Hyperpigmentation Research Papers - Academia.edu (original) (raw)

This article focuses on developments in pigmentary disorders that extend dermatologists' understanding of the field. Areas that are reviewed include the basic biochemistry, pharmacology, and physiology of the melanocortin system; melanosome development; genetic diseases associated with pigmentary disorders; pigmentary disorders secondary to systemic disease; drug-induced hyperpigmentation; environmental exposure to chemicals; and primary disorders of hyperpigmentation such as melasma and lentigines. Basic, clinical, and epidemiological research, along with a number of clinical case reports, were included in the review. This article also reports on the new health-related quality-of-life instrument (MELASQOL) that has been developed for women with melasma. ( J Am Acad Dermatol 2006;54:S255-61.)

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- Quality of life, Clinical Sciences, Hyperpigmentation, Indexation

BACKGROUND There are no randomized split-face model studies investigating treatments for postinflammatory hyperpigmentation (PIH) in dark skin. OBJECTIVE To assess the efficacy, safety, and effect on quality of life of salicylic acid peels for PIH in dark skin. METHODS Ten subjects with Fitzpatrick skin phototypes IV to VI were randomized to receive two 20% salicylic acid peels followed by three 30% salicylic acid peels to half of the face. The contralateral half remained untreated. Response was evaluated by photography reviewed by three blinded dermatologists. The Visual Analog Scale, Dermatology Life Quality Index (DLQI), and treatment quality questionnaire were administered. RESULTS Improvement of PIH on the treatment side according to each rater (p = .81, p = .81, p = .42) and according to the raters combined (p = .11) approached but did not reach statistical significance. Subjects' Visual Analog Scale scores indicated significantly greater improvement of PIH on the treatment side than in the control (p = .004). Quality of life measured according to the DLQI improved after treatment but not statistically significantly so (p = .13). Treatment had no significant adverse effects. CONCLUSIONS Salicylic acid peels are safe in this population. Although patients rated them as clinically effective, blinded raters found a brief series of peels to have less efficacy. Measured quality of life improved nominally.

- by Roopal Kundu
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- Surgery, Photography, Quality of life, Treatment
- by Mitchel Goldman
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- Follow-up studies, Patient Satisfaction, Clinical Sciences, Photochemotherapy

The differential diagnosis of pigmented macules on the mottled chronic sun-damaged skin of the face is challenging and includes lentigo maligna (LM), pigmented actinic (solar) keratosis, solar lentigo, and lichen-planus-like keratosis. Although dermatoscopy improves the diagnostic accuracy of the unaided eye, the accurate diagnosis and management of pigmented facial macules remains one of the most challenging scenarios in daily practice. This is related to the fact that pigmented actinic (solar) keratosis, lichen-planus-like keratosis, and LM may reveal overlapping criteria, making their differential diagnosis clinically difficult. For this reason, practical rules have been introduced, which should help to minimize the risk for inappropriate diagnosis and management of LM.

- by Aimilios Lallas and +1
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- Differential Diagnosis, Clinical Sciences, Hyperpigmentation, Dermoscopy
- by Meera Thomas and +1
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- Immunohistochemistry, India, Collagen, Differential Diagnosis

Klinefelter's syndrome whose SS resolved after oral testosterone replacement. 4 Although there is a scarcity of clinical investigation studying testosterone treatment for DES, laboratory studies support the plausibility of this therapy. Multiple mechanisms maybe responsible for the amelioration of DES symptoms in those treated with combined EE ϩ MT. Likely mechanisms include (1) anti-inflammatory action within the lacrimal gland; (2) ocular surface protection by increased IgA levels; and (3) stimulation of meibomian gland secretions, affecting both the quality and quantity of the lipid phase. 5 Through one or a combination of these three mechanisms, androgens could improve the quality and quantity of the tear film. Prospective controlled trials are necessary to determine the value of EE ϩ MT therapy for DES.

