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Postinflammatory Hyperpigmentation

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101. Polypodium leucotomos as an Adjunct Treatment of Pigmentary Disorders. Full Text available with Trip Pro

improved the severity of melasma in women after 12 weeks. Three randomized, double-blind, placebo-controlled studies have demonstrated significant improvements in vitiligo when oral Polypodium leucotomos therapy was combined with psoralens plus ultraviolet A and narrowband ultraviolet B. No controlled studies have assessed the efficacy of Polypodium leucotomos for the treatment of postinflammatory hyperpigmentation; however, its known antioxidant and anti-inflammatory properties and demonstrated (...) effectiveness for melasma support its use for treating this condition. No adverse events have been associated with the use of Polypodium leucotomos.In addition to preventing many harmful effects associated with sunlight exposure, orally administered Polypodium leucotomos also appears to provide adjunctive benefits in treating vitiligo, melasma, and may have the potential to help with postinflammatory hyperpigmentation.

2014 The Journal of clinical and aesthetic dermatology Controlled trial quality: uncertain

102. A split-face, evaluator-blind randomized study on the early effects of Q-switched Nd:YAG laser plus Er:YAG micropeel (combined therapy) versus Q-switched Nd:YAG alone in light solar lentigines in Asians. (Abstract)

of postinflammatory hyperpigmentation (PIH) with combined therapy (73.3 vs 40%), the degree of pigment reduction in the combined side of the face was found significantly lower than that of the QSNY-alone side at 1-month follow-up (P = 0.014). Although our study results show that both combined therapy and QSNY alone are capable of reducing pigmentation, QSNY alone is considered to have more favorable qualities than combined treatment for light solar lentigines in Asians.

2014 Lasers in medical science Controlled trial quality: uncertain

103. Melasma treatment using an erbium:YAG laser: a clinical, immunohistochemical, and ultrastructural study. (Abstract)

area and severity index score decreased dramatically.Erbium:YAG laser resurfacing effectively improves melasma; however, the almost universal appearance of transient postinflammatory hyperpigmentation necessitates prompt and persistent intervention.© 2014 The International Society of Dermatology.

2014 International Journal of Dermatology

104. Benign Vulvar Lesions (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

105. Becker Melanosis (Follow-up)

factional laser therapy at 10 mJ/microbeam, coverage 35-45%, and topical bleaching (to reduce laser-induced postinflammatory hyperpigmentation), or topical bleaching alone. Treatment was moderately effective in some patients. However, postinflammatory hyperpigmentation and relatively negative patient-reported outcomes still preclude ablative fractional laser therapy from being a standard therapy. [ ] These results have been observed by this author, and the concern of both postinflammatory (...) Updated: May 24, 2018 Author: Jason K Rivers, MD, FRCPC; Chief Editor: Dirk M Elston, MD Share Email Print Feedback Close Sections Sections Becker Melanosis Treatment Surgical Care Therapeutic intervention for Becker nevus primarily is for cosmetic reasons. Patients present with complaints related to hypertrichosis and/or hyperpigmentation. Q-switched ruby laser (694 nm) has been used with variable success in the treatment of both the hypertrichosis and hyperpigmentation of Becker nevus

2014 eMedicine.com

106. 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

107. Urticaria, Chronic (Diagnosis)

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

108. Scabies (Diagnosis)

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.com

109. Nonlaser Hair Removal Techniques (Diagnosis)

, 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

110. Nonneoplastic Epithelial Disorders of the Vulva (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

111. 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

112. 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

113. 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

114. Oral Manifestations of Systemic Diseases (Diagnosis)

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

115. Oral Malignant Melanoma (Diagnosis)

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

116. Laser Treatment of Benign Pigmented Lesions (Diagnosis)

. 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

117. Laser Tissue Resurfacing (Diagnosis)

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 treatment with fractional CO2 laser device. J Drugs Dermatol . 2008 Aug. 7(8):774-7. . Avram MM, Tope

2014 eMedicine.com

118. Laser Treatment of Leg Veins (Diagnosis)

. 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

119. Laser Treatment of Acquired and Congenital Vascular Lesions (Diagnosis)

% 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

120. Psoriasis, Guttate (Diagnosis)

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

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