DOCSLIB.ORG

Efficacy of Targeted Phototherapy in Idiopathic Guttate Hypomelanosis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Efficacy of Targeted Phototherapy in Idiopathic Guttate Hypomelanosis EFFICACY OF TARGETED PHOTOTHERAPY IN IDIOPATHIC GUTTATE HYPOMELANOSIS Dissertation Submitted to THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY In the fulfilment of the regulations for the award of the degree M.D. DERMATOLOGY, VENEREOLOGY AND LEPROLOGY BRANCH – XX REG. NO. 201730353 DEPARTMENT OF DERMATOLOGY, VENEROLOGY AND LEPROLOGY PSG INSTITUTE OF MEDICAL SCIENCE AND RESEARCH THE TAMILNADU DR.M.G.R.MEDICAL UNIVERSITY CHENNAI, TAMILNADU MAY 2020 EFFICACY OF TARGETED PHOTOTHERAPY IN IDIOPATHIC GUTTATE HYPOMELANOSIS In the fulfilment of the regulations for the award of the degree M.D. DERMATOLOGY, VENEREOLOGY AND LEPROLOGY BRANCH – XX REG. NO. 201730353 GUIDE Dr. SHANMUGASEKAR C, MD DEPARTMENT OF DERMATOLOGY, VENEREOLOGY AND LEPROLOGY PSG INSTITUTE OF MEDICAL SCIENCE AND RESEARCH THE TAMILNADU DR.M.G.R.MEDICAL UNIVERSITY CHENNAI, TAMILNADU MAY 2020 CERTIFICATE This is to certify that the thesis entitled “EFFICACY OF TARGETED PHOTOTHERAPY IN IDIOPATHIC GUTTATE HYPOMELANOSIS” is a bonafide work of Dr. KANNAN .P done under the direct guidance and supervision of Dr. SHANMUGASEKAR .C MD, in the department of Dermatology, Venereology and Leprology, PSG Institute of Medical Sciences and Research, Coimbatore in fulfillment of the regulations of Dr.MGR Medical University for the award of M.D. degree in Dermatology, Venereology and Leprology. Dr. REENA RAI Dr. RAMALINGAM Professor DEAN Dept. of DVL DECLARATION I hereby declare that this dissertation entitled “EFFICACY OF TARGETED PHOTOTHERAPY IN IDIOPATHIC GUTTATE HYPOMELANOSIS” was prepared by me under the direct guidance and supervision of Dr. SHANMUGASEKAR .C MD, PSG Institute of Medical Sciences and Research, Coimbatore. The dissertation is submitted to the Tamilnadu Dr.MGR Medical University in fulfillment of the University regulation for the award of M.D. degree in Dermatology, Venereology and Leprology. This dissertation has not been submitted for the award of any other Degree or Diploma. DR. KANNAN .P CERTIFICATE BY THE GUIDE This is to certify that the thesis entitled “EFFICACY OF TARGETED PHOTOTHERAPY IN IDIOPATHIC GUTTATE HYPOMELANOSIS” is a bonafide work of Dr. KANNAN .P done under my direct guidance and supervision in the department of Dermatology, Venereology and Leprology, PSG Institute of Medical Sciences and Research, Coimbatore in the fulfillment of the regulations of Dr.MGR Medical University for the award of MD degree in Dermatology, Venereology and Leprology. Dr. SHANMUGASEKAR .C Professor Dept. of DVL PLAGIARISM TOOL CERTIFICATE – II This is to certify that this dissertation work titled “EFFICACY OF TARGETED PHOTOTHERAPY IN IDIOPATHIC GUTTATE HYPOMELANOSIS” of the candidate Dr. KANNAN P. with registration Number 201730353 for the award of In the branch of MD degree in Dermatology, Venereology and Leprology. I personally verified the urkund.com website for the purpose of plagiarism check. I found that the uploaded thesis file contains from introduction to conclusion pages and results shows 14 percentage of plagiarism in the dissertation. Guide & Supervisor Sign with Seal, ACKNOWLEDGEMENT The successful completion of my dissertation would not have been possible without the contribution of many people to whom, I would like to express my deep sense of gratitude. First and foremost, I am very grateful to my guide, Dr. Shanmugasekar .C for his timely advice and guidance at various stages of my dissertation. I am very grateful to Dr. Reena Rai, Dr. Mahadevan K, Dr. Priya S, and Dr. Setu Mittal for their continuous support and encouragement. I would like to make a special mention of Dr. Ryan