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Postinflammatory Hyperpigmentation

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101. Skin Resurfacing: Chemical Peels

of the condition and the wishes of the patient. These wishes should be tempered with information on what is possible and what is desirable for the patient in terms of treatment. Approach each patient truthfully, discussing possibilities, risks, benefits, and alternatives. Indications related to pigmentary disorders are as follows: Melasma Postinflammatory hyperpigmentation Freckles Lentigines Facial melanoses Periorbital hyperpigmentation Indications related to acne are as follows [ , ] : Superficial acne (...) - and long-term changes that occur. Initially, as with most damage to the human body, the response is inflammatory. This tends to subside rather quickly in the skin, but continuous damage can result in prolonged inflammatory responses. Although postinflammatory hyperpigmentation is often considered a limited medical condition, most individuals express it to some extent, and prolonged exposure to damaging environmental factors results in tanning and prolonged hyperpigmentation. The increased volume

2014 eMedicine Surgery

102. Skin Resurfacing, Chemical Peels

of the condition and the wishes of the patient. These wishes should be tempered with information on what is possible and what is desirable for the patient in terms of treatment. Approach each patient truthfully, discussing possibilities, risks, benefits, and alternatives. Indications related to pigmentary disorders are as follows: Melasma Postinflammatory hyperpigmentation Freckles Lentigines Facial melanoses Periorbital hyperpigmentation Indications related to acne are as follows [ , ] : Superficial acne (...) - and long-term changes that occur. Initially, as with most damage to the human body, the response is inflammatory. This tends to subside rather quickly in the skin, but continuous damage can result in prolonged inflammatory responses. Although postinflammatory hyperpigmentation is often considered a limited medical condition, most individuals express it to some extent, and prolonged exposure to damaging environmental factors results in tanning and prolonged hyperpigmentation. The increased volume

2014 eMedicine Surgery

103. 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

104. Pityriasis Alba (Overview)

, 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 Pediatrics

105. Pityriasis Rosea (Overview)

, especially in black people. Both postinflammatory hyperpigmentation and hypopigmentation may occur. However, lesions do not result in scars. Bacterial superinfections may occur, but are rare. In pregnant women, pityriasis rosea is sometimes associated with miscarriage if occurring within the first 15 weeks of pregnancy, premature delivery, or neonatal hypotonia and hyporeactivity. [ , ] Previous Next: Patient Education Patients should be instructed to avoid contact with irritants. In addition, patients

2014 eMedicine Pediatrics

106. Scabies (Follow-up)

for lesions, but all sites are vulnerable. Secondary lesions These lesions result from scratching, secondary infection, and/or the host’s immune response against the scabies mites and their products. Characteristic findings include the following [ , , ] : Excoriations Widespread eczematous dermatitis Honey-colored crusting Postinflammatory hyperpigmentation Erythroderma Prurigo nodules Frank pyoderma See for more detail. Diagnosis The diagnosis of scabies can often be made clinically in patients

2014 eMedicine Pediatrics

107. Cutaneous Laser Resurfacing: Carbon Dioxide (Follow-up)

been shown to be effective against treating many of the same skin conditions as traditional ablative carbon dioxide lasers. Several studies have shown carbon dioxide fractional photothermolysis to be effective against rhytids, postinflammatory hyperpigmentation, melasma, nevus of Ota, hypopigmented and hyperpigmented scars, dyschromia, laser-induced hypopigmentation and hyperpigmentation, and poikiloderma of Civatte. [ ] The ultrapulsed fractional carbon dioxide laser has been shown (...) pain and edema to pruritus and tightness. Mild complications sometimes occur and usually are of minimal consequence. Minor complications include milia formation, perioral dermatitis, acne and/or rosacea exacerbation, contact dermatitis, and postinflammatory hyperpigmentation. Treatment with hydroquinone can effectively attenuate hyperpigmentation. Providers might consider the addition of serial glycolic acid peels in patients with Fitzpatrick skin types III-VI, as they are more prone to pigmentary

