Reversal of Laser-Induced Hypopigmentation with a Narrow-Band UV-B Light Source in a Patient with Skin Type VI
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Clinicopathological Correlation of Acquired Hyperpigmentary Disorders
Symposium Clinicopathological correlation of acquired Dermatopathology hyperpigmentary disorders Anisha B. Patel, Raj Kubba1, Asha Kubba1 Department of Dermatology, ABSTRACT Oregon Health Sciences University, Portland, Oregon, Acquired pigmentary disorders are group of heterogenous entities that share single, most USA, 1Delhi Dermatology Group, Delhi Dermpath significant, clinical feature, that is, dyspigmentation. Asians and Indians, in particular, are mostly Laboratory, New Delhi, India affected. Although the classic morphologies and common treatment options of these conditions have been reviewed in the global dermatology literature, the value of histpathological evaluation Address for correspondence: has not been thoroughly explored. The importance of accurate diagnosis is emphasized here as Dr. Asha Kubba, the underlying diseases have varying etiologies that need to be addressed in order to effectively 10, Aradhana Enclave, treat the dyspigmentation. In this review, we describe and discuss the utility of histology in the R.K. Puram, Sector‑13, diagnostic work of hyperpigmentary disorders, and how, in many cases, it can lead to targeted New Delhi ‑ 110 066, India. E‑mail: and more effective therapy. We focus on the most common acquired pigmentary disorders [email protected] seen in Indian patients as well as a few uncommon diseases with distinctive histological traits. Facial melanoses, including mimickers of melasma, are thoroughly explored. These diseases include lichen planus pigmentosus, discoid lupus erythematosus, drug‑induced melanoses, hyperpigmentation due to exogenous substances, acanthosis nigricans, and macular amyloidosis. Key words: Facial melanoses, histology of hyperpigmentary disorders and melasma, pigmentary disorders INTRODUCTION focus on the most common acquired hyperpigmentary disorders seen in Indian patients as well as a few Acquired pigmentary disorders are found all over the uncommon diseases with distinctive histological traits. -
Dermatologic Manifestations of Hermansky-Pudlak Syndrome in Patients with and Without a 16–Base Pair Duplication in the HPS1 Gene
STUDY Dermatologic Manifestations of Hermansky-Pudlak Syndrome in Patients With and Without a 16–Base Pair Duplication in the HPS1 Gene Jorge Toro, MD; Maria Turner, MD; William A. Gahl, MD, PhD Background: Hermansky-Pudlak syndrome (HPS) con- without the duplication were non–Puerto Rican except sists of oculocutaneous albinism, a platelet storage pool de- 4 from central Puerto Rico. ficiency, and lysosomal accumulation of ceroid lipofuscin. Patients with HPS from northwest Puerto Rico are homozy- Results: Both patients homozygous for the 16-bp du- gous for a 16–base pair (bp) duplication in exon 15 of HPS1, plication and patients without the duplication dis- a gene on chromosome 10q23 known to cause the disorder. played skin color ranging from white to light brown. Pa- tients with the duplication, as well as those lacking the Objective: To determine the dermatologic findings of duplication, had hair color ranging from white to brown patients with HPS. and eye color ranging from blue to brown. New findings in both groups of patients with HPS were melanocytic Design: Survey of inpatients with HPS by physical ex- nevi with dysplastic features, acanthosis nigricans–like amination. lesions in the axilla and neck, and trichomegaly. Eighty percent of patients with the duplication exhibited fea- Setting: National Institutes of Health Clinical Center, tures of solar damage, including multiple freckles, stel- Bethesda, Md (a tertiary referral hospital). late lentigines, actinic keratoses, and, occasionally, basal cell or squamous cell carcinomas. Only 8% of patients Patients: Sixty-five patients aged 3 to 54 years were di- lacking the 16-bp duplication displayed these findings. -
A Genome-Wide Association Study Reveals a Locus for Bilateral Iridal Hypopigmentation in Holstein Friesian Cattle Anne K
