetts, focusing on individuals with skin of color. Clinical and dermoscopic images were taken of those with P-VMM, documenting size, color, distribution, localization, and dermoscopic patterns. Additionally, participants completed questionnaires covering demographics, occupational roles, and trauma history.

Among participants with P-VMM, 91.8% were Black, followed by mixed-race individuals (5.2%), Indian Asian (2.1%), and Hispanic (1%). Women were more affected, with a female-to-male ratio of 2.5:1. Both palms and soles were involved in 67% of cases. The lesions appeared as light-to-dark brown, round or oval macules and patches that were consistent in appearance. There was no significant association with a history of trauma, and the macules showed no predilection for weight-bearing areas. However, manual labor occupations were linked to the presence of P-VMM (P = .019).

Dermoscopy revealed a predominantly homogeneous pattern in over 90% of cases. Less common patterns, such as bland ridge, beaded, and fibrillar, were rarely observed. Despite the study’s valuable findings, limitations included the absence of histopathological analysis and an unbalanced representation of different skin of color subgroups.

In conclusion, P-VMM is prevalent in Black adults and shows no clear relationship with trauma or weight-bearing areas. The lesions are characterized by a uniform brown color and primarily exhibit a homogeneous dermoscopic pattern. This study highlights the importance of recognizing P-VMM in clinical practice, particularly in individuals with skin of color, and suggests that manual labor occupations may play a role in its development.

Reference: Ho JD et al. A cross-sectional study of physiologic volar melanotic macules: Demographic, historical, clinical, and dermatoscopic features of a common yet neglected pigmentary variant in individuals with skin of color. J Am Acad Dermatol. 2024;DOI:10.1016/j.jaad.2024.10.097.

Katie Wright | AMJ

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