Raju, Dr. Iyshwariya, Dr. Steffi, Dr. Geoni, Dr. Mohankumar Dr. Sri Rathna Maheswari and Dr. Janani, Dr. Yuvasri who were not only wonderful seniors, but also very good friends. I would also like to thank my juniors Dr. Sudha, Dr. Krishna Priya, and Dr. Lakshmi Prabha, Dr. Shenbagaraj, Dr. Harish, Dr. Nithya, Dr. Sushmitha, Dr. Vinitha who helped me in the completion of my dissertation by taking care of my other responsibilities towards the department. I would take this as a great opportunity to thank all my patients without whose consent, I would not have been able to complete this study. I would like to exceptionally thank Dr. Anjali, Dr. Bede Anand, Dr. Arunprasath, for always being there for me and for being a constant source of support and motivation. I would be failing in my duty if I do not immensely thank my beloved parents for making me what I am today, and offering constant support all along without which this thesis would not have been completed. TABLE OF CONTENTS SL.NO. CONTENT PAGE NO. 1 INTRODUCTION 1 2 AIMS AND OBJECTIVES 2 3 REVIEW OF LITERATURE 3 - 65 4 MATERIALS AND METHODS 66 - 71 5 RESULTS 72 - 73 6 DISCUSSION 74 - 79 7 CONCLUSION 80 8 BIBLIOGRAPHY 9 ANNEXURES Clinical Photographs Consent Forms Proforma Master chart List of Abbreviations LIST OF TABLES SL.NO. CONTENT PAGE NO. DIFFERENTIAL DIAGNOSIS OF 1 GUTTATE LEUCODERMA 30 LIST OF FIGURES SL. PAGE CONTENT NO. NO. 1 MELANOCYTE DEVELOPMENT AND 5 MIGRATION 2 MELANIN SYNTHESIS 8 3 MELANOSOME TRANSFER TO 10 KERATINOCYTES 4 EPIDERMAL MELANIN UNIT 11 5 DERMOSCOPIC APPEARANCE OF IGH 24 6 UVR DEPTH OF PENETRATION 42 7 EFFECTS OF PHOTOTHERAPY AND 43 PHOTOCHEMOTHERAPY INTRODUCTION INTRODUCTION Idiopathic guttate hypomelanosis (IGH) is a commonly acquired guttate leukoderma, affecting the elderly population.(1) With multiple, discrete round to oval sharply defined round to oval depigmented porcelain – white macules, approximately 2-5 mm diameter. Melanocytopenic hypomelanosis is considered to be the basic pathomechanism for idiopathic guttate hypomelanosis. Clinical feautures include multiple, discreet round to oval, sharply defined hypopigmented to depigmented porcelain-white macules commonly over the extremities, usually ranging from 2-5 mm in diameter with increasing number with age.(2,3) Commonly involved areas include extensor forearms and pretibial areas, usually sparing of the face and trunk.[3,4] It is considered as a benign condition, patients typically seek medical attention for their cosmetic concerns only to be reassured regarding its natural course. Treatment of this skin condition still remains unsatisfactory even though newer treatment modalities are being described. AIM OF THE STUDY AIM OF THE STUDY To assess the effect of a targeted phototherapy in idiopathic guttate hypomelanosis. REVIEW OF LITERATURE REVIEW OF LITERATURE MELANOCYTES Melanocytes are heterogeneous group of specialized cells of the human epidermis. They originate from embryonic cells named neural 5 crest cells (NCC) and produce the pigment called melanin . During embryogenesis, Melanoblasts originate in neural crest, migrate first to dermis & then to basal lamina of epidermis. Immunocytochemical marker studies with melanocyte‐specific antibody showed melanoblasts appear in epidermis by 7 weeks gestation. In the human body melanocytes are present in basal layer of the epidermis, hair bulb and outer root sheath of hair follicle, and give a color of these structures. Melanocytes are also seen in the iris, inner ear, 6,7 nervous system, heart, adrenal glands and various organs . They contain oval nuclei slightly smaller than that of surrounding keratinocytes. In hematoxylin and eosin (H&E)–stained sections they give processing artefact of a clear halo of cytoplasm. The life cycle of melanocytes consists of multiple steps including: 