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Postinflammatory Hyperpigmentation

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161. 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

162. 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

163. 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

164. 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

165. Drug-Induced Pigmentation (Overview)

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

166. Dermatologic Manifestations of Hematologic Disease (Overview)

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

167. Pityriasis Rosea (Overview)

, especially in black people. Both postinflammatory hyperpigmentation and hypopigmentation may occur. However, lesions do not result in scars. Bacterial superinfections may occur, but are rare. In pregnant women, pityriasis rosea is sometimes associated with miscarriage if occurring within the first 15 weeks of pregnancy, premature delivery, or neonatal hypotonia and hyporeactivity. [ , ] Previous Next: Patient Education Patients should be instructed to avoid contact with irritants. In addition, patients

2014 eMedicine.com

168. Pityriasis (Overview)

, especially in black people. Both postinflammatory hyperpigmentation and hypopigmentation may occur. However, lesions do not result in scars. Bacterial superinfections may occur, but are rare. In pregnant women, pityriasis rosea is sometimes associated with miscarriage if occurring within the first 15 weeks of pregnancy, premature delivery, or neonatal hypotonia and hyporeactivity. [ , ] Previous Next: Patient Education Patients should be instructed to avoid contact with irritants. In addition, patients

2014 eMedicine.com

169. Pityriasis Alba (Overview)

, 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

170. Phytophotodermatitis (Overview)

be intensified by wet skin, sweating, and heat. The onset of the rash may be delayed and may not occur immediately after exposure to all of the elements. [ ] Once the rash does occur, it may take weeks to resolve. [ ] Phytophotodermatitis typically manifests as a burning erythema that may subsequently blister. Postinflammatory hyperpigmentation lasting weeks to months may ensue (see the images below). In some patients, the preceding inflammatory reaction may be mild and go unrecognized by the patient (...) exposure led to a drip-pattern blister formation on the dorsal forearm consistent with phytophotodermatitis. This picture clearly delineates the potential severity of phytophotodermatitis with extensive blister formation. The 2-month follow-up picture of a patient with a drip-pattern blister formation on the dorsal forearm demonstrates the potential postinflammatory pigmentation changes and scarring that may occur with severe blistering of phytophotodermatitis. See , a Critical Images slideshow

2014 eMedicine.com

172. Dermatofibroma (Overview)

of common dermatofibromas with an increased mitotic rate but no other worrisome features, none recurred or metastasized. [ ] Spontaneous regression has been reported, [ ] and this may yield postinflammatory hypopigmentation, although this appears to be quite rare. Previous Next: Patient Education For patient education resources, see the , as well as . Previous References Naversen DN, Trask DM, Watson FH, Burket JM. Painful tumors of the skin: "LEND AN EGG". J Am Acad Dermatol . 1993 Feb. 28(2 Pt 2):298 (...) Venereol Leprol . 2007 May-Jun. 73(3):194-5. . Alonso-Castro L, Boixeda P, Segura-Palacios JM, de Daniel-Rodríguez C, Jiménez-Gómez N, Ballester-Martínez A. Dermatofibromas treated with pulsed dye laser: Clinical and dermoscopic outcomes. J Cosmet Laser Ther . 2012 Apr. 14(2):98-101. . Media Gallery Erythematous, slightly hyperpigmented nodule on the leg. Courtesy of David Barnette, MD. Acanthotic epithelium with basilar hyperpigmentation (dirty feet) over a dermal spindle cell proliferation (X10

2014 eMedicine.com

173. 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

174. 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

175. Keratosis Pilaris (Treatment)

: Activity Keratosis pilaris does not limit any patient activities. Previous Next: Complications Complications from keratosis pilaris (KP) are infrequent. However, postinflammatory hypopigmentation or hyperpigmentation and scarring may occur. A gradual loss of hair in affected facial areas, especially the lateral eyebrows, may be seen in ulerythema ophryogenes (keratosis pilaris atrophicans faciei). Previous Next: Prevention In patients with keratosis pilaris (KP), measures should be taken to prevent (...) -3% salicylic acid in 20% urea cream. Intermittent dosing of topical retinoids (eg, weekly or biweekly) seems to be quite effective and well tolerated, but usually the response is only partial. After initial clearing with stronger medications, patients may then be placed on a milder maintenance regimen. Persistent skin discoloration, termed hyperpigmentation, may be treated with fading creams such as hydroquinone 4%, kojic acid, and azelaic acid 15-20%. Special compounded creams for particularly

2014 eMedicine.com

176. 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

178. 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

179. 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

180. 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

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