Background The endocrine, metabolic, and immunologic changes during pregnancy give Hospital, Lahore, Pakistan rise to a number of physiologic cutaneous changes. Objective We evaluated 140 pregnant women to determine the pattern of pregnancy-Correspondence induced physiologic skin changes in our community. Farhana Muzaffar, FCPS 538-A, Gulshan-e-Ravi Results The various changes observed include: increased pigmentation (90.7%), striae Lahore (77.1%), edema (48.5%), melasma (46.4%), vascular changes (34.2%), and others. Pakistan Conclusions Pigmentary changes were the most common finding, whereas the incidence of vascular changes was quite low (p Ͻ 0.01).

- by Ijaz Hussain
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- Dermatology, Adolescent, Pregnancy, Clinical Sciences

Background Although it is important that dermatologists and the general population know the irritation potential of products marketed for dry skin used for body cleansing, this information is not usually available. Objective To assess the irritative effect of different soaps and liquid cleansers recommended for sensitive skin. To study the correlation of the irritation effect of each substance with its pH and with the presence or absence of syndet in the product. Methods Seventeen products marketed for dry skin and 12 common soaps used by the general population were studied. Fresh soap emulsions (8%) were applied to the volar side of the right forearm of 30 individuals with sensitive skin for 5 consecutive days using aluminum chambers. The appearance of irritation (erythema, scaling and fissures) was recorded, scored, and expressed in an Irritation index (IrIn). The pH of each solution was measured. Results Products with a low IrIn were White Dove TM (Dove, Lever Pond's, Toronto, Ontario, Canada), Dove Baby TM , Cetaphil TM (bar) (Cetaphil, Gulderma Lab., Forth Worth, TX, USA), Dove liquid cleanser for hands TM , Dove pink TM , and Aderma TM (Adenma, Pierre Fabre, Dermo-Cosmetique, Boulagne, France). Most corresponded to syndet products. Among the most used brand-name soap, Camay Classic TM (Camay, Procter & Gamble de Mexico, México, U.F.) had the lowest IrIn. Dove Baby TM was the only product with a neutral pH. A significant correlation between pH and the IrIn of cleansers was found (P < 0.006). Conclusions Most products recommended for sensitive skin have a considerable irritation effect, which is related to the pH of the product. Better regulation of advertisement specifications including the pH level and type of cleanser contained is necessary for the majority of soaps and cleansers.

- by Dra. Bertha Torres Alvarez Slp
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- Dermatology, Adolescent, Medicine, Clinical Sciences

Background Different conservative and surgical approaches are used for periorbital region rejuvenation, but none of them is effective in the treatment of the medial third of the lower eyelid. Objective The present study is designed to assess the effectiveness of carboxytherapy in the treatment of wrinkles on the median and medial region of the lower eyelid and dark circles around the eyes. Methods and Materials From January 2008 to December 2010, 90 patients with moderate to severe periorbital wrinkles and/or dark circles underwent subcutaneous injections of CO 2 once a week for 7 weeks. Patients were assessed before and 2 months after the treatment through photographic documentation and the compilation of visual analog scales. Results At the end of the study period, patients reported a reduction of facial fine lines and wrinkles as well as a decrease in periorbital hyperpigmentation. A few side effects were observed but they were all transient and did not require discontinuation of treatment. Conclusion Carbon dioxide therapy results as an effective noninvasive modality for the rejuvenation of the periorbital area.

- by Nefer Fallico
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- Photography, Carbon Dioxide, Cosmetic Dermatology, Clinical Sciences

Hydroquinone is one of the most effective molecules for the treatment of hyperpigmentary disorders, with over 40 years of efficacy and safety data. Concerns over its safety have been raised because of the fact that it is a derivative of benzene and because of the long-term side-effects observed with cosmetic products containing high concentrations of hydroquinone. However, despite 40-50 years use of hydroquinone for medical conditions, there has not been a single documented case of either a cutaneous or internal malignancy associated with this drug. This article reviews the evidence for the safety of hydroquinone in the treatment of hyperpigmentation conditions.