Hollmann et al. BMC Genetics (2017) 18:30 DOI 10.1186/s12863-017-0496-4 RESEARCHARTICLE Open Access A genome-wide association study reveals a locus for bilateral iridal hypopigmentation in Holstein Friesian cattle Anne K. Hollmann1, Martina Bleyer2, Andrea Tipold3, Jasmin N. Neßler3, Wilhelm E. Wemheuer1, Ekkehard Schütz1 and Bertram Brenig1* Abstract Background: Eye pigmentation abnormalities in cattle are often related to albinism, Chediak-Higashi or Tietz like syndrome. However, mutations only affecting pigmentation of coat color and eye have also been described. Herein 18 Holstein Friesian cattle affected by bicolored and hypopigmented irises have been investigated. Results: Affected animals did not reveal any ophthalmological or neurological abnormalities besides the specific iris color differences. Coat color of affected cattle did not differ from controls. Histological examination revealed a reduction of melanin pigment in the iridal anterior border layer and stroma in cases as cause of iris hypopigmentation. To analyze the genetics of the iris pigmentation differences, a genome-wide association study was performed using Illumina BovineSNP50 BeadChip genotypes of the 18 cases and 172 randomly chosen control animals. A significant association on bovine chromosome 8 (BTA8) was identified at position 60,990,733 with a -log10(p) = 9.17. Analysis of genotypic and allelic dependences between cases of iridal hypopigmentation and an additional set of 316 randomly selected Holstein Friesian cattle controls showed that allele A at position 60,990,733 on BTA8 (P =4.0e–08, odds ratio = 6.3, 95% confidence interval 3.02–13.17) significantly increased the chance of iridal hypopigmentation. Conclusions: The clinical appearance of the iridal hypopigmentation differed from previously reported cases of pigmentation abnormalities in syndromes like Chediak-Higashi or Tietz and seems to be mainly of cosmetic character. -
Melasma on the Nape of the Neck in a Man
Letters to the Editor 181 Melasma on the Nape of the Neck in a Man Ann A. Lonsdale-Eccles and J. A. A. Langtry Sunderland Royal Hospital, Kayll Road, Sunderland SR4 7TP, UK. E-mail: [email protected] Accepted July 19, 2004. Sir, sunlight and photosensitizing agents may be more We report a 47-year-old man with light brown macular relevant. pigmentation on the nape of his neck (Fig. 1). It was The differential diagnosis for pigmentation at this site asymptomatic and had developed gradually over 2 years. includes Riehl’s melanosis, Berloque dermatitis and He worked outdoors as a pipe fitter on an oilrig module; poikiloderma of Civatte. Riehl’s melanosis typically however, he denied exposure at this site because he involves the face with a brownish-grey pigmentation; always wore a shirt with a collar that covered the biopsy might be expected to show interface change and affected area. However, on further questioning it liquefaction basal cell degeneration with a moderate transpired that he spent most of the day with his head lymphohistiocytic infiltrate, melanophages and pigmen- bent forward. This reproducibly exposed the area of tary incontinence in the upper dermis. It is usually pigmentation with a sharp cut off inferiorly at the level associated with cosmetic use and may be considered of his collar. He used various shampoos, aftershaves and synonymous with pigmented allergic contact dermatitis shower gels, but none was applied directly to that area. of the face (6, 7). Berloque dermatitis is considered to be His skin was otherwise normal and there was no family caused by a photoirritant reaction to bergapentin; it history of abnormal pigmentation. -
Poikiloderma of Civatte, Slapped Neck Solar Melanosis, Basal Melanin Stores
American Journal of Dermatology and Venereology 2019, 8(1): 8-13 DOI: 10.5923/j.ajdv.20190801.03 Slapped Neck Solar Melanosis: Is It a New Entity or a Variant of Poikiloderma of Civatte?? (Clinical and Histopathological Study) Khalifa E. Sharquie1,*, Adil A. Noaimi2, Ansam B. Kaftan3 1Department of Dermatology, College of Medicine, University of Baghdad 2Iraqi and Arab Board for Dermatology and Venereology, Dermatology Center, Medical City, Baghdad, Iraq 3Dermatology Center, Medical City, Baghdad, Iraq Abstract Background: Poikiloderma of Civatte although is a common complaint among population, especially European, still it was not reported in dark skin people as in Iraqi population. Objectives: To study all the clinical and histopathological features of Poikiloderma of Civatte in Iraqi population. Patients and Methods: This study is descriptive, clinical and