British Journal of Dermatology (1977) 96, 245.

Locahzation of melanin pigmentation in the skin

with Wood's lamp
BARBARA A.GILCHREST, THOMAS B.FITZPATRICK, R.ROX ANDERSON
AND JOHN A.PARRISH
Department of Dermatology, Harvard Medical School, Massachusetts General Hospital,
Boston, Massachusetts 02114, U.S.A.

Accepted for publication 2S June 1976

SUMMARY
Examination of the skin or hair with Wood's lamp has long been used to aid in the clinical diagnosis of
some cutaneous disorders. A new observation reported here illustrates that Wood's light can be used
to determine the depth of melanin pigmentation in the skin: contrast in epidermal pigmentation is
increased while contrast in dermal pigmentation is decreased under Wood's lamp illumination com-
pared to ambient visible light. The principles underlying this phenomenon are discussed. Use of the
Wood's lamp to localize abnormal melanin pigmentation in the skin can be a guide to clinical diagnosis
of hypermelanosis.

In 1903, Robert W. Wood developed a filtered ultraviolet light system generated by high pressure
mercury arc radiation passing through a nickel oxide phosphor filter, for application to several military
problems (Wood, 1919; Harvey & Raymond, 1971). Since that time. Wood's lamp has been used
in medical practice by dermatologists to diagnose such disorders as tinea capitis, erythrasma, some
pseudomonas infections, and porphyria cutanea tarda by the characteristic fluorescence of hair shafts,
skin, and urine, respectively (Table i).
When a substance fluoresces, some energy is dissipated in the process, and the emitted light is
of less energy (longer wavelength) than the light originally absorbed. In the cases hsted above,
longwave ultraviolet or black light from the Wood's lamp (340-400 nm with maximum output at
365 nm) (Task Force Report, 1974) is absorbed and light in the visible spectrum (400-700 nm) is
emitted.
Fluorescence of epidermal and, to a lesser degree, dermal proteins under Wood's lamp illumination
is responsible for the following clinical observations:
(1) Variations in epidermal pigmentation are more apparent under Wood's lamp than under visible
light. Areas of hypomelanosis such as vitiligo, which lack all epidermal pigmentation, are therefore
easily identified with a Wood's lamp (Mustakallio & Korhonen, 1966).
(2) Variations in dermal pigmentation are less apparent under visible hght.
It is also of interest that dermal pigmentation appears blue under visible light, while epidermal
pigmentation appears brown or black.
These phenomena may be explained by optical properties of the skin: in any layer of skin, light may
be reflected back towards the surface, scattered (defleaed from its original path), or absorbed by the
Correspondence address: Dr T.B.Fitzpatrick, Department of Dermatology, Massachusetts General Hospital,
Boston, Massachusetts 02114, U.S.A.
246 B.A.Gilchrest et al.
TABLE I. Fluorescence under Wood's lamp

Colour observed
Clinical setting with Wood's lamp Fluorescent compound

Tinea cap it is* Blue-green Pteridine

(e.g. Microsporum)
Erythrasma* Coral-red Porphyrin
{Corynebacterium minutissimum}
Pseudomonas infection* Yeilow-green Fiuorescein
Porphyria cutanea tarda* Orange-pink or Uroporphyrin
pink-orange
Normal skint Blue-white Dermal and epidermal proteins

References: * Fitzpatrick et al. (1971); + Findlay (1970).

tissues. The light that is not refiected, scattered, or absorbed is transmitted to deeper tissues. Within
the ultraviolet and visible portions of the electromagnetic spectrum the longer the wavelength, the
deeper the penetration of photons into the skin (Pathak & Epstein, 1971). Scatter is inversely
proportional to the wavelength so that photons of slightly shorter wavelengths are scattered
much more. Thus, visible light penetrates deeper than ultraviolet light (wavelengths 320-400 nm)
and red light (700 nm) deeper than blue (400 nm) light. These properties also eause shorter blue
wavelengths to be preferentially refiected from the superficial layers (stratum corneum, epidermis,

WavelBngtns (nmj

Wood's
amp
250 365 400

Stratum
corneum

Epidermis

Dermis

Fat

FIGURE I. Schematic representation of depth of penetration of light in Caucasian skin (Adapted

from Everett et al. 1966).
 Melanin pigmentation under Wood's lamp 247

FIGURE 2. Ephelides, a disorder characterized by increased epidermal pigmentation, photographed

(a) under visible light and (b) under Wood's lamp illumination.