- by Pearl Grimes
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- Safety, Antioxidants, Phytotherapy, Cosmetic Dermatology

Skin pigmentation results in part from the transfer of melanized melanosomes synthesized by melanocytes to neighboring keratinocytes. Plasma membrane lectins and their glycoconjugates expressed by these epidermal cells are critical molecules involved in this transfer process. In addition, the derivative of vitamin B 3 , niacinamide, can inhibit melanosome transfer and induce skin lightening. We investigated the effects of these molecules on the viability of melanocytes and keratinocytes and on the reversibility of melanosome-transfer inhibition induced by these agents using an in vitro melanocyte-keratinocyte coculture model system. While lectins and neoglycoproteins could induce apoptosis in a dose-dependent manner to melanocytes or keratinocytes in monoculture, similar dosages of the lectins, as opposed to neoglycoproteins, did not induce apoptosis to either cell type when treated in coculture. The dosages of lectins and niacinamide not affecting cell viability produced an inhibitory effect on melanosome transfer, when used either alone or together in cocultures of melanocytes-keratinocytes. Cocultures treated with lectins or niacinamide resumed normal melanosome transfer in 3 days after removal of the inhibitor, while cocultures treated with a combination of lectins and niacinamide demonstrated a lag in this recovery. Subsequently, we assessed the effect of niacinamide on facial hyperpigmented spots using a vehicle-controlled, split-faced design human clinical trial. Topical application of niacinamide resulted in a dose-dependent and reversible reduction in hyperpigmented lesions. These results suggest that lectins and niacinamide at concentrations that do not affect cell viability are reversible inhibitors of melanosome transfer.

- by Raymond Boissy and +1
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- Keratinocytes, Lectins, Clinical Sciences, Experimental
- by Quân Nguyễn
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- Dermatology, Cell Division, Acne Vulgaris, Skin

Dark circles under the eyes (DC) are defined as bilateral, round, homogeneous pigment macules on the infraorbital regions. Despite its significant prevalence, there are a few published studies about its pathogenesis. DC are caused by multiple etiologic factors that include dermal melanin deposition, postinflammatory hyperpigmentation secondary to atopic or allergic contact dermatitis, periorbital edema, superficial location of vasculature, and shadowing due to skin laxity. The purpose of this review is to discuss some of the available evidences about the anatomic features that could explain dark circles and the proposed treatments for this unpleasant condition.

- by Tânia Cestari
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- Face, Cosmetic Dermatology, Skin, Clinical Sciences
- by George Panagoulias
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- Depression, Treatment Outcome, Biopsy, Diarrhea

Photo-damaged skin of the chest is characterized by skin laxity, lines and wrinkles, hyperpigmentation, erythema, tactile roughness, atrophy, and telangiectasias. A Medline search was performed on rejuvenation of the chest from 1960 to 2010. Practical applications to these procedures are also provided. Chest-based reports of injectable poly-L-lactic acid (PLLA), botulinum toxin, sclerotherapy, and chemical peels, along with lasers and light therapies such as intense pulsed light (IPL), photodynamic therapy (PDT), nonablative fractionated lasers, and ablative fractionated lasers were identified. Review of the literature revealed that options for minimally invasive treatment options for rejuvenation of the skin of the chest include injectable PLLA, botulinum toxin, sclerotherapy, and chemical peels, along with lasers and light therapies such as IPL, PDT, and nonablative fractionated lasers. For more dramatic results, ablative fractional lasers can be safely used, although longer healing times and potential adverse effects are to be expected. Adverse events are often due to the thinness of the dermis and epidermis and the lower concentration of pilosebaceous units. If treatments are tailored to the skin of the chest, the incidence of adverse events is lower, and patients can be safely treated.

- by Mitchel Goldman
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- Thorax, Clinical Sciences, Atrophy, Rejuvenation

Many modalities of treatment for acquired skin hyperpigmentation are available including chemical agents or physical therapies, but none are completely satisfactory. Depigmenting compounds should act selectively on hyperactivated melanocytes, without short-or long-term side-effects, and induce a permanent removal of undesired pigment. Since 1961 hydroquinone, a tyrosinase inhibitor, has been introduced and its therapeutic efficacy demonstrated, and other whitening agents specifically acting on tyrosinase by different mechanisms have been proposed. Compounds with depigmenting activity are now numerous and the classification of molecules, based on their mechanism of action, has become difficult. Systematic studies to assess both the efficacy and the safety of such molecules are necessary. Moreover, the evidence that bleaching compounds are fairly ineffective on dermal accumulation of melanin has prompted investigations on the effectiveness of physical therapies, such as lasers. This review which describes the different approaches to obtain depigmentation, suggests a classification of whitening molecules on the basis of the mechanism by which they interfere with melanogenesis, and confirms the necessity to apply standardized protocols to evaluate depigmenting treatments.

