Dyschromatosis universalis hereditaria (DUH) is a rare genodermatosis that presents with early onset of diffuse mottled pigmentation. It is seen predominantly in individuals of Japanese descent, although cases have been described in multiple different populations worldwide. The majority of cases are inherited in an autosomal dominant fashion, but autosomal recessive and sporadic cases have been reported. Mutations in the ABCB6 (ATP-binding cassette subfamily B, member 6) gene on chromosome 2q have been linked to autosomal dominant cases of DUH, but the pathogenesis largely remains unknown. Two other genetic loci, 6q24.2-q25.2 and 12q21-q23, have been linked to DUH, but no causative genes have been identified.

DUH is characterized by asymptomatic, reticular, hyper- and hypopigmented macules of irregular shape and size that are distributed diffusely over the trunk and extremities. While involvement of the face is present in roughly 50% of affected individuals, palms and soles are typically spared. Dyspigmentation usually appears in infancy or early childhood and persists throughout life.

In general, DUH is skin limited, but there have been reports of associated conditions, including cataracts, diabetes, glaucoma, hypothyroidism, intellectual disability, photosensitivity, primary ovarian insufficiency, sensorineural hearing loss, small stature, tuberous sclerosis, and X-linked ocular albinism.

Related topic: dyschromatosis symmetrica hereditaria