histopathological study. It was carried out at the Dermatology Center, Medical City, Baghdad, Iraq, from September 2017 to October 2018. Thirty-one patients with Poikiloderma of Civatte were included and evaluated by history, physical examination, Wood’s light examination. Lesional skin biopsies were obtained from 9 patients, with histological examination of the sections stained with Hematoxylin and Eosin (H&E) and Fontana-Masson stain. Results: Thirty-one patients were included in this study, with mean age +/- SD was 53.32+/-10 years, and all patients were males. Twenty-six patients (84%) were with skin phenotype III&IV, The pigmentation was either mainly erythematous (22.5%), mainly dark brown pigmentation (29%), and mixed type of pigmentation (48.5%). These lesions were distributed on the sides of the neck and the face and the V shaped area of the chest. -
Pigmented Contact Dermatitis and Chemical Depigmentation
18_319_334* 05.11.2005 10:30 Uhr Seite 319 Chapter 18 Pigmented Contact Dermatitis 18 and Chemical Depigmentation Hideo Nakayama Contents ca, often occurs without showing any positive mani- 18.1 Hyperpigmentation Associated festations of dermatitis such as marked erythema, with Contact Dermatitis . 319 vesiculation, swelling, papules, rough skin or scaling. 18.1.1 Classification . 319 Therefore, patients may complain only of a pigmen- 18.1.2 Pigmented Contact Dermatitis . 320 tary disorder, even though the disease is entirely the 18.1.2.1 History and Causative Agents . 320 result of allergic contact dermatitis. Hyperpigmenta- 18.1.2.2 Differential Diagnosis . 323 tion caused by incontinentia pigmenti histologica 18.1.2.3 Prevention and Treatment . 323 has often been called a lichenoid reaction, since the 18.1.3 Pigmented Cosmetic Dermatitis . 324 presence of basal liquefaction degeneration, the ac- 18.1.3.1 Signs . 324 cumulation of melanin pigment, and the mononucle- 18.1.3.2 Causative Allergens . 325 ar cell infiltrate in the upper dermis are very similar 18.1.3.3 Treatment . 326 to the histopathological manifestations of lichen pla- 18.1.4 Purpuric Dermatitis . 328 nus. However, compared with typical lichen planus, 18.1.5 “Dirty Neck” of Atopic Eczema . 329 hyperkeratosis is usually milder, hypergranulosis 18.2 Depigmentation from Contact and saw-tooth-shape acanthosis are lacking, hyaline with Chemicals . 330 bodies are hardly seen, and the band-like massive in- 18.2.1 Mechanism of Leukoderma filtration with lymphocytes and histiocytes is lack- due to Chemicals . 330 ing. 18.2.2 Contact Leukoderma Caused Mainly by Contact Sensitization . -
Atypical Variants of Mycosis Fungoides
Altınışık et al. Atypical Variants of Mycosis Fungoides REVIEW DOI: 10.4274/jtad.galenos.2021.09719 J Turk Acad Dermatol 2021;15(2):30-33 Atypical Variants of Mycosis Fungoides Dursun Dorukhan Altınışık, Özge Aşkın, Tuğba Kevser Uzunçakmak, Burhan Engin Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Dermatology, Istanbul, Turkey ABSTRACT Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma (CTCL) and it is characterised by specific histological features. MF is in a spectrum of disorders which includes Sezary syndrome and other CTCL subtypes. Clinically and histopathologically it can imitate other T-cell mediated dermatosis hence making its diagnosis difficult. Due to different prognosis and difference in treatment strategies other subtypes of CTCL must be differentiated from MF. MF is a clinically indolent low-grade lymphoma which is seen in people aged between 55- 60 and it’s seen more commonly in men (2:1 ratio). Meanwhile other subtypes of MF like folliculotropic variant may show relatively a more aggressive course and our treatment strategy may differ. Keywords: Mycosis fungoides, Cutaneous T-cell lymphoma, Phototherapy, PUVA Introduction follicles frequently causing alopecia and in the paediatric population Mycosis fungoides (MF) is the most common type of cutaneous T-cell it tends to accompany hypopigmented patches and plaques. FMF lymphoma (CTCL) and it is characterised by specific histological preferentially involves the head and neck region however it can features [1]. MF is in a spectrum of disorders which includes Sezary sometimes involve the trunk or the extremities [6]. Patients with syndrome and other CTCL subtypes. Clinically and histopathologically FMF have significant pruritus which may be overlapped by S. -
