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Postinflammatory Hyperpigmentation

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161. 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

162. 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

163. 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

164. 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

165. 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

166. 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

167. 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

168. 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

169. 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

170. 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

171. 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

172. 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

173. 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

174. 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

175. 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

176. 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

177. 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

178. 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

179. 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

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