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Questions and Answers
Which type of pigmentation is commonly associated with pregnancy?
Café au lait macules are typically located on the arms and legs.
False
What is the primary treatment for Post inflammatory Hyperpigmentation?
Hydroquinone
Melasma can be triggered by ____ exposure.
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Match the type of treatment to its description:
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Which of the following factors does NOT contribute to the development of melasma?
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Epidermal hyperpigmentation fades less readily than dermal hyperpigmentation.
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Name one type of surgical treatment for hyperpigmentation.
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What causes the hyperpigmentation seen in Addison's disease?
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Mongolian spots are permanent and do not resolve spontaneously.
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What is the characteristic location for Mongolian spots on the body?
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The nevus of Ota is primarily associated with pigmentation in the area of the _____ nerve.
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Match the following pigmentation disorders with their descriptions:
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Which treatment is considered the most successful for Nevus of Ota?
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Café au lait patches can exist in isolation or as part of a genodermatosis.
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What results from the destruction of the adrenal cortex in Addison's disease?
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What is the characteristic color of Mongolian spots?
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Mongolian spots do not usually resolve on their own and require surgical intervention.
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What condition is characterized by hyperpigmentation of the skin and mucous membranes in Addison's disease?
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The nevus of Ota primarily affects the area of the _____ nerve.
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Match the following conditions with their descriptions:
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Which treatment method is recognized as most effective for Nevus of Ota?
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Café au lait patches can only occur as part of a genodermatosis.
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What is a common treatment option for Mongolian spots if they do not regress?
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What is a key characteristic of Peutz–Jeghers syndrome?
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Melasma is an extremely rare type of hyperpigmentation.
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What is one common treatment method for melasma?
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Hydroquinone is considered the gold standard treatment for ________ pigmentation.
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Match the following treatments to their descriptions:
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Which factor is NOT associated with the development of melasma?
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Extrafacial melasma can occur on the forearm.
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Name one lightening agent used in the treatment of melasma.
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Study Notes
Melanocytes
- One melanocyte provides melanin to 36 keratinocytes
Hyperpigmentation
-
Generalized
- Addison’s disease
- Caused by adrenal cortex destruction
- Hyperpigmentation of skin and mucous membranes
- Longitudinal pigmented bands in nails
- Excess pituitary peptides due to lack of adrenal steroids
- Non-melanin causes of brown-black discoloration
- Addison’s disease
-
Localized
- Mongolian spot
- Congenital blue-tinged hyperpigmentation
- Caused by dermal melanocytosis
- Mainly in individuals with darker skin color
- Sacral region
- Usually regresses spontaneously during childhood
- Laser treatment can be effective
- Nevus of Ota and Nevus of Ito
- Congenital, large, flat, grey-brown hyperpigmentation
- Dermal melanocytosis
- Unilateral pigmentation in the trigeminal nerve area
- 60% affected have scleral involvement
- More prevalent in Asian females
- Laser surgery is the treatment of choice (Nd:YAG laser is most successful)
- Picosecond lasers have also shown effectiveness
- Nevus of Ito is a variant of Nevus of Ota
- Involves the acromioclavicular and deltoid region
- Café au lait patches
- Multiple, flat, light-brown macules (0.5 to 4cm)
- Present all over the skin surface
- Characteristic in the axillae
- May exist in isolation or as part of a genodermatosis
- Lasers may be used to lighten spots, but relapses are common
- Peutz-Jeghers Syndrome pigmentation
- Multiple brown macules on the lips, around the mouth, and fingers
- Accompanied by intestinal hamartomatous polyposis
- Melasma
- Common localized acquired hyperpigmentation
- May be related to pregnancy, sun exposure, or contraceptive drugs
- Affects cheeks, periocular regions, forehead, and neck ("mask of pregnancy")
- Extrafacial areas (e.g., forearm)
- Types: epidermal, dermal, mixed
- Treatment
- High relapse rate
- Avoidance of exacerbating factors
- Sun protection
- Mechanical: umbrella, face cover
- Chemical: sunscreen lotions
- Physical: ointments with titanium, zinc oxide, and kaolin
- Bleaching agents: decrease melanocyte function
- Topical steroids, Vitamin A derivatives
- Other lightening agents: arbutin, azelaic acid, kojic acid
- Antioxidant drugs: Vitamin C or E
- Surgical treatment: chemical peeling, dermabrasion, laser
- Post-inflammatory hyperpigmentation
- Extremely common, especially in darker skin tones
- Develops after inflammation or injury to the skin
- Preceding inflammation may be transient or subclinical
- Increased melanin may be in the dermis or epidermis
- Hydroquinone is the gold standard treatment
- Clinical course is variable
- Can resolve spontaneously
- Epidermal hyperpigmentation fades faster than dermal hyperpigmentation
- Mongolian spot
Melanocytes
- A melanocyte provides melanin to 36 keratinocytes to form an epidermal melanin unit
Hyperpigmentation: Generalized
- Addison's disease results from destruction of the adrenal cortex due to tuberculosis, autoimmune influences, or metastases.