- by Mauro Picardo
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- Melanin, Biological Sciences, Peroxidase, Classification

Background Hyperpigmentation and solar damage remains a difficult problem to treat with topical agents. Aims To evaluate a novel skin-lightening complex (SLC) comprising four actives targeting melanin formation at multiple levels, namely disodium glycerophosphate, L-leucine, phenylethyl resorcinol, and undecylenoyl phenylalanine, in an oil-in-water emulsion cream. Patients ⁄Methods Skin-lightening complex was evaluated in 80 female subjects of skin types I-III with at least moderate mottled hyperpigmentation. After a wash-out period of 1 month with a sunscreen, the subjects added a cream containing the SLC for 12 weeks twice daily to entire face and continued the sunscreen use.

- by Mitchel Goldman
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- Treatment Outcome, California, Cosmetic Dermatology, Follow-up studies
- by Sueli Carneiro
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- Biopsy, Aged, Hyperpigmentation

Laugier-Hunziker syndrome (LHS) is a rare disorder characterized by melanotic pigmentation of the mouth and lips which is frequently associated with longitudinal melanonychia. Laugier and Hunziker described lenticular melanotic pigmentation of the oral cavity and lips in 1970. 1 Some cases have been described in which the neck, thorax, abdomen, fingers and soles have been involved. Fingernails are more frequently involved than the toenails. 2 Melanonychia may also be seen with or after lichen planus (LP). 3,4 We report a case of LHS associated with actinic LP.

- by Semahat Alp erdal and +1
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- Differential Diagnosis, Clinical Sciences, Lichen Planus, Mouth Diseases

Just see to it to utilize the Kojic acid cream and also soap daily, and also if you typically go out imaginable, make sure to make use of some sun block cream for added security. This is to make sure that you could quickly see the... more

- by Ellen Anderson
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- Kojic Acid, Hyperpigmentation, Kojic

BACKGROUND. Advances in nonablative skin rejuvenation technologies have sparked a renewed interest in the cosmetic treatment of aging skin. More options exist now than ever before for reversing cutaneous changes caused by long-term exposure to sunlight. Although Caucasian skin is more prone to ultraviolet light injury, ethnic skin (typically classified as types IV to VI) also exhibits characteristic photoaging changes. Widespread belief that inevitable or irreversible textural changes or dyspigmentation occurs following laser-or light-based treatments has been challenged in recent years by new classes of devices capable of protecting the epidermis from injury during treatment. Demographic changes in the US population favor an increasing trend of older, ethnically diverse patients requesting treatment to recapture a youthful appearance.

- by Girish Munavalli and +1
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- Skin, Ethnic Groups, African Americans, Clinical Sciences

A 63-year-old man with aortic regurgitation and a 6.0-cm ascending aortic aneurysm was referred for surgical repair. He was known to have chronic pulmonary aspergillosis, for which he was receiving long-term minocycline therapy. His medical history included primary hyperaldosteronism and Parkinson disease. The auricles of both ears were stained with a black pigment .

- by Mary Sheppard
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- Cardiology, Pigmentation, Anesthesia, Clinical Sciences

Background Topical niacinamide and N-acetyl glucosamine (NAG) each individually inhibit epidermal pigmentation in cell culture. In small clinical studies, niacinamide-containing and NAG-containing formulations reduced the appearance of... more

- by Paul Matts and +1
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- Face, Treatment Outcome, Dermatology, Randomised Controlled Trial