2014 eMedicine.com

108. Common Pregnancy Complaints and Questions (Follow-up)

nigricans, vulvar or dermal melanocytosis, or postinflammatory hyperpigmentation secondary to specific dermatologic conditions of pregnancy, are fairly common as well. See , a Critical Images slideshow, for help identifying several types of cutaneous eruptions associated with pregnancy. Do ocular changes occur in pregnancy? Physiologic changes of pregnancy create stress to all of the mother's body systems, including the eye and visual system. Pregnant women often report dry eyes, which is thought (...) to Pregnancy Why do women undergo skin pigmentation changes during pregnancy? Pigmentation changes are directly related to melanocyte-stimulating hormone (MSH) elevations during pregnancy. Some evidence suggests that elevated estrogen and progesterone levels cause hyperpigmentation in women. This is typically evident in the nipples, umbilicus, axillae, perineum, and linea alba, which darkens enough to be considered a linea nigra. More than 90% of patients have skin darkening. Facial darkening, called

2014 eMedicine.com

109. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (Diagnosis)

and toxic epidermal necrolysis and can affect 23-100% of these patients. [ ] Cutaneous complications can include the following: Postinflammatory dyspigmentation (hyperpigmentation or hypopigmentation) Abnormal scarring Eruptive nevi Nail changes (onychomadesis, anonychia, pterygium formation, ridging, dystrophy, abnormal pigmentation) Telogen effluvium Alopecia areata Chronic pruritus Hyperhidrosis Photosensitivity Heterotopic ossification Disseminated ectopic sebaceous glands A 2017 article (...) and caused less discomfort to the patients. [ ] Postinflammatory hyperpigmentation changes are common and affect most Stevens-Johnson syndrome and toxic epidermal necrolysis patients. It has been recommended that when an “anti-shear approach is undertaken and the detached skin is left in-situ” that the postinflammatory hyperpigmentation appears less severe. [ ] Previous References Mockenhaupt M. Stevens-Johnson syndrome and toxic epidermal necrolysis: clinical patterns, diagnostic considerations

2014 eMedicine.com

110. Cutaneous Laser Resurfacing: Carbon Dioxide (Diagnosis)

been shown to be effective against treating many of the same skin conditions as traditional ablative carbon dioxide lasers. Several studies have shown carbon dioxide fractional photothermolysis to be effective against rhytids, postinflammatory hyperpigmentation, melasma, nevus of Ota, hypopigmented and hyperpigmented scars, dyschromia, laser-induced hypopigmentation and hyperpigmentation, and poikiloderma of Civatte. [ ] The ultrapulsed fractional carbon dioxide laser has been shown (...) pain and edema to pruritus and tightness. Mild complications sometimes occur and usually are of minimal consequence. Minor complications include milia formation, perioral dermatitis, acne and/or rosacea exacerbation, contact dermatitis, and postinflammatory hyperpigmentation. Treatment with hydroquinone can effectively attenuate hyperpigmentation. Providers might consider the addition of serial glycolic acid peels in patients with Fitzpatrick skin types III-VI, as they are more prone to pigmentary

2014 eMedicine.com

111. Cutaneous Manifestations Following Exposures to Marine Life (Diagnosis)

, angioedema) or delayed hypersensitivity reactions. Complications include pain, postinflammatory hyperpigmentation, scarring, and contractions. Systemic reactions range from mild to severe (eg, cardiac arrest, anaphylactic shock). Two species of box jellyfish around Queensland (Australia) are known to produce venom with hemolytic, dermatonecrotic, and cardiotoxic components. The Irukandji syndrome is caused by a small amount of venom leading to severe muscle cramps, back pain, and systemic signs

2014 eMedicine.com

113. Dermatofibroma (Diagnosis)

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

114. Dermatologic Manifestations of Hematologic Disease (Diagnosis)

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

115. Botanical Dermatology (Diagnosis)

-presenting cells of the epidermis. In some patients, asymptomatic and persistent black lesions may appear on the skin. These lesions are referred to as black lacquer spots. They occur where a sufficient amount of resin has been deposited to cause a vesicant reaction (the oleoresin is a vesicant at high concentrations). On rare occasions, severe reactions to poison ivy can cause erythema multiforme, [ ] erythema scarlatiniform, or urticarial eruptions. Postinflammatory hyperpigmentation is common in dark