1) Lineage specification from embryonic neural crest cells (melanoblasts), 2) Migration and proliferation of melanoblasts, 3) Differentiation of melanoblasts into melanocytes, 4) Maturation of melanocytes (melanin production), 5) Transport of mature melanosomes to keratinocytes 6) And eventual cell death. The embryonic origin of epidermal and hair melanocytes are similar but development is different 8,9. The microscopic analysis of the mature melanocytes show oval or fusiform, dendritic cells, smaller than keratinocytes with clear halo of cytoplasm in H&E staining. Melanin is produced by melanosomes which are special membrane-bound organelles in the cytoplasm of melanocytes10. Fig.1 MELANOCYTE DEVELOPMENT AND MIGRATION One melanocyte is in contact with 36 basal and suprabasal keratinocytes; this group of cells forms an epidermal melanin unit 11. The number of melanocytes per unit of surface area varies at different body sites but there is no difference in the density of melanocytes in different races. The racial differences are due to the distribution and size of melanosomes within keratinocytes12. MELANIN BIOSYNTHESIS Melanins are synthesized in melanosomes of melanocytes and are classified into two main groups: 1) the brown to black insoluble high molecular weight eumelanins, 2) the yellow to reddish‐brown alkali‐soluble low molecular weight phaeomelanins. oxidation of the common amino acid tyrosine by tyrosinase produce DOPA and dopaquinone. Dopaquinone further converted to eumelanins or phaeomelanins. These two types of melanin are different in size, shape and packaging of their granules. Eumelanosomes have a more elliptical form, and phaeomelanin has a rounded contour. Eumelanin or phaeomelanin production is determined primarily by the melanocortin 1 receptor, which is itself under the control of α‐MSH and agouti signal protein 13,14. EUMELANIN SYNTHESIS Dopaquinone is a highly reactive intermediate it spontaneously undergoes intramolecular cyclization to form cyclodopa in the absence of sulfhydryl compounds. Then undergoes redox exchange between cyclodopa and dopaquinone to form the red intermediate, dopachrome,
Load more

Recommended publications
  • Update on Challenging Disorders of Pigmentation in Skin of Color Heather Woolery-Lloyd, M.D
    Update on Challenging Disorders of Pigmentation in Skin of Color Heather Woolery-Lloyd, M.D. Director of Ethnic Skin Care Voluntary Assistant Professor Miller/University of Miami School of Medicine Department of Dermatology and Cutaneous Surgery What Determines Skin Color? What Determines Skin Color? No significant difference in the number of melanocytes between the races 2000 epidermal melanocytes/mm2 on head and forearm 1000 epidermal melanocytes/mm2 on the rest of the body differences present at birth Jimbow K, Quevedo WC, Prota G, Fitzpatrick TB (1999) Biology of melanocytes. In I. M. Freedberg, A.Z. Eisen, K. Wolff,K.F. Austen, L.A. Goldsmith, S. I. Katz, T. B. Fitzpatrick (Eds.), Dermatology in General Medicine 5th ed., pp192-220, New York, NY: McGraw Hill Melanosomes in Black and White Skin Black White Szabo G, Gerald AB, Pathak MA, Fitzpatrick TB. Nature1969;222:1081-1082 Jimbow K, Quevedo WC, Prota G, Fitzpatrick TB (1999) Biology of melanocytes. In I. M. Freedberg, A.Z. Eisen, K. Wolff, K.F. Austen, L.A. Goldsmith, S. I. Katz, T. B. Fitzpatrick (Eds.), Dermatology in General Medicine 5th ed., pp192- 220, New York, NY: McGraw Hill Role of Melanin-Advantages Melanin absorbs and scatters energy from UV and visible light to protect epidermal cells from UV damage Disadvantages Inflammation or injury to the skin is almost immediately accompanied by alteration in pigmentation Hyperpigmentation Hypopigmentation Dyschromias Post-Inflammatory hyperpigmentation Acne Melasma Lichen Planus Pigmentosus Progressive Macular Hypomelanosis
