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Postinflammatory Hyperpigmentation

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181. Laser Treatment of Benign Pigmented Lesions (Treatment)

. This may be due to either a sublethal change in the melanosome (interfering with the normal feedback inhibition of melanogenesis) or simply postinflammatory hyperpigmentation. Further studies are required to evaluate the therapeutic implications of this paradoxical reaction. Laser irradiation leads to histologic melanosomal disruption and vacuolization of pigment-laden cells in the basal layer. Both keratinocytes and melanocytes exhibit pigment and nuclear material condensation at the periphery (...) patients with Becker nevi showed clearing with up to 6 treatments. As a general rule, this laser produces a variable response in epidermal pigmented lesions such as café au lait macules, Becker nevi, and epidermal melasma. Epidermal postinflammatory hyperpigmentation also may respond. Dermal pigmented lesions predominantly show little to no response. Because some lesions show a variable clinical response, spot testing the treatment areas of the respective lesion may be prudent prior to engaging

2014 eMedicine.com

182. Laser Treatment of Acquired and Congenital Vascular Lesions (Treatment)

% clearing after only one laser treatment; another study achieved significant clearing in 80% with up to 3 irradiations. Transient hyperpigmentation was the most common adverse effect. Smaller leg telangiectasias may clear faster and with less pain during treatment compared with larger vessels. When sclerotherapy with 0.25% sodium tetradecyl sulfate was compared with 1064-nm Nd:YAG laser therapy for lower extremity telangiectasias (0.1-1.5 mm), significant clinical improvement was seen in all sites (...) with either modality. However, earlier clearing and higher average improvement scores were seen with sclerotherapy. Both modalities were associated with pain and localized tissue erythema and edema. Temporary post-inflammatory hyperpigmentation was seen only with sclerotherapy. Despite recent advances in laser technology and the effectiveness of lasers for facial telangiectasias, treatment of lower extremity telangiectasias with vascular­-specific lasers can be ineffective. Treatment failures are often

2014 eMedicine.com

183. Laser Tissue Resurfacing (Treatment)

of oral antibiotics (eg, tetracycline, Achromycin V, Lederle Labs) or oral isotretinoin usually is very helpful. Comedones and milia can be expressed manually using a comedo extractor. Post–resurfacing hyperpigmentation Hyperpigmentation after resurfacing is common, especially in patients with dark skin. Usually, it is seen in the first 14-21 days after the procedure and represents a postinflammatory hyperpigmentation phenomenon. Preconditioning the skin prior to carbon dioxide resurfacing (...) (6):417-26. . Carter SR, Stewart JM, Khan J, et al. Infection after blepharoplasty with and without carbon dioxide laser resurfacing. Ophthalmology . 2003 Jul. 110(7):1430-2. . Trelles MA, Mordon S, Svaasand LO, Mellor TK, Rigau J, Garcia L. The origin and role of erythema after carbon dioxide laser resurfacing. A clinical and histological study. Dermatol Surg . 1998 Jan. 24(1):25-9. . Tan KL, Kurniawati C, Gold MH. Low risk of postinflammatory hyperpigmentation in skin types 4 and 5 after

2014 eMedicine.com

184. Lentigo (Treatment)

in the treatment of solar lentigines of the back of the hands, particularly in lighter-complexioned individuals. For darker-complexioned people, TCA 33% may be preferred, although postinflammatory hyperpigmentation remains a risk for both modalities. A triple combination cream with fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05% as adjuvant to cryotherapy for solar lentigines on the dorsal hands was found to be effective. [ ] The effect of a bleaching solution containing 2% mequinol (4

2014 eMedicine.com

185. Pityriasis Rosea (Follow-up)

or widespread (eg, vesicular pityriasis rosea), topical or oral steroids may be used. Ultraviolet (UV) radiation therapy has been demonstrated to be effective for pityriasis rosea but may leave postinflammatory pigmentation at the site of the pityriasis rosea lesion. [ ] For patients in whom superficial tinea infection is a concern or possibility, topical antifungal therapy can be used. Some data suggest that the antiviral agent acyclovir could hasten resolution. [ , ] No restriction of activity (...) , topical steroids can be applied. It must be kept in mind that although steroids alleviate the pruritus, they do not modify the eruption. The sedative effect of the antihistamines may help the patient to sleep better at night. Systemic steroids are not recommended because they may exacerbate the disease. However, some dermatologists use prednisone (0.5-1 mg/kg/day for 7 days) in selected patients with severe pruritus, vesicular lesions, or the potential for significant postinflammatory