2014 eMedicine.com

116. Benign Vulvar Lesions (Diagnosis)

], 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

117. Urticarial Vasculitis (Diagnosis)

, 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

118. Melanonychia (Diagnosis)

or chronic) (single band) Poor-fitting shoes (single band) Onychotillomania (single band) Nail biting (single band) (single band) Foreign body (subungual) (single band) Radiation therapy (multiple bands) Ultraviolet light (multiple bands) [ ] Postinflammatory hyperpigmentation (single band) Systemic causes of melanonychia are as follows: (multiple bands) (multiple bands) (multiple bands) (multiple bands) (multiple bands) (multiple bands) Alcaptonuria (multiple bands) (multiple bands) (multiple bands (...) . Clin Exp Dermatol . 2014 Sep 30. . Wang YJ, Sun PL. Fungal melanonychia caused by Trichophyton rubrum and the value of dermoscopy. Cutis . 2014 Sep. 94(3):E5-6. . Karanth SS, Gupta A, Prabhu M. Melanonychia and mucocutaneous hyperpigmentation from hydroxyurea use for the treatment of essential thrombocytosis. Singapore Med J . 2014 Jan. 55(1):e7-8. . Charan S, Mishra K, Jandial A, Khadwal A, Malhotra P. Melanonychia. QJM . 2018 Jul 6. . Miličević T, Žaja I, Tešanović D, Radman M. Laugier-Hunziker

2014 eMedicine.com

119. Melasma (Diagnosis)

, Anderson RR. Ineffective treatment of refractory melasma and postinflammatory hyperpigmentation by Q-switched ruby laser. J Dermatol Surg Oncol . 1994 Sep. 20(9):592-7. . Lakhdar H, Zouhair K, Khadir K, Essari A, Richard A, Seité S, et al. Evaluation of the effectiveness of a broad-spectrum sunscreen in the prevention of chloasma in pregnant women. J Eur Acad Dermatol Venereol . 2007 Jul. 21(6):738-42. . Kanwar AJ, Dhar S, Kaur S. Treatment of melasma with potent topical corticosteroids. Dermatology (...) , Hohenleutner U. Ruby laser treatment of melasma and postinflammatory hyperpigmentation. Dermatol Surg . 1995 Nov. 21(11):994. . Manaloto RM, Alster T. Erbium:YAG laser resurfacing for refractory melasma. Dermatol Surg . 1999 Feb. 25(2):121-3. . Rokhsar CK, Fitzpatrick RE. The treatment of melasma with fractional photothermolysis: a pilot study. Dermatol Surg . 2005 Dec. 31(12):1645-50. . Kroon MW, Wind BS, Beek JF, et al. Nonablative 1550-nm fractional laser therapy versus triple topical therapy

2014 eMedicine.com

120. Lupus Erythematosus, Acute (Diagnosis)

for several days to weeks. Lesions wax and wane with sun exposure over a period of several hours; however, some patients experience prolonged disease activity. Resolution of lesions may result in postinflammatory hyperpigmentation, especially in patients with darkly pigmented skin. Usually, the lesions are nonscarring. (See , , and .) Previous Next: Etiology The etiology of lupus erythematosus is believed to be multifactorial, involving genetic, environmental, and hormonal factors. An association (...) systemic disease. Postinflammatory hyperpigmentation may occur in dark-skinned patients following resolution. Previous Next: Patient Education Educate patients about the nature of skin, which acts as a barometer of disease activity. Control of the cutaneous manifestations depends ultimately on overall control of the disease. Instruct patients regarding the effects of ultraviolet light in exacerbating the disease. For patient education information, see the , as well as . Previous References Petri M

2014 eMedicine.com

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