    [Show full text]
  • Hydroxychloroquine-Associated Hyperpigmentation Mimicking Elder Abuse
    Dermatol Ther (Heidelb) (2013) 3:203–210 DOI 10.1007/s13555-013-0032-z CASE REPORT Hydroxychloroquine-Associated Hyperpigmentation Mimicking Elder Abuse Philip R. Cohen To view enhanced content go to www.dermtherapy-open.com Received: June 17, 2013 / Published online: August 14, 2013 Ó The Author(s) 2013. This article is published with open access at Springerlink.com ABSTRACT cleared of suspected elder abuse. A skin biopsy of the patient’s dyschromia confirmed the Background: Hydroxychloroquine may result diagnosis of hydroxychloroquine-associated in cutaneous dyschromia. Older individuals hyperpigmentation. who are the victims of elder abuse can present Conclusion: Hyperpigmentation of skin, with bruising and resolving ecchymoses. mucosa, and nails can be observed in patients Purpose: The features of hydroxychloroquine- treated with antimalarials, including associated hyperpigmentation are described, hydroxychloroquine. Elder abuse is a significant the mucosal and skin manifestations of elder and underreported problem in seniors. abuse are reviewed, and the mucocutaneous Cutaneous findings can aid in the discovery of mimickers of elder abuse are summarized. physical abuse, sexual abuse, and self-neglect in Case Report: An elderly woman being treated elderly individuals. However, medication- with hydroxychloroquine for systemic lupus associated effects, systemic conditions, and erythematosus developed drug-associated black accidental external injuries can mimic elder and blue pigmentation of her skin. The abuse. Therefore, a complete medical history dyschromia was misinterpreted by her and appropriate laboratory evaluation, including clinician as elder abuse and Adult Protective skin biopsy, should be conducted when the Services was notified. The family was eventually diagnosis of elder abuse is suspected. Keywords: Abuse; Dyschromia; Elderly; P.
    [Show full text]
  • Light-Based Treatment of Pigmented Lesions E
    CosmetiC teChnique Light-Based Treatment of Pigmented Lesions E. Victor Ross, MD Pigmented lesions are common among patients presenting to dermatologists. Fortunately, a large arsenal of light-based technology is available for the reduction and removal of these lesions. By developing a comprehensive understanding of the microanatomy of dyschromia, physicians can optimize protocols based on principles of laser-tissue interactions and reports in the literature. This article will examine the author’s experience and preferences in treating specific types of pigmented lesions with various lasers and light devices. Cosmet Dermatol.COS 2011;24:515-522. DERM ermatologists commonly treat patients laser and nonlaser devices can be employed, sometimes with pigmented lesions. A large arsenal with different wavelengths, spot sizes, and pulse widths, of light-based devices are available for the but still achieve similar results.1 reduction and removal of these lesions. Chemical peels and cryotherapy at one time were wor- The most important factor to consider thy opponents of the laser but can present challenges Dwhen choosing the best light source for the treatment of related to damage confinement. For generalized superfi- pigmentedDo lesions is the microanatomy Not of the dyschro- cial pigmentCopy reduction, chemical peeling in experienced mia. A crucial factor in treatment of excessive pigment hands is quite sufficient. However, in focal destruction, is having an understanding of the pigment distribution the agent often will extend beyond the perimeter of the with the lesion. Lesion microanatomy should be con- lesion, even with careful application. Cryotherapy also is sidered when strategizing for optimal removal. It also notoriously challenging to control.
