{'fraction_non_alphanumeric': 0.04060687193217314, 'fraction_numerical': 0.004462293618920125, 'mean_word_length': 5.176308539944904, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Disfiguring Leukoderma Caused by Banned Cosmetics: A Quiz.

A 47-year-old African man was referred to our clinic for multiple, rapidly progressive, hypopigmented lesions, which first occurred on his face and later on his scalp and trunk. Dermatological examination showed whitish patches, either isolated in a confetti-like pattern, or confluent in larger hypopigmented areas with ill-defined margins (Fig. 1a, b). Examination under Wood’s lamp and direct microscopy for possible fungal infection were both negative. Otherwise healthy, the patient had no personal or family history of vitiligo and autoimmune diseases. Three days prior to onset of the hypopigmentation, he had begun application to his face of a “carrot extract and vitamin E cream”, a bleaching cream, named Skin Light® (RODIS, Abidjan, Ivory Coast), which he had bought in an ethnic shop in Italy, It was the first-time the patient had used this specific product, but he had used other bleaching creams previously, with no complaints or skin reaction. The patient was precise about the name and composition of these cosmetics. He also reported a mild itching sensation and redness during first application of Skin Light®, but only the appearance of the pigmentation disorder led him to seek a dermatological consultation. In order to determine the composition of the cream, we conducted chemical and physical analysis in our university laboratory, including liquid chromatography and mass spectrometry. A biopsy was taken from the patient’s neck in order to investigate the type of pigmentation disorder. Patch tests were performed with the baseline series recommended by the Società Italiana Dermatologia Allergologica Professionale ed Ambientale (SIDAPA) using Rapid Patch Test (RPT®, F.I.R.M.A. SpA, Florence, Italy) and the commercial cream “as it is”, with an additional reading on day 4. A positive patch-test reaction developed exclusively to the cream (Fig. 1c, d). Vitiligo was excluded by histological examination, showing non-specific findings: mild orthohyperkeratosis (Fig. 1e), normally pigmented epidermal basal keratinocytes with Fontana-Masson stain (Fig. 1f), and uniform distribution of melanocytes on immunohistochemistry (HMB-45; Melan-A) (Fig. 1g, h).