Author Affiliation: Pinderfields General Hospital, Wakefield, England.
I read with interest a case study presented in this journal,1 as I had previously been made aware of the particulars by the patient's own physician. It is a now well-documented phenomenon that one of the adverse effects of topical prostaglandin F2α analogues is that they may cause periocular hyperpigmentation2 - 3 ; this case was unusual, as the pigmentation occurred within a juxta-ocular skin graft placed after removal of a malignant melanoma.
The article discusses the scant evidence available related to the pathogenesis of this hyperpigmentation, which suggests that prostaglandins increase the activity of the rate-limiting enzyme in melanin synthesis, tyrosinase, resulting in increased skin pigmentation.4
Histological findings unavailable at the time of the original article challenge the assertions about pathogenicity made therein. Two months after halting Latanoprost, the pigmentation had not fully resolved; a punch biopsy was performed. This showed brown deposits both in macrophages and interstitium throughout the superficial and deep dermis that tested positive for Perl stain, consistent with the presence of ferric iron. There was no evidence of melanocytic proliferation or increase in melanin.
The etiology of the iron deposition in the patient's juxtaocular skin graft remains uncertain. However, it is well known that grafts may be complicated by venous congestion, and it is possible that a subclinical example of this phenomenon combined with the vasoconstrictive effects of the prostaglandin analogue on graft blood vessels could have led to increased pressures with consequential hemosiderin deposition in the tissues.
Correspondence: Ms Digger, Pinderfields General Hospital, Wakefield WF1 4DG, England (quinquage@gmail.com).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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