2014 eMedicine.com

186. Pityriasis Alba (Follow-up)

, or skin colored and have fine lamellar or branny scaling with indistinct margins Usually 1-4 cm in diameter Most commonly range in number from 4 or 5 to 20 or more Found on the face, upper arms, neck, or shoulders; the legs and trunk are less commonly involved; in approximately one half of all patients, the lesions are limited to the face [ ] Uncommon variants of pityriasis alba are as follows: Pigmenting pityriasis: Typical lesion has a central zone of bluish hyperpigmentation surrounded (...) . The condition is not contagious, and no infectious agent has been identified. Leading theories as to the origin of the lesions in pityriasis alba involve atopy and postinflammatory changes, with a large number of patients with pityriasis alba having a history of atopic disease, and atopic patients are being more prone to developing the condition. [ , ] Theories of origin also include hypopigmentation secondary to pityriacitrin, a substance produced by Malassezia yeasts that acts as a natural sunscreen

2014 eMedicine.com

187. Pityriasis (Follow-up)

steroids can be applied. It must be kept in mind that although steroids alleviate the pruritus, they do not modify the eruption. The sedative effect of the antihistamines may help the patient to sleep better at night. Systemic steroids are not recommended because they may exacerbate the disease. However, some dermatologists use prednisone (0.5-1 mg/kg/day for 7 days) in selected patients with severe pruritus, vesicular lesions, or the potential for significant postinflammatory hyperpigmentation (...) (eg, vesicular pityriasis rosea), topical or oral steroids may be used. Ultraviolet (UV) radiation therapy has been demonstrated to be effective for pityriasis rosea but may leave postinflammatory pigmentation at the site of the pityriasis rosea lesion. [ ] For patients in whom superficial tinea infection is a concern or possibility, topical antifungal therapy can be used. Some data suggest that the antiviral agent acyclovir could hasten resolution. [ , ] No restriction of activity or isolation

2014 eMedicine.com

188. Nonneoplastic Epithelial Disorders of the Vulva (Follow-up)

], retardation [of growth], and deafness syndrome), or somatic mosaicism. Melanocytic nevus Vulvar nevi are fairly common (0.1% of nevi have this location). The etiology of nevi at other skin sites is still a matter of debate. Nevus cells deriving from the neural crest migrate into the skin during embryogenesis and collect in the basal cell layer of the epidermis, where they proliferate in small nests. Postinflammatory hyperpigmentation Postinflammatory hyperpigmentation is due to melanin deposition (...) postinflammatory hyperpigmentation. Soreness and itching are common symptoms. Secondary candidosis may exacerbate intertrigo. Allergic contact dermatitis Physical examination often reveals dryness, scaling, excoriations, and, at times, ulceration. Itching is usually intense. Benign vulvar lesions. Allergic vulvitis. The clinical pattern may be subacute, with weeping and oozing, especially when bacterial superinfection occurs. Without treatment, allergic dermatitis can progress to squamous cell hyperplasia

2014 eMedicine.com

189. Nonlaser Hair Removal Techniques (Follow-up)

, no published data prove that damage occurs in the hair follicle or that these devices produce permanent hair removal. More likely, these devices represent a means for temporary hair shaft removal similar to waxing or plucking, but do not work well as a means of permanent hair removal. [ ] Important, and potentially permanent, adverse effects of electrolysis include scarring (ie, keloid formation) and postinflammatory hyperpigmentation or hypopigmentation, and these adverse effects are dependent (...) , such as those found on the eyebrows, chin, or nipples. The results of plucking last longer than shaving because hair is pulled from the hair shaft, as in waxing. This method is time consuming, tedious, and painful. Generally, plucking does not reduce the number of hairs that ultimately regrow. [ ] The reaction of the hair follicle to plucking can be unpredictable, possibly resulting in adverse effects such as folliculitis, hyperpigmentation, scarring, ingrown hairs, and distorted follicles. Adverse effects

2014 eMedicine.com

190. Oral Manifestations of Systemic Diseases (Follow-up)

European descent. Of these five subtypes, hemochromatosis type 1 (OMIM #235200) is the most common, with population studies in the United States indicating a frequency of homozygosity at about 0.3%. [ , ] As iron is deposited in the tissues of the body, organ function may be disrupted. Common systemic sequelae include liver cirrhosis, cardiomyopathy, arthritis, and various endocrinopathies. [ ] Cutaneous manifestations of hemochromatosis include skin hyperpigmentation resulting in the classic “bronzed (...) ” appearance. [ ] Oral manifestations are observed in approximately 15-25% of patients. In the majority of these patients, there is a blue-gray hyperpigmentation of the oral mucosa. [ ] The most commonly affected sites are the buccal mucosa and gingiva, although a minority of patients have diffuse, homogenous pigmentation of the oral cavity. [ , , ] Histologic examination with Prussian blue stain reveals iron mineral deposits. [ ] Also see . Congenital erythropoietic porphyria Congenital erythropoietic

