Physiologic volar melanotic macules disproportionally affect Black patients

Key takeaways:

• 91.8% of the patients with physiologic volar melanotic macules were Black.
• Women vs. men were also more likely to have the condition with a ratio of 2.5:1.

Physiologic volar melanotic macules mainly affect Black patients, especially women, and occur predominately on the soles, according to a study.

Volar melanotic macules (VMM) are patches of discoloration found on the hands and feet of predominately patients with skin of color. Conditions which are nearly identical to VMM have often been misclassified as such.

“Given the identical appearance of the published lesions to VMM, we suspect these patients had physiologic pigmentation,” Jonathan D. Ho, MBBS, DSc, a consultant at the University Hospital of the West Indies, Jamaica, and colleagues wrote. “To distinguish this entity from other VMM, we utilize the term ‘physiologic volar melanotic macules’ (P-VMM).”

In this study, the authors evaluated the factors associated with P-VMM in 200 adults with skin of color using dermatoscopic images and questionnaires.

Results showed that 91.8% of the patients with P-VMM were Black, followed by 5.2% that were mixed-race, 2.1% that were Indian Asian and 1% that were Hispanic. Women were more likely to have P-VMM with a ratio of 2.5:1 to men.

In 67% of patients, both the palms and soles were involved with the palmar lesions being more subtle than the lesions on the soles. Pigmentation of the soles alone occurred in 25.8% of cases, whereas pigmentation isolated to the palms occurred less frequently at 7.2%.

Light brown was the most common lesion color (55.6%), whereas the remainder were a mix between lighter and darker macules. Most patients (76.2%) had both oval and round lesions.

Dermatoscopic features showed that more than 90% of lesions had a homogenous pattern, although they rarely had bland ridge, beaded and fibrillar patterns.

While the researchers found no association between P-VMM and trauma or weight-bearing areas, they did find that subjects with manual labor jobs were significantly more likely to have the condition (P = .019).

Although most patients would not seek treatment, according to the authors, 30% reported that they would. As there is currently no evidence-based treatment for P-VMM, this highlights an important therapeutic gap in the dermatology field and a need for further research.

“We believe this to be physiologic pigmentation most common in, but not limited to, Black individuals,” the authors concluded. “Future work includes examining the histopathology, association with other pigmentary variants, further assessment of frequency in non-Black [skin of color] populations, treatment and teasing out the relationship (if any) to [acral lentiginous melanoma].”