Hyper-Pigmentation PDF

Pigmentary Disorders 2 Dr. Sarah Raed Dermatologist  Melanocytes Epidermal melanin unit: 1 melanocyte which gives melanin to 36 keratinocytes Hyperpigmentation Generalized  Addison’s disease Ø Due to destruction of the adrenal corte...

Pigmentary Disorders 2 Dr. Sarah Raed Dermatologist  Melanocytes Epidermal melanin unit: 1 melanocyte which gives melanin to 36 keratinocytes Hyperpigmentation Generalized  Addison’s disease Ø Due to destruction of the adrenal cortex from tuberculosis, autoimmune influences, metastases. Ø Hyperpigmentation of skin and mucous membranes marked in the flexures and exposed areas. Ø Longitudinal pigmented bands in the nails Ø The hyperpigmentation is due to an excess of pituitary peptides resulting from the lack of adrenal steroids. Non-melanin causes of brown- black discoloration Hyperpigmentation Localized  Mongolian spot Congenital circumscribed blue-tinged hyperpigmentation caused by dermal melanocytosis. Mainly occurs in persons with darker skin color. Usually occurs in the sacral region. Clinical Course and Prognosis In most cases, Mongolian spots spontaneously regress during childhood, but persistence into adulthood has been described. Management Spontaneous resolution usually means treatment can be avoided but laser treatment in childhood or adolescence can give favorable results. Mongolian spot  Nevus of Ota and the nevus of Ito Congenital circumscribed large, flat, grey-brown patchy hyperpigmentation with dermal melanocytosis. Unilateral pigmentation in the area of the first and second branches of the trigeminal nerve. Of those affected, 60% have scleral involvement. Mostly occurs in Asian females. Laser surgery is the treatment of choice , (Nd:YAG) laser having the most success in the treatment of this condition. Picosecond lasers also have been reported as effective in treating this condition Nevus of Ota  Nevus of Ota in a 20-year-old woman. Hyperpigmentation around the orbit. The hyperpigmentation extends into the sclera.  NEVUS OF ITO Considered a variant of nevus of Ota. Involvement of the acromioclavicular and deltoid region.  Café au lait patches v Numerous flat, light-brown macules, which vary from 0.5cm to 4cm are present all over the skin surface – characteristically in the axillae v May exist in isolation or as part of a genodermatosis (neurofibromatosis disease). v Lasers may be used to lighten spots but relapses are common. Café au lait Peutz–Jeghers syndrome pigmentation multiple brown macules on the lips, around the mouth and on the fingers are seen in Peutz–Jeghers syndrome, accompanied by intestinal hamartomatous polyposis  Melasma v A very common type of localized acquired hyper- pigmentation. v This facial pigmentation may be part of the increased pigmentation of pregnancy or may occur due to sun exposure, contraceptive drug and others. v The cheeks, periocular regions, forehead and neck may be affected in this so-called ‘mask of pregnancy’. Extrafacial (e.g forearm) Types: Epidermal, Dermal, Mixed Melasma  Treatment Ø Cure is very difficult due to high relapse rate. Ø Avoidance of the initiating or exacerbating factors. Ø Sunscreens to reduce the effect of sunlight on the skin: § Mechanical: umbrella, Face cover § Chemical: that absorb certain wavelengths of the solar radiation usually in lotion form e.g. Para amino benzoic acid. § Physical : That reflects the UV light. They usually in ointment form that is messy with bad cosmetic appearance e.g. Titanium, zinc oxide and kaolin.  Bleaching agents: decrease the function of the melanocytes and reduce the production of new melanin. They have no effect on preformed melanin, so they should be used for long periods (3-6 months), e.g : Hydroquinone Topical steroids, Vitamin A derivatives. v Others lightening agents: Arbutin , Azelaic acid, Kojic acid v Antioxidant drugs like Vitamin C or E v Surgical treatment: to remove the epidermis and superficial layers of the dermis using chemical peeling, dermabrasion or Laser.  Post inflammatory Hyperpigmentation Extremely common, especially in individuals with darker skin color Develops after inflammation or injury to the skin, but preceding inflammation may be transient or subclinical The increased melanin may be primarily within the dermis (e.g. following lichen planus) or in the epidermis (e.g. following acne or atopic dermatitis) Hydroquinone remains the gold standard Treatment. Clinical Course and Prognosis The clinical course is variable and depends on the location of the inflammation or injury. Spontaneously resolves over a variable period of time. Epidermal hyperpigmentation fades more readily than dermal hyperpigmentation Thank You