chemical leucoderma ( cl ) occurs after repeated topical or systemic exposure to a variety of chemicals , usually without preceding inflammation . herein , a case of cl secondary to ear - ring stoppers made of polyvinyl chloride ( pvc ) is illustrated . a 15-year - old girl presented with a patterned depigmentation over the back of both ear lobules of 2 months duration . she refused previous history of spontaneous depigmented lesions on her body or in family members . examination revealed well - defined circular areas of depigmentation , symmetrically involving back of both ear lobules and extending to the immediate retroauricular region , with no signs of inflammation or change in skin texture [ figure 1 ] . the location of the lesions almost corresponded to the site of contact of the plastic ear - ring stoppers [ figure 2 ] . patterned circular area of depigmentation over the back of left ear lobule plastic ear - ring stoppers made of polyvinyl chloride standard patch testing was done with the indian standard series and cosmetic series of allergens ( chemotechnique ) , approved by the contact and occupational dermatoses forum of india . it was negative after 48 h. the patient refused patch testing for extended duration for fear of possible induced depigmentation at the patch test site . she was started on topical 0.1% tacrolimus cream , but unfortunately she was lost to follow - up . in a clinic - aetiological study of 864 cases , the aetiological agents causing cl identified were : hair dye 27.4% ( 21% self - use , 6.4% not self - use ) , deodorant and spray perfume 21.6% , detergent and cleansers 15.4% , adhesive bindi 12% , rubber chappal 9.4% , black socks and shoes 9.1% , eyeliner 8.2% , lip liner 4.8% , rubber condoms 3.5% , lipstick 3.3% , fur toys 3.1% , toothpaste 1.9% , insecticides 1.7% , therapeutic response was much better in  pure  cl ( 73.4% ) than in those with co - existing vitiligo ( 20.9% ) . cl may pose a diagnostic dilemma as clinicopathological criteria do not reliably differentiate cl from vitiligo . nevertheless , a history of repeated exposure to a known or suspected depigmenting agent is often useful . genetically determined fragility of melanocytes is speculated to be the key mechanism . unlike idiopathic vitiligo , predisposing factors are implicated in cl , which initiate programmed cell death or apoptosis of melanocytes . genetic inability of melanocytes to tolerate and/or respond to oxidative stress may be the underlying molecular mechanism in cl . to facilitate the diagnosis of cl , clinical diagnostic criteria have been proposed , according to which any three out of the following four should be present : a ) acquired vitiligo - like lesions , b ) history of repeated exposure to specific chemical compounds , c ) patterned vitiligo - like macules conforming to the site of exposure and d ) confetti macules . our case met the first three criteria and hence labelled as a case of cl . cl may occur at patch test sites , and patch test results may not always be positive in cases of cl . in a study of 50 patients of contact leucoderma , positive patch test reactivity with offending agent was seen in 18 ( 36% ) and depigmentation was seen in only 4 ( 8% ) cases after 21 days of patch testing . the final pvc products , when completely cured or hardened , are generally considered to be inert and non - hazardous to the skin . however , there are a number of additives included in the final pvc products such as plasticisers and stabilisers , as well as molecules of the monomer . di ( 2-ethylhexyl ) phthalate ( dop ) , butyl benzyl phthalate and di - n - butyl maleate are used as plasticisers for soft pvc . these plasticisers are known to cause contact dermatitis and contact urticaria . however , after a meticulous search on pubmed and medline , only three reports of pvc - induced cl have been found . kim et al . reported cl with oxygen nasal cannula containing both pvc and plasticisers like dop , dibutyl phthalate and diethyl phthalate . frenk and kocsis reported a case of depigmentation from adhesive tape made of pvc with a natural rubber adhesive base that contained a derivative of dihydroxydiphenyl methane . it would have been interesting to know what plasticisers were used in its manufacture , but the facility was not available in our institution . though the exact mechanism of pvc - induced depigmentation is not known , it has been mooted that pvc causes cl following prolonged contact . treatment options of cl include discontinuation of the offending agent , topical steroids , tacrolimus , oral steroid pulse , phototherapy ( narrow band - uvb , puva ) , etc . techniques of surgical repigmentation involve the transfer of melanocytes , melanocytes and keratinocytes , or full - thickness skin from normally pigmented areas to hypomelanotic patches . autologous skin grafts can be divided into three major groups : ( 1 ) grafting of normal skin ( epidermis with or without dermis ) that contains melanocytes , ( 2 ) grafting of a noncultured epidermal or hair follicle suspension that contains melanocytes , and ( 3 ) grafting of cultured melanocytes with or without keratinocytes , in suspension or as sheets . in this case , the patient was advised to use the metallic stoppers instead of the pvc ear - ring stoppers . pvc ear - ring stoppers are in vogue among girls / women as a substitute to the precious and expansive metals like gold or silver . this is the first report of cl induced by plastic ear - ring stoppers . in future , with increasing use of pvc ear - ring stoppers in precious as well as imitation jewellery , dermatologists are more likely to encounter this patterned depigmentation , and therefore it is imperative to take cognisance of this new pattern and cause of cl .