- Addison's disease causes hyperpigmentation of the skin and mucous membranes, particularly in flexures and exposed areas.
- Longitudinal pigmented bands in the nails are also a feature.
- Hyperpigmentation in Addison's disease is caused by excess pituitary peptides due to a lack of adrenal steroids.
Hyperpigmentation: Localized
-
Mongolian Spot: Congenital circumscribed blue-tinged hyperpigmentation; caused by dermal melanocytosis.
- Primarily found in individuals with darker skin tones.
- Usually occurs in the sacral region.
- Often regresses during childhood but can persist into adulthood.
- Laser treatment can yield favorable results in childhood or adolescence.
-
Nevus of Ota & Nevus of Ito: Congenital, circumscribed, large, flat, grey-brown patchy hyperpigmentation with dermal melanocytosis.
- Nevus of Ota: Unilateral pigmentation in the area of the first and second branches of the trigeminal nerve.
- 60% of those affected have scleral involvement.
- Primarily occurs in Asian females.
- Laser surgery is the preferred treatment, with Nd:YAG lasers being most effective.
- Picosecond lasers have also shown effectiveness.
- Nevus of Ito: Considered a variant of Nevus of Ota.
- Involvement of the acromioclavicular and deltoid region.
- Nevus of Ota: Unilateral pigmentation in the area of the first and second branches of the trigeminal nerve.
-
Café au Lait Patches: Numerous, flat, light-brown macules, ranging in size from 0.5cm to 4cm, found across the skin surface, particularly in the axillae.
- May exist in isolation or as part of a genodermatosis (Neurofibromatosis disease).
- Lasers may be used for lightening, but relapses are common.
-
Peutz-Jeghers Syndrome Pigmentation: Multiple brown macules on the lips, around the mouth, and on the fingers, accompanied by intestinal hamartomatous polyposis.
-
Melasma: Common type of acquired localized hyperpigmentation on the face.
- May be associated with pregnancy or triggered by sun exposure, contraceptive drugs, and other factors.
- Affects cheeks, periocular regions, forehead, and neck, resembling a "mask of pregnancy."
- Can also occur extrafacially, such as on the forearms.
- Types: Epidermal, Dermal, and Mixed.
Melasma Treatment
- Cure is challenging due to high relapse rates.
- Avoidance of initiating or exacerbating factors is crucial.
- Sunscreens are essential:
- Mechanical (umbrella, face cover)
- Chemical (absorb specific wavelengths of solar radiation, e.g. Para amino benzoic acid)
- Physical (reflect UV light, e.g. Titanium, zinc oxide, and kaolin)
- Bleaching agents: Decrease melanocyte function and reduce melanin production.
- Have no effect on preformed melanin, thus require long-term use (3-6 months).
- Examples: Hydroquinone
- Topical steroids, Vitamin A derivatives are also used.
- Other lightening agents: Arbutin, Azelaic acid, Kojic acid
- Antioxidant drugs: Vitamin C or E
- Surgical treatment: Removal of the epidermis and superficial layers of the dermis through chemical peeling, dermabrasion, or lasers.
Post-Inflammatory Hyperpigmentation
- Extremely common, particularly in individuals with darker skin tones.
- Develops after inflammation or injury to the skin, even if the preceding inflammation was transient or subclinical.
- Increased melanin can be primarily within the dermis (e.g., following lichen planus) or the epidermis (e.g., following acne or atopic dermatitis).
- Hydroquinone remains the gold standard treatment.
- Clinical Course: Variable depending on the location of inflammation or injury.
- Prognosis: Spontaneous resolution occurs over a variable period of time.
- Epidermal hyperpigmentation fades more readily than dermal hyperpigmentation.
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Description
Explore the role of melanocytes in skin pigmentation and the various forms of hyperpigmentation, including conditions like Addison's disease and localized examples such as Mongolian spots. This quiz will test your knowledge on key concepts related to skin discoloration and pigmentation abnormalities.
