67 disorders of hyperpigmentation Flashcards
inflammatory mediators that enhance pigment production
prostaglandins E2 and D2
flagellate erythema a/w …
bleomycin use, shiitake mushroom ingestion, dermatomyositis, Still disease
treatment of PIH
1) hydroquinone +/- Cs +/- topical retinoid
2) azelaic acid, alpha-hydroxy acid, L-ascorbic acid, kojic acid …
laser: Q-switched ruby, alexandrite, and Nd:YAG (for dermal pigment)
EDP reported associated triggers
ammonium nitrate (usually in fertilizers and explosives), oral-X ray contrast media, medications (benzos, penicillin); various pesticides, fungicides or toxins; endocrinopathies such as thyroid, infection: whipworm and HIV; presence of HLA-DR4 allele Mexican patients
EPD path (active lesions)
vacuolar degeneration of the basal cell layer, perivascular mononuclear cell infiltrate and melanophages in the upper dermis with increased epidermal melanin seen
main ddx of EPD
idiopathic eruptive macular hyperpigmentation (IEMH), but in the latter there is primarily epidermal pigment; also lichenoid drug eruption, lichen planus pigmentosus
lichen planus pigmentosus
variant of LP, mostly in darker skin types; irregularly shaped or oval, brown to gray brown macules and patches in either sun exposed areas (e.g. forehead, temples, neck) or intertriginous areas; decent response to tacrolimus (clinically difference from EDP is distribution)
melasma triggers
sun exposure, pregnancy, oral contraceptives
melasma three classic patterns
centrofacial, malar, and mandibular; less common sites area forearms and mid upper chest
hyperfunctional melanocytes (d/t UV radiation) in melasma supported by
increased number of mitochondria, Golgi apparati, and RER in lesional melanocytes
tx of melasma
1st line: - hq + retinoid + CS - 4% hq - azelaic acid 15-20% adjunctive: - L-ascorbic acid - kojic acid 2nd line: -glycolic acid and salicylic acid peels every 4-6 weeks 3rd line: -fractional laser intense pulsed light (IPL)
cutaneous amyloidosis
macular and lichenoid forms, have asso hyperpigmentation, in the upper back (macular amyloidosis) and extensor LE (lichen amyloidosis), characteristic rippled pattern with parallel bands or ridges of hyperpigmentation; often pruritic, caused by rubbing
urticaria pigmentation
maculopapular form of mastocytosis which features hyperpigmented lesions: red-brown macules and papules which urticate when stroked (Darier’s sign), when in children - often resolves with adolescence
lesion urticates when stroked, sign:
Darier’s sign
atrophic form of morphea in young adults, presents with multiple oval hyperpigmented patches 4-10 cm in daimeter on the posterior trunk; lesions have a subtle depression (cliff sign)
atrophoderma of Pasini and Pierini
solar lentigines pathogenesis
epidermal hyperplasia in response to chronic sun exposure, in spectrum with macular SK’s, rete ridges with club-shaped or bud-like extensions with increased basal layer pigmentation; variable proliferation of melanocytes and accumulation of melanin within keratinocytes
looks like a CALM but with speckled macules
nevus spilus
main causes of DIH
minocycline, antimalarials, chemotherapeutic agents, zidovudine
drug in DIH that is diffuse
think chemotherapeutic drugs: bisulfan, cyclophosphamide, dactinomycin (face>body), mechlorethamine (N mustard, when used topically for tx of CTCL), PUVA (after exposure to UVA light)
drug in DIH that is in sun-exposed areas
think metals, MTX and psychotropic
-daunorubicin, 5FU (in patient’s treated systemically), MTX, gold, silver (argyria), ACTH/MSH/afamelnotide, amiodarone, diltiazem, dioxins (when chlorinated think chloracne), psychotropic drugs
drug in DIH at pressure points, overlying joints, or sites of trauma
bleomycin (flagellate), doxorubicin (joints of hands), hydroxyurea
drug in DIH most prominent on the face
dactinomycin, bismuth, amiodarone
drug in DIH at mucosa
cyclophosphamide, chloroquine, bismuth, lead (gingival), zidovudine (oral macules), minocycline
drug in DIH at skin folds/groin
arsenic (also volar), mercury
drug in DIH at special sites
antimalarials and minocycline (tibial), gold (around the eyes)
common nail finding in DIH
transverse melanonychia
an adverse rxn to hydroquinone
exogenous ochronosis
pigmentary demarcation lines
seen between dorsal surfaces and ventral surface
flagellate pigmentation in bleomycin vs shiitake mushroom
shiitake mushroom more pruritic and a/w scratching
incontinentia pigmenti stages
XLD multi-system disorder with skin lesions along Blaschko lines
1) inflammatory vesicular
2) verrucous
3) hyperpigmented
CARP
confluent and reticulated pillomatosis
prurigo pigmentosa
pruritic eruption of erythematous papules and paplovesicles on the trunk and neck, crops develop rapidly then involute w/in a week, leaving behind a macular reticulated hyperpigmentation; think Japanese females
dyskeratosis congenita
XLR, triad of triculated hyperpigmentation, nail dystrophy (peterygium) and leukoplakia
segmental pigmentation disorder
a subtype of pigmentary mosaicism