    [Show full text]
  • Hyperpigmented Patches on a Woman's Sun-Exposed Face
    What’s Your Diagnosis?® Hyperpigmented Patches on a Woman’s Sun-Exposed Face: What’s the Cause? Alexander K. C. Leung, MD, and Benjamin Barankin, MD 45-year-old woman presented with brownish macules and Her past health was unremarkable, and she was not on any patches on her face. The pigmentation had developed ap- topical or oral medications. She denied any history of inflam- A proximately 10 years ago with the birth of her third child. matory dermatosis prior to the appearance of her skin problem. The lesions had gradually increased in size and number over The family history was not contributory. time. She had taken oral contraceptives for a few years after the Physical examination revealed symmetric, well-circumscribed, birth of her second child. She enjoyed a variety of outdoor ac- brownish macules and patches with irregular borders on the tivities, and she reported that the pigmentation was more pro- forehead, cheeks, nose, upper lip, and chin. The rest of the nounced with sun exposure. physical examination findings were normal. What’s Your Diagnosis? A. Solar lentigo D. Melasma B. Ephelides (freckles) E. Café au lait macules C. Actinic dyschromia www.consultant360.com • August 2017 • CONSULTANT 485 What’s Your Diagnosis?® Answer: Melasma A diagnosis of melasma was made. Wood lamp examination basement membrane disruption and dermal changes, indepen- showed accentuation of pigmentation suggestive of epidermal dent of UV radiation.1,17 pigmentation. The patient was treated with a series of trichlo- roacetic acid chemical peels, as well as a topical azelaic acid and HISTOPATHOLOGY a retinoid-hydroquinone-steroid (modified Kligman) formula- Three histologic patterns of pigmentation have been described: tion with significant, albeit incomplete, improvement.
    [Show full text]
  • Review on Skin Hyperpigmentation: Etiology, Diagnosis and Treatment
    J Pharm Sci Bioscientific Res. 2020. 10 (1):142-148 ISSN NO. 2271-3681 Review on Skin Hyperpigmentation: Etiology, Diagnosis and Treatment Sohan A. Patel*1, Jayant. B. Dave2, Timir Y. Mehta3 1. Assistant Professor, Department of Pharmacology, Smt. S M. Shah Pharmacy College, Amasaran, Mahedavad- Ahmedabad, Highway, Gujarat, India 2. Professor, Department of Quality Assurance, L. M. College of Pharmacy, Ahmedabad, Gujarat, India 3. Dermatologist, Samarpan Medical Research Organization, Modasa, Gujarat, India Article History: ABSTRACT: Received 29 April 2020 Hyperpigmentation is common dermatological condition. Skin color is determined Accepted 03 May 2020 Available online 11 May 2020 by melanin and other chromophores and is influenced by physical factors (ultraviolet radiation) and other endocrine, autocrine, and paracrine factors. Being Citation: the largest organ of the body, any abnormality in skin color can have impact on the Patel S. A., Dave J. B., Mehta T. Y., Review patients’ psychosocial impairment of life. In Indian population have verities of on Skin Hyperpigmentation: Etiology, Diagnosis and Treatment. J Pharm Sci hyperpigmentation condition on skin due to multifactorial region; hence, a Bioscientific Res. 2020. 10(1):142-148 multipronged approach is needed in such cases. The biggest challenge in such cases is to treat the hyperpigmentation itself; hence, counseling and general treatment *For Correspondence: (the use of broad-spectrum sunscreen, the avoidance of sun exposure, etc.) play Mr. Sohan A. Patel crucial role, and an interdisciplinary approach may be required, especially when Assistant professor, Department of the hyperpigmentation is due to a systemic cause. A thorough understanding of Pharmacology, Smt. S. M. Pharmacy the aetiology and management strategies of hyperpigmentation is of importance College, Amasaran, Bhumapura in caring for those afflicted and also in the development of new therapies.
