DYSTROPHIES 



-229 



the face and hands which are affected, and there may be a certain 

 symmetry. The initial patches are often surrounded by a zone 

 of hyperpigmentation. Occasionally within the white areas small 

 dot -like zones of pigmentation are left. The hairs of the affected 

 parts frequently become white, but sometimes remain of normal 

 colour. The white patches do not show any marked change in 

 sensation ; there is never anaesthesia ; in many cases there is hyper- 

 aesthesia to heat and light stimulation. The texture of the skin re- 

 mains normal; occasionally slight atrophic processes may be noted. 

 It is usually stated that the 

 general health is not im- 

 paired. In our experience, 

 however, when the patches 

 are large and situated on 

 uncovered parts of the 

 body, especially the face, 

 symptoms of severe as- 

 thenia have been noticed. 

 Moreover, the patients 

 complain that they cannot 

 do any work in the sun, 

 as they experience a 

 burning sensation in the 

 white patches, and they 

 suffer from giddiness. 



Clinical Varieties — 

 Melung [Beta). — This type 

 of leucoderma was first 

 described by Ziemann, 

 and is fairly common 

 among West African 

 negroes. It is found also 

 in Ceylon, India, and 

 Burma, in the last-men- 

 tioned country having 

 been described by Castor. 

 The affection is always 

 symmetric, and attacks 

 only the palms or the soles, 

 or both palms and soles. Fig. 873.— Leucoderma in a Sinhalese. 

 Small areas of the skin 



undergo a slow process of depigmentation, ibecoming whitish or 

 yellowish; there is no alteration of sensibility. The'.depigmented 

 areas, which are generally of various shape, are intermixed with 

 patches of normally pigmented skin, so that the '^palms ^and 'soles 

 present a marmoriform appearance. 



The disease is chronic and incurable. It often develops in child- 

 hood, and several members of the same family may be affected. : 



A variety of leucoderma in the shape of two small, often triangular 



