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Postinflammatory Hyperpigmentation

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121. Drug-Induced Pigmentation (Diagnosis)

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

122. Common Pregnancy Complaints and Questions (Diagnosis)

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

123. Pseudofolliculitis of the Beard (Treatment)

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

124. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (Treatment)

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

125. Oral Manifestations of Systemic Diseases (Treatment)

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

126. Oral Malignant Melanoma (Treatment)

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

127. Scabies (Overview)

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

128. Cheek Reconstruction (Treatment)

be associated with a slightly higher rate than other regions of the face. [ ] Long-term follow up has been suggested to improve the early detection rate of delayed ectropion. [ ] The most common and notable complications are infection, tissue necrosis, wound dehiscence, bleeding, and hematomas. [ ] Other adverse sequelae encountered by the dermatologic surgeon include suture reactions, contact dermatitis (often to topical antibiotic postoperative therapy), postinflammatory hyperpigmentation

2014 eMedicine.com

129. Common Pregnancy Complaints and Questions (Treatment)

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

130. Benign Vulvar Lesions (Treatment)

], 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

131. Cutaneous Laser Resurfacing: Carbon Dioxide (Treatment)

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

132. Botanical Dermatology (Treatment)

-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

133. Becker Melanosis (Treatment)

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

134. Xanthomas (Treatment)

. [ , , , , , , , , , , , ] However, lesions may recur. Factors that predict recurrence are systemic hyperlipidemia, involvement of all four eyelids, and previous history of recurrent xanthelasma. [ ] Er:YAG laser treatment may be recurrence-free for up to 12 months. [ ] Transient erythema, infections, scarring, and postinflammatory hyperpigmentation may occur with all surgical treatment alternatives. Nonablative 1,450-nm diode laser treatment may achieve satisfactory results for patients with xanthoma disseminatum. [ ] Wide

2014 eMedicine.com

135. Nonneoplastic Epithelial Disorders of the Vulva (Treatment)

], 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

136. Nonablative Resurfacing (Treatment)

, 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

137. Nonlaser Hair Removal Techniques (Treatment)

, 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

138. Urticarial Vasculitis (Treatment)

. 2000 Dec. 143(6):1324. . Ghadban R, Zenone T, Leveque-Michaud C, Louerat C, 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 (...) of onset of the lesions; duration of the lesions (eg, >24 h); whether lesions are painful or burning, rather than pruritic; and the history of resolution with purpura or hyperpigmentation. Inquire about the patient's medications, fever, arthralgia, dyspnea, abdominal pain, and symptoms of angioedema. Omalizumab has produced mixed results. [ , ] Next: Consultations Consultation with the following specialists may be needed: Dermatologist: Skin biopsy is evaluated by a dermatologist/dermatopathologist

2014 eMedicine.com

139. Psoriasis, Guttate (Treatment)

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

140. Pityriasis Alba (Treatment)

, 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

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