    [Show full text]
  • Case Report Progressive Macular Hypomelanosis: a Rarely Diagnosed Hypopigmentation in Caucasians
    Hindawi Publishing Corporation Dermatology Research and Practice Volume 2009, Article ID 607682, 4 pages doi:10.1155/2009/607682 Case Report Progressive Macular Hypomelanosis: A Rarely Diagnosed Hypopigmentation in Caucasians Sven Neynaber, Christina Kirschner, Stefanie Kamann, Gerd Plewig, and Michael J. Flaig Department of Dermatology and Allergology, Ludwig-Maximilians University, Frauenlobstrasse 9-11, DE-80337 Munich, Germany Correspondence should be addressed to Sven Neynaber, [email protected] Received 4 February 2009; Accepted 24 April 2009 Recommended by Iris Zalaudek A 35-year-old woman who developed whitish macules on trunk and limbs at 12 years of age and observed a remarkable increase of the hypopigmentated lesions after her pregnancies at ages 29 and 32 years. Because of the highly characteristic clinical aspect and the light- and electron-microscopic histopathologic findings, we diagnosed progressive macular hypomelanosis (PMH). It is a nonscaly disorder with hypopigmented macules mainly on the trunk and is more often seen in young women. In contrast to some authors assuming the presence of Propionibacterium spp. as a matter of principle in PMH, we report a case with no evidence for Propionibacterium spp. Copyright © 2009 Sven Neynaber et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1. Introduction the nonaffected skin was remarkably intensified. She had not been on antibiotics, birth-control or hormone, containing Hypopigmented lesions of the skin are common and display pills, had no noteworthy history of dermatitis or eczema.
    [Show full text]
  • Treatment of Multiple Skin Conditions with Advanced Broadband Lightbbl
    Treatment of Multiple Skin Conditions with Advanced BroadBand Light BBL™ : My Experience with Asian Patients KEI NEGISHI, MD, PhD Aoyama Institute of Women’s Medicine, Tokyo Women’s Medical University; Tokyo, Japan INTRODUCTION In Asian skin, the most common and severe manifestations of photodamage are pigmentary disorders (1). Ablative resurfacing with pulsed CO2 lasers, although effective, have not found wide acceptance by Asian patients because downtime is long and hyperpigmentation, hypopigmentation, hypertrophic scars, and other post treatment complications may persist for up to one year (2). The groundbreaking flash lamp technology study by Dr. Patrick Bitter, Jr. (3) showed that a series of four to six full-face treatments with a non-ablative, non-coherent, filtered, visible light device provided improvement in all aspects of photodamage, including irregular pigmentation, skin smoothness, facial erythema, and telangiectasias. Dr. Bitter’s report was followed by a series of papers from our group describing the use of similar devices to rejuvenate Asian skin, the addition of contact cooling to reduce post-treatment complications, and the acquisition of objective spectrophotometric data to document improvements in epidermal pigmentation and skin tone in Japanese patients (4-6). An additional study describes the use of adjunctive epidermal care by hydroquinone and tretinoin cream between treatments to enhance the efficacy (7). Treatment of melasma by flash lamp on Asian skin is also reported (8); however, its use needs careful attention since melasma can easily become worse by aggressive parameters of flash lamp irradiation (9). In the author’s experience, skin attributes such as pigment and scars are more refractory in Asian patients than patients with lighter skin.
    [Show full text]
  • The Stepwise Approach to the Treatment of Melasma
    HIGHLIGHTING SKIN OF COLOR The Stepwise Approach to the Treatment of Melasma Maritza I. Perez, MD Melasma is a symmetric progressive hyperpig- of the pigment within the skin and the reflection of mentation of facial skin that occurs in all races light determine the perception of color. Epidermal but has a predilection for darker skin pheno- pigment is usually light to dark brown; dermal pig- types. Melasma has been associated with hor- ment is gray-blue. On Wood light examination, pig- monal imbalances, sun damage, and genetic ment that resides within the epidermis is predisposition. Clinically, melasma can be accentuated, while dermal pigment is not enhanced. divided into centrofacial, malar, and mandibular Fortunately, epidermal melasma is the most common according to the pigment distribution on the form and also the most treatable.1 Dermal melasma, skin. On Wood light examination, the pigment however, is very difficult to treat because the pig- can be found within the epidermis, where it will ment is entrapped in the dermis in the melanin enhance, or within the dermis, where it will not granules within the melanophages. To date, very few enhance. Melasma can be classified as mild, treatments are effective for dermal melasma. moderate, or severe for evaluation and treatment Clinically, facial melasma is described in accor- purposes. In this article, we will discuss the dance with the anatomic location of the discol- objective evaluation of the patient with melasma, oration.2 The centrofacial area is the most as well as the treatments based on disease commonly affected area, as seen in two thirds of severity.
