PIGMENT DISORDERS

Question 1

Hyperpigmentation - Caused by

Answer 1

• Inflammation
• Trauma/friction
• UVR (or in combination with other triggers)
• Medications
• Underlying systemic

Question 2

Hyperpigmentation – Drug Induced

Answer 2

Brown: minocycline, hydroxychloroquine
Blue-gray: minocycline, tricyclic antidepressants, gold, silver Blue: minocycline, amiodorone
Red-brown: rifampicin, clofazimine
Purple-gray: phenothiazines
Brown streaks: bleomycin

Question 3

Exogenous Ochronosis

Answer 3

Hyperpigmentation after prolonged treatment with skin lightening agents
• Hydroquinone, phenol, picric acid
• Localized, asymptomatic, blue-gray, pinpoint papules
• Resistant to treatment

Question 4

Vitiligo

Answer 4

• ≈ 80% prior to age 30
• Unknown etiology; proposed theories
• Autoimmune (significant increase in those w/vitiligo)
• Oxidative stress
• Frequently associate with other autoimmune disorders, esp hypothyroidism

Question 5

Vitiligo – Clinical Presentation

Answer 5

• Asymptomatic, depigmented macules & patches with well- defined borders
• Most common sites – hands, orifices, and genitals
• Poliosis – absence or decrease of melanin in hair

Question 6

Nonsegmental vitiligo

Answer 6

most common type
• Bilateral and generalized
• 6-26% of pediatrics with nonsegmental vitiligo have halo nevi

Question 7

Segmental vitiligo

Answer 7

Unilateral

• Dermatomal or quasi-dermatomal (trigeminal nerve)

Question 8

Vitiligo – Management

Answer 8

First line
Combination treatment more effective
• Topical corticosteroids
• Topical calcineurin inhibitors (no risk for atrophy)
• Can add phototherapy

Question 9

laser for vitiligo

Answer 9

Narrowband UVB (NB-UVB) –
Peak emission of ≈ 311nm

Question 10

stabilizing rapid progression of vitiligo

Answer 10

Oral prednisone +/ - NBUVB
• Duration: 2 weeks, repeat in 4-6 weeks PRN
• Not effective if vitiligo is stable

Question 11

Postinflammatory Hypopigmentation

Answer 11

• Topical Pimecrolimus 1% BID for 6 weeks • ≥ 2-years-old
• NBUVB
• Excimer laser (308nm)

Question 12

Minocycline Drug- Induced Pigmentation

Answer 12

Clinical Presentation
• Blue-gray (dirty) discoloration
• Blue-black in old acne scars or other sites of inflammation
• May involve nails, sclera, oral mucosa, teeth
Management
• D/C medication
• Months for resolution

Question 13

Lentigines laser

Answer 13

Nd:Yag (532nm) most effective

Question 14

Confluent & Reticulated Papillomatosis

Answer 14

• Asymptomatic, brown, scaly macules & patches, some reticulated
• Begin as hyperkeratotic/verrucous 1-2mm papules that coalesce
• Begin on neck or upper trunk, spread centrifugally (face, axillae, groin)
• KOH negative, unresponsive to antifungals

Question 15

CARP mgmt

Answer 15

• Minocycline 50-100 mg BID for 6 weeks
Topicals
• Vit D analogs - calcipotriol • Topical retinoids
• Tacrolimus