2014 eMedicine.com

191. Oral Malignant Melanoma (Follow-up)

appear in perioral and oral locations as pigmented macules. Addison disease presents as adrenal cortical hypofunction along with splotchy or generalized bronzing of the mucosa and skin. Peutz-Jeghers syndrome has periorificial freckling along with hamartomatous intestinal polyps, and, as a differential diagnosis, Laugier-Hunziker syndrome presents with macular mucocutaneous hyperpigmentation and melanonychia with no known systemic disease association. may range from light brown to blue-black (see (...) , are said to have a more aggressive course. Mucosal lesions have been described in the veterinary literature. Pigmented epithelioid melanocytoma is a melanocytic neoplasm with a Carney complex (myxomas, mucocutaneous hyperpigmentation, endocrinopathy) association. The lesion is frequently deeply pigmented and occurs on skin and mucosal surfaces. While it can metastasize to lymph nodes, the long-term prognosis is favorable. [ ] Melanotic macules are common on the lip, but they are also found in the oral

2014 eMedicine.com

192. Nonablative Resurfacing (Follow-up)

, topical corticosteroids after laser resurfacing with ablative fractional carbon dioxide laser reduce the risks of postinflammatory hyperpigmentation. [ ] Next: Surgical Therapy Currently used nonablative systems are based on the studies discussed below. New systems include the 1927-nm system of fractional thulium fiber that produces laser light. In 2012, articles noted that nonablative lasers have been used to treat burn scars, striae, macular seborrheic keratosis, actinic keratosis, and a variety (...) , Wanitphakdeedecha R. Topical corticosteroids minimise the risk of postinflammatory hyper-pigmentation after ablative fractional CO2 laser resurfacing in Asians. Acta Derm Venereol . 2015 Feb. 95 (2):201-5. . Cohen JL, Ross EV. Combined fractional ablative and nonablative laser resurfacing treatment: a split-face comparative study. J Drugs Dermatol . 2013 Feb 1. 12(2):175-8. . Verhaeghe E, Ongenae K, Bostoen J, Lambert J. Nonablative Fractional Laser Resurfacing for the Treatment of Hypertrophic Scars

2014 eMedicine.com

193. Lentigo (Follow-up)

in the treatment of solar lentigines of the back of the hands, particularly in lighter-complexioned individuals. For darker-complexioned people, TCA 33% may be preferred, although postinflammatory hyperpigmentation remains a risk for both modalities. A triple combination cream with fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05% as adjuvant to cryotherapy for solar lentigines on the dorsal hands was found to be effective. [ ] The effect of a bleaching solution containing 2% mequinol (4

2014 eMedicine.com

194. Laser Treatment of Benign Pigmented Lesions (Follow-up)

. This may be due to either a sublethal change in the melanosome (interfering with the normal feedback inhibition of melanogenesis) or simply postinflammatory hyperpigmentation. Further studies are required to evaluate the therapeutic implications of this paradoxical reaction. Laser irradiation leads to histologic melanosomal disruption and vacuolization of pigment-laden cells in the basal layer. Both keratinocytes and melanocytes exhibit pigment and nuclear material condensation at the periphery (...) patients with Becker nevi showed clearing with up to 6 treatments. As a general rule, this laser produces a variable response in epidermal pigmented lesions such as café au lait macules, Becker nevi, and epidermal melasma. Epidermal postinflammatory hyperpigmentation also may respond. Dermal pigmented lesions predominantly show little to no response. Because some lesions show a variable clinical response, spot testing the treatment areas of the respective lesion may be prudent prior to engaging

2014 eMedicine.com

195. Laser Tissue Resurfacing (Follow-up)

of oral antibiotics (eg, tetracycline, Achromycin V, Lederle Labs) or oral isotretinoin usually is very helpful. Comedones and milia can be expressed manually using a comedo extractor. Post–resurfacing hyperpigmentation Hyperpigmentation after resurfacing is common, especially in patients with dark skin. Usually, it is seen in the first 14-21 days after the procedure and represents a postinflammatory hyperpigmentation phenomenon. Preconditioning the skin prior to carbon dioxide resurfacing (...) (6):417-26. . Carter SR, Stewart JM, Khan J, et al. Infection after blepharoplasty with and without carbon dioxide laser resurfacing. Ophthalmology . 2003 Jul. 110(7):1430-2. . Trelles MA, Mordon S, Svaasand LO, Mellor TK, Rigau J, Garcia L. The origin and role of erythema after carbon dioxide laser resurfacing. A clinical and histological study. Dermatol Surg . 1998 Jan. 24(1):25-9. . Tan KL, Kurniawati C, Gold MH. Low risk of postinflammatory hyperpigmentation in skin types 4 and 5 after