Albinism: Modern Molecular Diagnosis
British Journal of Ophthalmology 1998;82:189–195 189 Br J Ophthalmol: first published as 10.1136/bjo.82.2.189 on 1 February 1998. Downloaded from PERSPECTIVE Albinism: modern molecular diagnosis Susan M Carden, Raymond E Boissy, Pamela J Schoettker, William V Good Albinism is no longer a clinical diagnosis. The past cytes and into which melanin is confined. In the skin, the classification of albinism was predicated on phenotypic melanosome is later transferred from the melanocyte to the expression, but now molecular biology has defined the surrounding keratinocytes. The melanosome precursor condition more accurately. With recent advances in arises from the smooth endoplasmic reticulum. Tyrosinase molecular research, it is possible to diagnose many of the and other enzymes regulating melanin synthesis are various albinism conditions on the basis of genetic produced in the rough endoplasmic reticulum, matured in causation. This article seeks to review the current state of the Golgi apparatus, and translocated to the melanosome knowledge of albinism and associated disorders of hypo- where melanin biosynthesis occurs. pigmentation. Tyrosinase is a copper containing, monophenol, mono- The term albinism (L albus, white) encompasses geneti- oxygenase enzyme that has long been known to have a cally determined diseases that involve a disorder of the critical role in melanogenesis.5 It catalyses three reactions melanin system. Each condition of albinism is due to a in the melanin pathway. The rate limiting step is the genetic mutation on a diVerent chromosome. The cutane- hydroxylation of tyrosine into dihydroxyphenylalanine ous hypopigmentation in albinism ranges from complete (DOPA) by tyrosinase, but tyrosinase does not act alone. -
Leukemia Cutis Masquerading As Vitiligo
Leukemia Cutis Masquerading as Vitiligo Marissa D. Newman, MD; Sandy Milgraum, MD Chronic myelomonocytic leukemia (CMML) is a Case Report hematologic stem cell disorder with myelodys- A 57-year-old man presented with hypopigmented plastic and myeloproliferative characteristics. macules over his left forearm that had gradually Extramedullary leukemic infiltration of the skin, appeared over 2 months. The patient’s CMML although uncommon in CMML, has prognos- was diagnosed 4 months prior to his presentation tic relevance. We report a unique case of a to us. There was no personal or family history patient with CMML who clinically presented of autoimmune disease. At the time of CMML with vitiligo that was histologically diagnosed diagnosis, the peripheral blood showed a marked as leukemia cutis. This case underscores the monocytosis of 1.33109 cells/L (reference range, necessity of early recognition of skin changes 0.2–0.83109 cells/L) and abnormal granulocytic in patients with hematologic disorders and the maturation. Bone marrow aspirate demonstrated differentiation of nonspecific skin lesions from decalcified hypercellular marrow, maturing trilineage leukemia cutis. hematopoiesis, and dysplastic megakaryocytes. Immu- Cutis. 2008;81:163-165. nophenotyping by flow cytometry confirmed the pres- ence of a large monocytic cluster expressing abnormal CD56 and monocytic antigens CD14, CD64, CD33, hronic myelomonocytic leukemia (CMML) and CD4. Fluorescent in situ hybridization and poly- is a clonal disorder of hematopoietic stem merase chain reaction were both negative for the C cells with features of myelodysplastic breakpoint cluster region–Abelson gene, BCR-ABL. syndrome (MDS) characterized by monocytosis Cytogenetic analysis revealed trisomy 8, loss of Y, and and refractory anemia with excess blasts, as well rearrangement of the short arm of 1. -
Cutaneous Manifestations of Systemic Disease
