Pigment Disorders & Photosensitivity - AMS

Question 1

What is the management plan for acute photosensitivity?

Answer 1

• Prevention
• Cool wet dressings
• Aloe vera
• Anti-inflammatory

Question 2

What is the hallmark of a drug-induced phototoxicity?

Answer 2

-Exaggerated sunburn that itches or stings

Question 3

What is phytophotodermatitis, its clinical presentatoin, and Tx?

Answer 3

• Plant induced phototoxicity (lime, celery, figs, parsley)
• Erythema with marked pruritus
• Acute symptoms fade, hyperpigmentation may last
• Tx: cool wet dressings, antihistamines, NSAIDs

Question 4

What are common drugs/topicals responsible for drug-induced photoallergy?

Answer 4

• Salicylanides, phenothiazines, sulfa, benzocaine

- Sunscreen, after shave, perfume ingredients

Question 5

What is Stevens-Johnson Syndrome?

Answer 5

• immune-complex mediated hypersensitivity reaction that is a severe expression of erythema multiforme
• Pathologically → cell death results causing separation of the epidermis from the dermis

Question 6

Polymorphous Light Eruptions are what type of hypersensitivity reaction?

Answer 6

• Type IV
• Characterized by delayed reaction to UV radiation
• Pruritus and tingling, often precedes rash

Question 7

What is solar lentigo and what is the Tx?

Answer 7

• localized proliferation of melanocytes in epidermis only

- Tx: prevention

Question 8

What is the most common lesion with malignant potential to arise on the skin?

Answer 8

Actinic Keratosis (occupational and leisure related)

Question 9

What is the role of porphyrin?

Answer 9

pigment molecule → plays a role in binding metal (heme, bile)

Question 10

What is an area of dark pigmentation (light-brown patches) most commonly on a woman’s face?

Answer 10

Melasma (most prevalent in dark skin individuals)

Question 11

What is the Tx for melasma?

Answer 11

• Daily sunscreen (rigid adherence)

- Hydroquinone (skin whitening benzene derivative)

Question 12

What would be diagnosis for a patient with brown to black lesions following distribution of a primary dermatosis, caused by inflammatory mediators?

Answer 12

Post-inflammatory Hyperpigmentation

Question 13

What is Erythema Dyschromicum Perstans (Ashy dermatosis)?

Answer 13

• Ashen colored macules, may be erythematous, slightly raised borders
• Face, neck, trunk, upper extremities
• Tx: sunscreens, hydroquinone, bleaching creams, topical steroids, griseofulvin

Question 14

What are the different types of Lentigines?

Answer 14

1) Lentigo simplex: first decade of life
2) Solar Lentigines: Liver spots, later in adult life
3) Nevus spilus: speckled lentiginosis nevus → congenital brown patch that develops dotted brown macules

Question 15

What is the name of the Autosomal Dominant Disorder characterized by brownish-black macules of flexures and reticulated patterns?

Answer 15

Dowling-Degos Dz

Tx: Adapelene

Question 16

What disorder is characterized by the complete absence of melanocytes, with development of white patches of skin, and more common in families with DM and thyroid disease?

Answer 16

Vitiligo

-Antibodies directed against melanocytes

Question 17

Does the Tx of thyroid disorders affect vitiligo?

Answer 17

No

Question 18

What is the treatment of choice for vitiligo Repigmentation? Depigmentation?

Answer 18

Repigmentation: Narrow-band UVB → stimulates the production of melanocyte-stimulating hormone.
Depigmentation: Monobenzylether of hydroquinone (MBEH)

Question 19

What is the hallmark of piebaldism?

Answer 19

• Rare autosomal dominant congenital disorder of melanocyte development
• Congenital white forelock (i.e. Dave) with multiple symmetrical hypopigmented or depigmented macules

Question 20

What medication can cause hypopigmentation?

Answer 20

potent corticosteroids

Question 21

Hypopigmented patches on the central face with greasy scale are usually…?

Answer 21

seborrheic dermatitis

Question 22

Hypopigmented patches on the face of atopic children are usually…?

Answer 22

pityriasis alba