1 Hajjeh RA, Conn LA, Stephens DS et al. Cryptococcosis in the United States: population-based multistate active surveillance and risk factors in HIV-infected persons. J Infect Dis 1999; 179 : 449 -454. 2 Gaddoni D, Resta F, Baldassari L et al. Criptococcosi cutanea in corso di AIDS. G Ital Dermatol Venereol 1993; 128 : 129 -132. 3 Vandersmissen G, Meuleman L, Tits G et al. Cutaneous cryptococcosis in corticosteroid-treated patients without AIDS. Acta Clin Belg 1996; 51 (2): 111 -117. 4 Nampoory MR, Khan ZU, Johny KV et al. Invasive fungal infections in renal transplant recipients. J Infect 1996; 33 (2): 95 -101. 5 Krcmery V Jr, Kunova A, Mardiak J. Nosocomial Cryptococcus laurentii fungemia in a bone marrow transplant patient after prophylaxis with ketoconazole successfully treated with oral fluconazole. Infection 1997; 25 (2): 130. 6 Bangert RL, Cho BR, Widders PR et al. A survey of aerobic bacteria and fungi in the feces of healthy psittacine birds. Avian Dis 1988; 32 : 46 -52. 7 Slavikova E, Vadkertiova R. Yeasts and yeast-like organisms isolated from fish-pond waters. Acta Microbiol Pol 1995; 44 (2): 181-189. 8 Bellosta M, Gaviglio MR, Mosconi M et al. Primary cutaneous cryptococcosis in an HIV-negative patient. Eur J Dermatol 1999; 9 (3): 224 -226. 9 Dimino-Emme L, Gurevitch AW. Cutaneous manifestations of disseminated cryptococcosis. J Am Acad Dermatol 1995; 32 (5, Part 2): 844 -850. 10 Kordossis T, Avlami A, Velegraki A et al. First report of Cryptococcus laurentii meningitis and a fatal case of Cryptococcus albidus cryptococcaemia in AIDS patients. Med Mycol 1998; 36 (5): 335 -339. 11 Johnson LB, Bradley SF, Kauffman CA. Fungaemia due to Cryptococcus laurentii and a review of non-neoformans cryptococcaemia. References 1 Carlson JA, Murphy M. Androgen receptors and lichen sclerosus (letter). J Am Acad Dermatol 2000; 43: 559. 2 Clifton M, Smoller B. Androgen receptors and lichen sclerosus (reply). J Am Acad Dermatol 2000; 43: 559. 3 Kohlberger PD, Joura EA, Bancher D, Gitsch G, Breitenecker G, Kieback DG. Evidence of androgen receptor expression in lichen sclerosus: an immunohistochemical study. J Soc Gynecol Invest 1998; 5: 331-333. 4 Powell JJ, Wojnarowska F. Lichen sclerosus. Lancet 1999; 353: 1777-1783. 5 Carlson JA, Ambros R, Malfetano J et al. Vulvar lichen sclerosus and squamous cell carcinoma: a cohort, case control, and investigational study with historical perspective; implications for chronic inflammation and sclerosis in the development of neoplasia. J Am Board Fam Pract 1999; 12: 473 -476. 6 Tidy JA, Soutter WP, Luesley DM, MacLean AB, Buckley CH, Ridley CM. Management of lichen sclerosus and intraepithelial neoplasia of the vulva in the UK.

- by Attila Dobozy
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- Melanoma, Psoriasis, Calcitriol, Clinical Sciences

BACKGROUND Many clinicians have used glycolic acid (GA) peels for facial acne, scarring, and hyperpigmentation, mainly in lighter skin types. Salicylic-mandelic acid combination peels (SMPs) are a newer modality, and there have been no... more

- by Vijay Garg
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- Adolescent, Comparative Study, Young Adult, Acne Vulgaris

Chediak-Higashi syndrome is a rare autosomal recessive disorder due to a qualitative defect in leucocyte function characterized clinically by partial oculocutaneous albinism, recurrent bacterial infections, photophobia etc. The diagnostic... more

- by Kiran Agarwal
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- Face, Treatment Outcome, Neutrophils, Anti-Bacterial Agents

A 70-year-old white housewife presented with a rare presentation of coexistent generalized morphea and lichen sclerosus et atrophicus with unusual clinical aspects. The patient had disseminated erythematous lesions that evolved into indurated large plaques. Hypopigmentation and hyperpigmentation developed later, in addition to ivory, white, and shiny plaques on the trunk (Figure 1). The skin of the arms and legs showed a wavy contour (Figure 2). Various areas were markedly sclerotic and some had edematous papules (Figure 3). Multiple indurated, ivory, white, shiny, large, and hypochromic plaques were seen on the trunk Laboratory examinations showed increased immunoglobulin A and antinuclear antibodies 1:200 speckled. Scl-70, anti-centromere, anti-ribonucleoprotein, and anti-DNA tests were negative. Esophageal manometry and abdominal and pelvic ultrasound findings were all normal. Complete blood cell count, blood profile, and urinalysis were also within normal limits. Skin biopsy of ...

