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Postinflammatory Hyperpigmentation

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121. Impetigo (Diagnosis)

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

122. Psoriasis, Guttate (Overview)

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

123. Pseudofolliculitis of the Beard (Overview)

Pseudofolliculitis barbae affects men with facial hair (postpuberty). Previous Next: Prognosis Although usually not regarded as a serious medical problem, pseudofolliculitis barbae can cause cosmetic disfigurement. The papules can lead to scarring, postinflammatory hyperpigmentation, secondary infection, and . No cure exists, but effective treatment is available. If the patient is able to grow a beard, the problem usually disappears (except for any residual scarring). Previous Next: Patient Education Instruct

2014 eMedicine.com

124. 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

125. Nonlaser Hair Removal Techniques (Overview)

, 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

126. Nonneoplastic Epithelial Disorders of the Vulva (Overview)

], 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

127. Melanonychia (Overview)

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

128. Melasma (Overview)

, 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

129. Laser Treatment of Benign Pigmented Lesions (Overview)

. 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

130. Laser Tissue Resurfacing (Overview)

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

131. Laser Treatment of Leg Veins (Overview)

. 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

132. Laser Treatment of Acquired and Congenital Vascular Lesions (Overview)

% 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

133. Incontinentia Pigmenti (Overview)

of the IKK-deficient cells. This mechanism is believed to produce the cutaneous manifestations of the vesicular stage of incontinentia pigmenti. The proliferation of surviving IKK-positive cells may result in the production of the verrucous lesions seen in stage 2 of incontinentia pigmenti. The pathophysiology of the hyperpigmented cutaneous findings seen in stage 3 and the atrophic/hypopigmented manifestations of stage 4 remains unknown. Inflammation and subsequent postinflammatory changes may play (...) with incontinentia pigmenti. Blaschkoid hyperpigmentation in an infant with incontinentia pigmenti. Conical teeth in an infant with incontinentia pigmenti. of 12 Tables Contributor Information and Disclosures Author Kara N Shah, MD, PhD Associate Professor, Departments of Pediatrics and Dermatology, University of Cincinnati College of Medicine Kara N Shah, MD, PhD is a member of the following medical societies: , , Disclosure: Nothing to disclose. Specialty Editor Board David F Butler, MD Former Section Chief

2014 eMedicine.com

134. Cutaneous Manifestations Following Exposures to Marine Life (Overview)

, 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

135. 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

136. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (Overview)

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

137. Chemical Peels (Overview)

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 scars Postacne (...) . 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 of skin from inflammation tends

2014 eMedicine.com

138. Common Pregnancy Complaints and Questions (Overview)

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

139. Cutaneous Laser Resurfacing: Carbon Dioxide (Overview)

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

140. Botanical Dermatology (Overview)

-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

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