    [Show full text]
  • Treatment of Hyperpigmentation Heather Woolery-Lloyd, MD,*,† and Jenna N
    Treatment of Hyperpigmentation Heather Woolery-Lloyd, MD,*,† and Jenna N. Kammer, BA‡ Hyperpigmentation is a common dermatologic condition that is seen in all skin types but is most prominent in skin of color. In skin of color, any inflammation or injury to skin can almost immediately be accompanied by alterations in pigmentation, either hyperpigmen- tation or hypopigmentation. Post-inflammatory hyperpigmentation can be observed in many skin conditions including acne, eczema, and contact dermatitis and treatment can be challenging. The goal is to reduce the hyperpigmentation without causing undesirable hypopigmentation or irritation in the surrounding area. This review will discuss current research on treatments for hyperpigmentation and approaches to treating this condition. Semin Cutan Med Surg 30:171-175 © 2011 Elsevier Inc. All rights reserved. KEYWORDS hyperpigmentation, hydroquinone, dyschromia, ochronosis, melasma yperpigmentation is a common dermatologic condition none is available over-the-counter in the United States and Hthat is found in all skin types but is most prominent in Canada. Four percent hydroquinone is available by prescrip- skin of color. Any inflammation or injury to the skin can tion.3 The Kligman formula combines hydroquinone with a almost immediately be accompanied by alterations in pig- retinoid and a steroid, which enhances efficacy.3 mentation, either hyperpigmentation or hypopigmentation. A common side effect when one uses hydroquinone to Postinflammatory hyperpigmentation appears in many skin treat dyschromia attributable to acne is the “hydroquinone conditions, including acne, eczema, and contact dermatitis, halo.” This occurrence is characterized by a halo of hypopig- and treatment can be challenging. The goal is to reduce the mentation surrounding the dark macule attributable to the hyperpigmentation without causing undesirable hypopig- bleaching of the surrounding normal skin.
    [Show full text]
  • Cosmetic Interventions for Dyschromia: Chemical Peels Cosmetic Interventions for Dyschromia: Chemical Peels
    Cosmetic Interventions for Dyschromia: Chemical Peels Cosmetic Interventions for Dyschromia: Chemical Peels Dr. Neelam A. Vashi, MD, Department of Dermatology, Boston University School of Medicine, Boston Medical Center, Boston INTRODUCTION sulfur, and limestone were used later Social psychology has long shown us by the Greeks and Romans.7In the late that attractiveness ratings of images 1800s, dermatologists pioneered skin relate positively to parameters of skin peeling for therapeutic benefit publishing homogeneity.1Faces with even skin data on the removal of ephelides with color distribution attract more visual phenol.7 Today, we define chemical attention than those with greater color peeling as the application of chemical contrast illustrating the importance exfoliating agents to the skin which of skin color homogeneity with results in destruction of one or more perceptions of beauty.2,3,4Alexis et al parts of the epidermis and/or dermis showed that dyschromia was one of the with subsequent regrowth of these 5 most common diagnoses observed layers.8 at one dermatology center amongst darkly pigmented patients.5In particular, PEELING AGENTS melasma and post-inflammatory Peeling agents can broadly be classified hyperpigmentation are major concerns into different groups such asalpha- for skin of color patients. Pigment hydroxy acids and beta-hydroxy acids. deposition in the skin secondary to Other types of peeling agents include trauma from mechanical affects and/ trichloroacetic acid, retinoic acid, or inflammatory skin disease can phenol, and combination products, cause extreme dissatisfaction amongst i.e. Jessner’s solution. The following patients and therapeutic challenges discussion will focus on superficial and to the physician. The treatment of medium peels most safe and efficacious dyschromia in darkly pigmented patients in skin types III-VI.