- by Sueli Carneiro and +1
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- Biopsy, Aged, Hyperpigmentation

Albright hereditary osteodystrophy with pseudohypoparathyroidism is due to maternal loss-of-function mutations in the GNAS gene. Its typical clinical features encompass obesity, a round face and a short neck, osteoma of the skin, endocrinological abnormalities, and psychomotoric retardation. Here we present a 10-month-old Tunisian boy with a classical course of this rare disease.

- by Ulrike Blume-peytavi and +1
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- Infant, Skin, Hyperpigmentation, Pediatric dermatology

Background. Over 6 million people live in areas of West Bengal, India, where groundwater sources are contaminated with naturally occurring arsenic. The key objective of this nested case-control study was to characterize the dose-response relation between low arsenic concentrations in drinking water and arsenic-induced skin keratoses and hyperpigmentation. Methods. We selected cases (persons with arsenic-induced skin lesions) and age-and sex-matched controls from participants in a 1995-1996 cross-sectional survey in West Bengal. We used a detailed assessment of arsenic exposure that covered at least 20 years. Participants were reexamined between 1998 and 2000. Consensus agreement by four physicians reviewing the skin lesion photographs confirmed the diagnosis in 87% of cases clinically diagnosed in the field. Results. The average peak arsenic concentration in drinking water was 325 g/liter for cases and 180 g/liter for controls. The average latency for skin lesions was 23 years from first exposure. We found strong dose-response gradients with both peak and average arsenic water concentrations. Conclusions. The lowest peak arsenic ingested by a confirmed case was 115 g/liter. Confirmation of case diagnosis and intensive longitudinal exposure assessment provide the basis for a detailed dose-response evaluation of arsenic-caused skin lesions. (EPIDEMIOLOGY 2003;14:174 -182)

- by Soma Mitra
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- Statistics, Epidemiology, Arsenic, Adolescent

Background The use and misuse of skin-lightening products among women living in Arab communities have not been documented previously. This study investigates the determinants, the prevalence and users awareness associated with the use and... more

- by Reema Tayyem
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- Epidemiology, Culture, Dermatology, Jordan

Tetracyclines (TCN) were introduced in 1948 as broad-spectrum antibiotics that may be used in the treatment of many common infections in children and adults. One of the side-effects of tetracyclines is incorporation into tissues that are... more

- by Andres Sanchez
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- Dermatology, Toxicity, Teeth, Tooth Discoloration

Exogenous ochronosis is a cutaneous disorder characterized by blue-black or slate-gray hyperpigmentation resulting from the prolonged use of certain topical agents, most commonly hydroquinones. It is notoriously difficult to treat. To report the effectiveness of a quality-switched (QS) 755-nm alexandrite laser in treating hydroquinone-induced exogenous ochronosis. Hydroquinone-induced exogenous ochronosis in two patients was treated with a QS alexandrite laser. The first patient received six treatments (average fluence=7.8 J/cm(2)) at 2-month intervals. The second patient received four treatments (average fluence=6.9 J/cm(2)) at 4-month intervals. Biopsies of lesional skin were obtained before and after laser treatment for histologic evaluation. Significant lightening of the pigmented skin areas was achieved in both patients without scarring or textural changes. Decreased dermal pigmentation was observed on histologic examination of treated skin specimens. The QS alexandrite laser can effectively treat exogenous ochronosis without untoward side effects.

- by Tina Alster
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- Minerals, Face, Treatment Outcome, Clinical Sciences

Tyrosine kinase inhibitors (TKIs) are targeted treatments for various cancers. Skin toxicities are one of the most common nonhematological side-effects of TKIs. We report an imatinib mesylate (IM) induced hyperpigmented acne rosacea (AR) and sunitinib-induced palmar hyperkeratosis in the case with gastrointestinal stromal tumor. AR was arisen due to the discontinuation of IM. To the best of our knowledge, this kind of cutaneous side-effect with IM has not been documented previously.