2014 eMedicine.com

196. Laser Treatment of Leg Veins (Follow-up)

. Photoprotection with sun avoidance and/or sunscreens is very important for 3-4 weeks following treatment in order to minimize the appearance of postinflammatory hyperpigmentation. Previous Next: Postoperative Results After laser treatment of leg veins, the patient seldom experiences postoperative pain. Pain medication is usually not required. Smaller vessels may have disappeared completely, affording the patient and the physician with a visual record of success. Larger spider veins and reticular veins usually (...) hyperpigmentation, more so than when treated with sclerotherapy. Long-PDLs (ie, 585 nm, 590 nm, 595 nm, 600 nm) are capable of deeper penetration into the skin, and pulse durations from 1.5-40 milliseconds allow for thermal destruction of vessels corresponding to the size of the leg telangiectasias. Long-pulse alexandrite lasers (755 nm) have been modified to allow pulse durations of up to 20 milliseconds or longer. This wavelength theoretically penetrates to a depth of 2-3 mm. Optimal treatment parameters

2014 eMedicine.com

197. Laser Treatment of Acquired and Congenital Vascular Lesions (Follow-up)

% clearing after only one laser treatment; another study achieved significant clearing in 80% with up to 3 irradiations. Transient hyperpigmentation was the most common adverse effect. Smaller leg telangiectasias may clear faster and with less pain during treatment compared with larger vessels. When sclerotherapy with 0.25% sodium tetradecyl sulfate was compared with 1064-nm Nd:YAG laser therapy for lower extremity telangiectasias (0.1-1.5 mm), significant clinical improvement was seen in all sites (...) with either modality. However, earlier clearing and higher average improvement scores were seen with sclerotherapy. Both modalities were associated with pain and localized tissue erythema and edema. Temporary post-inflammatory hyperpigmentation was seen only with sclerotherapy. Despite recent advances in laser technology and the effectiveness of lasers for facial telangiectasias, treatment of lower extremity telangiectasias with vascular­-specific lasers can be ineffective. Treatment failures are often

2014 eMedicine.com

198. Keratosis Pilaris (Follow-up)

: Activity Keratosis pilaris does not limit any patient activities. Previous Next: Complications Complications from keratosis pilaris (KP) are infrequent. However, postinflammatory hypopigmentation or hyperpigmentation and scarring may occur. A gradual loss of hair in affected facial areas, especially the lateral eyebrows, may be seen in ulerythema ophryogenes (keratosis pilaris atrophicans faciei). Previous Next: Prevention In patients with keratosis pilaris (KP), measures should be taken to prevent (...) -3% salicylic acid in 20% urea cream. Intermittent dosing of topical retinoids (eg, weekly or biweekly) seems to be quite effective and well tolerated, but usually the response is only partial. After initial clearing with stronger medications, patients may then be placed on a milder maintenance regimen. Persistent skin discoloration, termed hyperpigmentation, may be treated with fading creams such as hydroquinone 4%, kojic acid, and azelaic acid 15-20%. Special compounded creams for particularly

2014 eMedicine.com

199. Psoriasis, Guttate (Follow-up)

months, may recur, or can develop into the chronic plaque-type of psoriasis. Scarring is not a problem. Previously affected areas may show postinflammatory hypopigmentation or postinflammatory hyperpigmentation. Data available on the prognosis of guttate psoriasis are sparse. Although guttate psoriasis often has a short-lived course, it may also represent the initial stage of chronic plaque-type psoriasis. Progression rates to chronic plaque psoriasis, reported in small studies, have ranged from one

2014 eMedicine.com

200. Pseudofolliculitis of the Beard (Follow-up)

that the hair becomes embedded in upon emerging from the follicle. [ , ] Topical combination cream (tretinoin 0.05%, fluocinolone acetonide 0.01%, and hydroquinone 4%) (Triluma) has been shown to provide some benefit by targeting the hyperkeratosis (tretinoin), inflammation (fluocinolone), and postinflammatory hyperpigmentation (hydroquinone). [ ] Mild topical corticosteroid creams reduce inflammation of papular lesions. [ ] Topical eflornithine HCL 13.9% cream (Vaniqa) has been used for excessive facial (...) scarring, hyperpigmentation, secondary infection, and keloid formation. The lack of understanding of this disease has created tension and hostility between soldiers and their chain of command. Proper education on shaving methods and treatment of pseudofolliculitis barbae, including judicious breaks from shaving (no shaving profiles), is essential. [ , , ] Next: Surgical Care Newer hair removal lasers may have a role in the treatment of pseudofolliculitis barbae. The problem with most laser and high

2014 eMedicine.com

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