Cutaneous Manifestations of Systemic Disease Dr. Lloyd J. Cleaver D.O. FAOCD FAAD Northeast Regional Medical Center A.T.Still University/KCOM Assistant Vice President/Professor ACOI Board Review Disclosure I have no financial relationships to disclose I will not discuss off label use and/or investigational use in my presentation I do not have direct knowledge of AOBIM questions I have been granted approvial by the AOA to do this board review Dermatology on the AOBIM ”1-4%” of exam is Dermatology Table of Test Specifications is unavailable Review Syllabus for Internal Medicine Large amount of information Cutaneous Multisystem Cutaneous Connective Tissue Conditions Connective Tissue Diease Discoid Lupus Erythematosus Subacute Cutaneous LE Systemic Lupus Erythematosus Scleroderma CREST Syndrome Dermatomyositis Lupus Erythematosus Spectrum from cutaneous to severe systemic involvement Discoid LE (DLE) / Chronic Cutaneous Subacute Cutaneous LE (SCLE) Systemic LE (SLE) Cutaneous findings common in all forms Related to autoimmunity Discoid LE (Chronic Cutaneous LE) Primarily cutaneous Scaly, erythematous, atrophic plaques with sharp margins, telangiectasias and follicular plugging Possible elevated ESR, anemia or leukopenia Progression to SLE only 1-2% Heals with scarring, atrophy and dyspigmentation 5% ANA positive Discoid LE (Chronic Cutaneous LE) Scaly, atrophic plaques with defined margins Discoid LE (Chronic Cutaneous LE) Scaly, erythematous plaques with scarring, atrophy, dyspigmentation DISCOID LUPUS Subacute Cutaneous -
Hereditary Hearing Impairment with Cutaneous Abnormalities
G C A T T A C G G C A T genes Review Hereditary Hearing Impairment with Cutaneous Abnormalities Tung-Lin Lee 1 , Pei-Hsuan Lin 2,3, Pei-Lung Chen 3,4,5,6 , Jin-Bon Hong 4,7,* and Chen-Chi Wu 2,3,5,8,* 1 Department of Medical Education, National Taiwan University Hospital, Taipei City 100, Taiwan; [email protected] 2 Department of Otolaryngology, National Taiwan University Hospital, Taipei 11556, Taiwan; [email protected] 3 Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei City 100, Taiwan; [email protected] 4 Graduate Institute of Medical Genomics and Proteomics, National Taiwan University College of Medicine, Taipei City 100, Taiwan 5 Department of Medical Genetics, National Taiwan University Hospital, Taipei 10041, Taiwan 6 Department of Internal Medicine, National Taiwan University Hospital, Taipei 10041, Taiwan 7 Department of Dermatology, National Taiwan University Hospital, Taipei City 100, Taiwan 8 Department of Medical Research, National Taiwan University Biomedical Park Hospital, Hsinchu City 300, Taiwan * Correspondence: [email protected] (J.-B.H.); [email protected] (C.-C.W.) Abstract: Syndromic hereditary hearing impairment (HHI) is a clinically and etiologically diverse condition that has a profound influence on affected individuals and their families. As cutaneous findings are more apparent than hearing-related symptoms to clinicians and, more importantly, to caregivers of affected infants and young individuals, establishing a correlation map of skin manifestations and their underlying genetic causes is key to early identification and diagnosis of syndromic HHI. In this article, we performed a comprehensive PubMed database search on syndromic HHI with cutaneous abnormalities, and reviewed a total of 260 relevant publications. -
Analysis of Ocular Hypopigmentation in Rab38cht/Cht Mice
ARTICLES Analysis of Ocular Hypopigmentation in Rab38cht/cht Mice Brian P. Brooks,1,2,3 Denise M. Larson,2,3 Chi-Chao Chan,1 Sten Kjellstrom,4 Richard S. Smith,5,6 Mary A. Crawford,1 Lynn Lamoreux,7 Marjan Huizing,3 Richard Hess,3 Xiaodong Jiao,1 J. Fielding Hejtmancik,1 Arvydas Maminishkis,1 Simon W. M. John,5,6 Ronald Bush,4 and William J. Pavan3 cht PURPOSE. To characterize the ocular phenotype resulting from and RPE thinning. The synergistic effects of the Rab38 and mutation of Rab38, a candidate gene for Hermansky-Pudlak Tyrp1b alleles suggest that TYRP1 is not the only target of syndrome. RAB38 trafficking. This mouse line provides a useful model for cht/cht METHODS. Chocolate mice (cht, Rab38 ) and control het- studying melanosome biology and its role in human ocular erozygous (Rab38cht/ϩ) and wild-type mice were examined diseases. (Invest Ophthalmol Vis Sci. 2007;48:3905–3913) clinically, histologically, ultrastructurally, and electrophysi- DOI:10.1167/iovs.06-1464 ologically. Mice homozygous for both the Rab38cht and the Tyrp1b alleles were similarly examined. he analysis of mice that exhibit defects in coat coloration cht/cht RESULTS. Rab38 mice showed variable peripheral iris trans- T(coat color mutants) has aided in the identification of 1 illumination defects at 2 months of age. Patches of RPE hypo- genes important in eye, skin, and hair pigmentation. Many of pigmentation were noted clinically in 57% of Rab38cht/cht eyes these genes are mutated in patients with pigmentary anoma- and 6% of Rab38cht/ϩ eyes. Rab38cht/cht mice exhibited thin- lies.