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Postinflammatory Hyperpigmentation

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141. 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

142. Granuloma Annulare (Treatment)

including rifampin at 600 mg, ofloxacin at 400 mg, and minocycline hydrochloride at 100 mg monthly for 3 months. Three to 5 months after the initiation of treatment, the plaques were cleared completely. Postinflammatory hyperpigmentation was reported by some patients. Although the treatment was successful, the authors suggested further studies may be needed to confirm this combination therapy as a successful option for recalcitrant granuloma annulare. [ ] Garg and Baveja also reported successful

2014 eMedicine.com

143. Hirsutism (Treatment)

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

144. Dermatologic Manifestations of Hematologic Disease (Treatment)

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

146. 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

147. 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

148. 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

149. 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

150. Laser Treatment of Leg Veins (Treatment)

. 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

151. Laser Treatment of Benign Pigmented Lesions (Treatment)

. 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

152. Laser Tissue Resurfacing (Treatment)

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

153. Laser Treatment of Acquired and Congenital Vascular Lesions (Treatment)

% 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

154. 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

155. 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

156. 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

157. 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

158. 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

159. Melasma (Treatment)

irritation, phototoxic reactions with secondary postinflammatory hyperpigmentation, and irreversible exogenous (reported even with long-term use of 2% HQ). Special care must be taken not to prescribe the monobenzyl ether of HQ (Benoquin), which causes an irreversible localized and generalized vitiligolike leukoderma. Outside the United States, topical creams with concentrations as high as 8% are available over the counter. These agents are associated with much higher rates of exogenous ochronosis (...) of potential adverse effects, including epidermal necrosis, postinflammatory hyperpigmentation, and hypertrophic scars. [ , ] As such, they are considered second-line therapies, to be used after management with topical medications has failed. The precise manner in which these modalities can be used has not been fully delineated. However, in some experienced hands, they have been anecdotally reported to be safe and effective and to produce results much quicker than topical medications. Superficial skin

2014 eMedicine.com

160. Lentigo (Treatment)

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

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