FIGURE 3. Naevus of Ota, a lesion consisting of dermal melanocytes, photographed (a) under
visible light and (b) under Wood's lamp illumination.
248 B.A.Gilchrest et al.
and upper dermis) and the longer red wavelengths are preferentially reflected from deeper tissues
(dermis). Fluorescence may occur only at depths to which the light causing the fluorescence has
penetrated. Fig. i indicates that the fluorescence of human skin seen under Wood's lamp arises
predominantly in the stratum corneum and epidermis.
Melanin strongly absorbs both visible and ultraviolet light and is the major absorber of light in the
skin. Hence, the colour observed in an area of melanized skin is made up of those wavelengths which
are reflected back to the eye from a depth in the skin superficial to the melanin pigment. If the
melanin is very superficial, as in black skin, most of the light is absorbed and only a small amount of
light returns to the eye, and the skin appears black: the absence of colour. Under Wood's lamp
illumination, the depth of melanin likewise determines the amount of fluorescence seen.
Applying these facts to the clinical observations listed above:
(1) Variations in epidermal pigmentation are more striking under Wood's lamp than under visible
light because one sees essentially only fluorescence from the epidermis and stratum corneum. Under
visible light, the 'background' of more deeply penetrating wavelengths reflected from the dermis tends
to diminish the contrast in epidermal pigmentation (Fig. 2).
(2) Variations in dermal pigmentation are much less evident or absent under Wood's lamp than
under visible light because less ultraviolet light reaches the dermis and hence the dermis contributes
much less of the fluoresced light which returns to the eye (Fig. 3).
(3) Dermal melanin appears blue under visible light because a large portion of the shorter (blue)
wavelengths are reflected back to the eye before reaching the deepest dermis, while most of the longer
(red) wavelengths penetrate to this depth and are absorbed by the melanin.
A simple model illustrates this third phenomenon: a water cell with plate glass sides at least 2 inches
in depth is filled with quinine water to which has been added several drops of a detergent. The liquid
should appear quite cloudy. A very small amount of ink may be added to the liquid to approximate
more closely the human skin tone. A glass microscope slide is then coated with a flat black paint. If the
slide is viewed with ambient light through the entire depth of the liquid, it appears blue. Under Wood's
lamp, it can no longer be seen at this depth. If the slide is held immediately below the surface of the
liquid, it appears black-brown in ambient light; under Wood's lamp it appears considerably darker.
In summary, the appearance of skin under Wood's lamp differs from that of skin under visible
light because only fluorescent compounds are seen and because the superficial layers of the skin are
better observed. Using Wood's lamp it is possible, therefore, to estimate not only the depth of
cutaneous hyperpigmentation and to diflferentiate hypopigmentation from absence of pigmentation
(vitiligo), but also to differentiate epidermal from dermal hypermelanosis. The diagnosticfindingsmay
be understood by considering the relative penetration of different wavelengths of light into the skin,
the phenomenon of fluorescence, and the role of melanin as an absorber.

REFERENCES
EVERETT, M.A., YEARGERS, E., SAYRE, R.M. & OLSON, R.L. (1966) Penetration of epidermis by ultraviolet rays.
Photochemistry and Photobiology, 5, 533.
FiNDLAY, G.H. C1970) Blue skin. British Journal of Dermatology, 83, 127.
FITZPATRICK, T.B., ARNDT, K.A., CLARK, W.H., EISEN, A.L., VAN SCOTT, E.J. & VAUGHAN, J.H. (eds) (1971)
Dermatology in General Medicine, McGraw-Hill, New York, pp. 1156, 1693, 1786.
HARVEY, H . A . & RAYMOND, D . (1971) The National Cyclopedia of American Biography, Vol. 46, p. 36. McGill,
New York,
MusTAKALLio, K.K., & KoRHONEN, P. C1966) Monocbromatic ultraviolet pbotograpby in dermatology. Journal
of Investigative Dermatology, 47, 351.
PATHAK, M.A. & EPSTEIN, J.H. (1971) Normal and abnormal reaction of man to ligbt. In: Dermatology in General
Medicine (Ed. by T.B. Fitzpatrick et al.), p. 983. McGraw-Hill, New York.
Task Force Report: Report on Ultraviolet Ligbt Sources (1974) In: Archives of Dermatology, 109, 833.
WOOD, R.W. (1919) Secret communications concerning light Tzy&. Journal de Physiologie, 5' serie, t IX.