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Postinflammatory Hyperpigmentation

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141. Pityriasis (Treatment)

steroids can be applied. It must be kept in mind that although steroids alleviate the pruritus, they do not modify the eruption. The sedative effect of the antihistamines may help the patient to sleep better at night. Systemic steroids are not recommended because they may exacerbate the disease. However, some dermatologists use prednisone (0.5-1 mg/kg/day for 7 days) in selected patients with severe pruritus, vesicular lesions, or the potential for significant postinflammatory hyperpigmentation (...) (eg, vesicular pityriasis rosea), topical or oral steroids may be used. Ultraviolet (UV) radiation therapy has been demonstrated to be effective for pityriasis rosea but may leave postinflammatory pigmentation at the site of the pityriasis rosea lesion. [ ] For patients in whom superficial tinea infection is a concern or possibility, topical antifungal therapy can be used. Some data suggest that the antiviral agent acyclovir could hasten resolution. [ , ] No restriction of activity or isolation

2014 eMedicine.com

142. Pityriasis Rosea (Treatment)

or widespread (eg, vesicular pityriasis rosea), topical or oral steroids may be used. Ultraviolet (UV) radiation therapy has been demonstrated to be effective for pityriasis rosea but may leave postinflammatory pigmentation at the site of the pityriasis rosea lesion. [ ] For patients in whom superficial tinea infection is a concern or possibility, topical antifungal therapy can be used. Some data suggest that the antiviral agent acyclovir could hasten resolution. [ , ] No restriction of activity (...) , topical steroids can be applied. It must be kept in mind that although steroids alleviate the pruritus, they do not modify the eruption. The sedative effect of the antihistamines may help the patient to sleep better at night. Systemic steroids are not recommended because they may exacerbate the disease. However, some dermatologists use prednisone (0.5-1 mg/kg/day for 7 days) in selected patients with severe pruritus, vesicular lesions, or the potential for significant postinflammatory

2014 eMedicine.com

143. 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

144. 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

145. Benign Vulvar Lesions (Overview)

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 in the dermis following a previous (...) be observed. Benign vulvar lesions. Primary irritant dermatitis and associated intertrigo. Chronic irritant dermatitis may lead to squamous cell hyperplasia. Intertrigo Typically, intertrigo is characterized by erythema, local edema, oozing, maceration, and fissuring of the inguinal fold, sometimes accompanied by considerable odor. It may be associated with similar findings in other skin folds. The surrounding skin may show reactive postinflammatory hyperpigmentation. Soreness and itching are common

2014 eMedicine.com

146. 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

147. 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

148. Urticarial Vasculitis (Overview)

, 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

149. 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

150. 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

151. 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

152. Acne Vulgaris (Overview)

American whites. African Americans have a higher prevalence of pomade acne, likely stemming from the use of hair pomades. Ethnicities with darker skin are also more prone to postinflammatory hyperpigmentation. [ ] Sex During adolescence, acne vulgaris is more common in males than in females. In adulthood, acne vulgaris is more common in women than in men. [ , ] Age Acne or acneform lesions, such as in neonatal cephalic pustulosis, may be present in the first few weeks and months of life, when a newborn (...) ; multiple open comedones, closed comedones, and papulopustules, plus cysts. Acne with reactive hyperpigmentation; before treatment. Acne with reactive hyperpigmentation; after treatment. of 6 Tables Contributor Information and Disclosures Author Jaggi Rao, MD, FRCPC Clinical Professor of Medicine, Division of Dermatology and Cutaneous Sciences, Director of Dermatology Residency Program, University of Alberta Faculty of Medicine and Dentistry Jaggi Rao, MD, FRCPC is a member of the following medical

2014 eMedicine.com

153. Lupus Erythematosus, Acute (Overview)

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

154. 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

155. 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

156. 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

157. Impetigo (Overview)

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

158. Impetigo (Overview)

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

159. Oral Manifestations of Systemic Diseases (Overview)

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

160. Oral Malignant Melanoma (Overview)

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

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