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Postinflammatory Hyperpigmentation

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181. Impetigo (Overview)

clinical trials have noted a 13-52% spontaneous resolution rate. [ ] However, treatment produces a higher cure rate and reduces the spread of infection to other parts of the body (via inoculation) or to other people. [ , ] Scarring is unusual, but postinflammatory hyperpigmentation or hypopigmentation may occur. Untreated lesions of nonbullous impetigo may rarely progress to , a deep dermal infection, after which subsequent scarring can occur. With appropriate treatment, lesions usually resolve after 7

2014 eMedicine.com

182. Dermatologic Manifestations of Hematologic Disease (Overview)

ulcerations, but the evidence for efficacy in sickle cell disease is lacking. Skin grafts are advocated for ulcers resistant to more conservative therapy. Hydroxyurea treatment of sickle cell anemia in children can be associated with nail hyperpigmentation, longitudinal bands, and hyperpigmentation of the palms. [ ] Such changes have been described after 6-16 weeks of hydroxyurea therapy. Fanconi anemia is an autosomal recessive disease that involves congenital abnormalities, bone marrow failure (...) , and predisposition to malignancy. [ ] Patients have an increased incidence of spontaneous chromosomal abnormalities, due to problems with DNA repair. [ ] By the end of childhood, patients with Fanconi anemia develop hypoplastic bone marrow that affects all 3 lineages. Skin findings consist of several abnormalities of pigmentation. Many patients present with café au lait spots, which, in most individuals, are present at birth. Diffuse hyperpigmentation, which can also be an acquired phenomenon because of iron

2014 eMedicine.com

184. Dermatofibroma (Overview)

of common dermatofibromas with an increased mitotic rate but no other worrisome features, none recurred or metastasized. [ ] Spontaneous regression has been reported, [ ] and this may yield postinflammatory hypopigmentation, although this appears to be quite rare. Previous Next: Patient Education For patient education resources, see the , as well as . Previous References Naversen DN, Trask DM, Watson FH, Burket JM. Painful tumors of the skin: "LEND AN EGG". J Am Acad Dermatol . 1993 Feb. 28(2 Pt 2):298 (...) Venereol Leprol . 2007 May-Jun. 73(3):194-5. . Alonso-Castro L, Boixeda P, Segura-Palacios JM, de Daniel-Rodríguez C, Jiménez-Gómez N, Ballester-Martínez A. Dermatofibromas treated with pulsed dye laser: Clinical and dermoscopic outcomes. J Cosmet Laser Ther . 2012 Apr. 14(2):98-101. . Media Gallery Erythematous, slightly hyperpigmented nodule on the leg. Courtesy of David Barnette, MD. Acanthotic epithelium with basilar hyperpigmentation (dirty feet) over a dermal spindle cell proliferation (X10

2014 eMedicine.com

185. Drug-Induced Pigmentation (Overview)

cause various adverse cutaneous effects, including photosensitivity and diffuse or localized hyperpigmentation of the skin, nails, and mucous membranes. Individual medications within this group induce a variety of distinctive patterns and colors of dyspigmentation. The pathogenesis underlying chemotherapy-related dyspigmentation is not completely known, but some proposed mechanisms for this hyperpigmentation include direct stimulation of melanin production and postinflammatory hyperpigmentation (...) to increase the risk of minocycline-related hyperpigmentation. Minocycline has the following three classic and distinct patterns of dyspigmentation (also see the images below): Type I is blue-black discoloration localized to scars and postinflammatory sites; this discoloration is proposed to be the result of hemosiderin and/or iron chelate dermal deposition. Type 2 is blue-gray pigmentation of normal skin on the extremities, especially the anterior shins (which may mimic antimalarial pigmentation

2014 eMedicine.com

186. Urticaria, Chronic (Overview)

may be pale to red (depending on background skin color) Lesions can be localized or generalized Lesions may be round, oval, annular, arcuate, serpiginous, or generalized Lesions resolve without postinflammatory pigmentary changes or scaling See for more detail. Diagnosis The diagnosis of chronic urticaria is largely clinical and based on a thorough history and physical examination. A limited set of laboratory studies may be indicated for some patients in the diagnosis of chronic urticaria (...) in females. [ ] Patients with chronic urticaria have a strong association with HLA-DR4 and the associated allele HLA-DQ8 compared with a control population. [ ] Previous Next: Prognosis The primary manifestations of urticaria are rash and pruritus. The course of the disease is unpredictable, and it may last months to years. About 50% of patients experience remission within 1 year. [ ] Only rarely does permanent hyperpigmentation or hypopigmentation occur. The only long-term consequences of chronic

2014 eMedicine.com

187. Urticarial Vasculitis (Overview)

, Rousset H. [Hypocomplementemic urticarial vasculitis]. Rev Med Interne . 2008 Nov. 29(11):929-31. . Mehregan DR, Gibson LE. Pathophysiology of urticarial vasculitis. Arch Dermatol . 1998 Jan. 134(1):88-9. . Media Gallery Raised erythematous wheals with postinflammatory hyperpigmentations suggest urticarial vasculitis. A low-power histologic image of urticarial vasculitis shows leukocytoclastic vasculitis with damage to the vessel wall and a neutrophilic infiltrate. A high-power view of the histology

2014 eMedicine.com

188. Benign Vulvar Lesions (Overview)

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 in the dermis following a previous (...) be observed. Benign vulvar lesions. Primary irritant dermatitis and associated intertrigo. Chronic irritant dermatitis may lead to squamous cell hyperplasia. Intertrigo Typically, intertrigo is characterized by erythema, local edema, oozing, maceration, and fissuring of the inguinal fold, sometimes accompanied by considerable odor. It may be associated with similar findings in other skin folds. The surrounding skin may show reactive postinflammatory hyperpigmentation. Soreness and itching are common

2014 eMedicine.com

189. 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

190. 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

191. 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

192. 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

193. 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

194. 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

195. 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

196. 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

197. 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

198. 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

199. Hirsutism (Follow-up)

follicle by reducing the sulfide bonds that are found in abundance in hairs. Irritant reactions and folliculitis may result. Temporary epilation Epilation involves the removal of the intact hair with its root. Plucking or tweezing is widely performed. This method may result in irritation, damage to the hair follicle, folliculitis, hyperpigmentation, and scarring. Waxing entails applying melted wax to the skin. When the wax cools and sets, it is abruptly peeled off the skin, and embedded hair is removed (...) (diathermy) uses a high-frequency alternating current and is much faster than the traditional electrolysis method, which uses a direct galvanic current. Electrolysis and thermolysis are slow processes that can be used on all skin and hair colors, but multiple treatments are required. Electrolysis and thermolysis can be uncomfortable and may produce folliculitis, pseudofolliculitis, and postinflammatory pigmentary changes in the skin. Lasers can treat larger areas and can do so faster than electrolysis

2014 eMedicine.com

200. 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

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