    [Show full text]
  • Boards Fodder Disorders of Dyschromia (Hypo- and Hyperpigmentation) by Parin Pearl Rimtepathip, MD, and Janna Mieko Vassantachart, MD
    boards fodder Disorders of dyschromia (hypo- and hyperpigmentation) by Parin Pearl Rimtepathip, MD, and Janna Mieko Vassantachart, MD Genetic conditions Gene Disorder Pathophysiology Clinical Features (Unique Features) Mutation Dyskeratosis XLR (MC): Reduced telomerase activ- Male > Female. Bone marrow failure up to Congenita DKC 1 ity and abnormally short- 90% (increase risk of hematopoietic malig- (Zinsser-Engman- ened telomeres chro- nancies) + triad of abnormal skin pigmenta- Cole syndrome) AD: TERT, mosomal instability/cellu- tion (poikilodermatous patches of face/neck/ TERC lar replication dysfunction upper torso), onychodystrophy, premalignant oral leukoplakia (vs benign oral leukoplakia in Pachyonychia Congenita type I) Dyschromatosis AD: ADAR Heterozygous mutations in Presents by 6-years-old with hyper/hypopig- Symmetrica (SDAR the gene encodes an RNA mented macules restricted to sun-exposed Hereditaria gene) specific adenosine deami- skin on the dorsal aspects of bilateral (Reticulate nase extremities and face Acropigmentation of Dohi) Naegeli- AD: Location of expression of Allelic to DPR. Brown gray reticulated hyper- Franceschetti- Keratin keratin 14 - Basal kerati- pigmentation typically localized to abdomen, Jadassohn 14 nocytes develops around age 2 and improves after Syndrome (NFJS) puberty. Other findings: PPK + adermato- glyphia (no finger prints) + dental anomalies including early loss of teeth (not seen in DPR) + hypohidrosis + onychodystrophy Dermatopathia AD: Location of expression of Allelic to NFJS. Unique features: diffuse non- Pigmentosa Keratin keratin 14 - Basal kerati- scarring alopecia (not seen in NFJS) + ony- Reticularis (DPR) 14 nocytes chodystrophy + adermatoglyphia + persistent reticulated hyperpigmentation of torso and proximal UE + No dental anomalies Dyschromatosis AD/AR: Mutation in ATP bind- Japanese. Torso predominant with mottled Universalis ABCB6 ing cassette subfamily B, appearance, nail dystrophy, and pterygium.
    [Show full text]
  • Pediatric Dermatology in Skin of Color
    Neonatal Pustular Melanosis Mongolian Spots Neonatal Pustular Melanosis TNPM is a common condition Affects 4%-5% of AA children at birth as compared to 0.1%-.3% of white infants Benign Self limited No treatment necessary Neonatal Pustular Melanosis Prominent pustules, especially on the palms and soles No erythema After rupture, peripheral collarettes of scale observed Hyperpigmentation develops, which may last for several months. Mongolian Spots Prevelance 10% white 50% Hispanic 90-100% Asian and African descent Possible association with inborn errors of metabolism Based primarily on case reports Most cases described with widespread MS GM1 gangliosidosis, Hurler’s disease, Hunter’s syndrome, mucolipidosis, Niemann-Pick disease and mannosidosis Persistence beyond one year associated with extrasacral position size larger than 10 cm dark-colored lesions (blue/blue-black) Pediatr Dermatol. 2013 Nov-Dec;30(6):683-8. doi: 10.1111/pde.12191. Epub 2013 Jul 9. Atopic Dermatitis Atopic Dermatitis More common in AA children AA race is considered a risk factor for having atopic dermatitis in the first 6 months of life Shaw TE, Currie GP, Koudelka CWet al.Eczema prevalence in the United States: data from the 2003 National Survey of Children’s Health. J Invest Dermatol2011;131:67–73 Moore, Megan M., et al. "Perinatal predictors of atopic dermatitis occurring in the first six months of life." Pediatrics 113.3 (2004): 468-474. Atopic Dermatitis Prevalence in pediatric population African Americans 15.9% Caucasians 9.7% Shaw TE, Currie GP, Koudelka CWet al.Eczema prevalence in the United States: data from the 2003 National Survey of Children’s Health.
    [Show full text]