- by Suleyman Buyukberber
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- Oncology, Treatment Outcome, Biopsy, Rosacea

- by Dra. Bertha Torres Alvarez Slp
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- Dermatology, Adolescent, Medicine, Clinical Sciences

A 66-year-old man with a past medical history of hypertension and arthritis was hospitalized and treated for bacterial pneumonia. Chest X-ray revealed a left-sided chest mass. Computed tomography (CT) scan of the chest demonstrated a large heterogeneously enhancing mass occupying most of the left lower lobe and extending to the inferior aspect of the hilum. It measured 16.6 × 12 cm and caused a mild shift of the mediastinum to the right. The patient declined further work-up or surgical resection of the mass. Dermatologic examination was unremarkable at that time.

- by Allen Sapadin
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- Dermatology, Blood Glucose, Hypoglycemia, Follow-up studies

Background and Objectives: Spider leg veins are telangiectasias located intracutaneously. This condition poses a cosmetic problem. Study Design/Patients and Methods: The purpose of this study was to determine what influence the KTP (532 nm) laser has on spider leg veins dependent on the vascular diameter and to what extent the skin has been affected. Seventy female patients were treated in three laser sessions. Analysis was done 30 weeks after the last laser treatment session. Results: Fifty-six patients completed the study. In group 1 (vascular diameter 0.6 mm), spider leg veins were no longer visible in 33%; in 40%, a decrease in vascular diameter could be observed; in 27%, no change in size occurred. In group 2 (vascular diameter 0.7-1.0 mm), laser-treated spider leg veins were visible in all patients. Hyperpigmentation occurred in 13 patients. Conclusions: The KTP (532 nm) laser is an effective for treating spider leg veins having a vascular diameter under 0.7 mm.

- by Andrea Berghold
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- Treatment Outcome, Adolescent, Prospective studies, Low Level Laser Therapy

Case Report A 55-year-old man developed an itchy, erythematous oedematous well-defined plaque 12 h after the application of an electrosurgical earthing plate on the left thigh. He was self-employed and worked as a windscreen repair mechanic. He was right handed and had a chronic dermatitis involving the right-thumb pulp and index finger. His work involved the use of acrylic resins to repair cracks in windscreens, although he protected his hands with latex gloves. Patch tests were performed to an extended European standard series, a (meth)acrylates series (Chemotechnique), his windscreen resin and the electrosurgical earthing plate (Niko). The reactions are shown in Table 1 and include several (meth)acrylates. There was a positive reaction to the patient's windscreen resin, suggesting that this exposure led to sensitization. (Meth)acrylates are present in the adhesive that attaches the electrosurgical earthing plate to the skin, which accounts for the acute allergic contact dermatitis that our patient developed at this site.

- by Domenico Bonamonte
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- Immunology, NUTS, Naphthoquinones, Clinical Sciences

Background Evidence suggests that periorbital hyperchromia (dark circles) occurs mainly as a consequence of postinflammatory hemodynamic congestion producing a typical bruising aspect on the lower eyelids. Aims To evaluate the clinical effects of Pfaffia paniculata ⁄ Ptychopetalum olacoides B. ⁄ Lilium candidum L.-associated compound (PPLAC) on periorbital hyperchromia and to study in vitro its underlying anti-inflammatory and antioxidant mechanisms. Methods Twenty-one volunteers presenting with periorbital hyperchromia received a serum sample containing 5.0% PPLAC, which was applied topically in the periorbital area twice a day for 28 days. Skin color was measured using variations in the individual typological angle (DITA 0 ) and skin luminance (DL*) calculated in the area around the eyes and in the adjacent area. Colorimetric readings were taken at the onset and end of the 28-day treatment. Volunteers were also asked to fill out a questionnaire concerning the improvement in ''dark circles.'' The anti-inflammatory and antioxidant effects of PPLAC were measured by quantification of prostaglandin E 2 , leukotriene B 4 , histamine, and superoxide dismutase levels using an in vitro model of human skin culture. Results Topical application of PPLAC led to a significant improvement in skin luminance and tone in the periorbital area, which was demonstrated by increased values of ITA 0 and L* in about 90% of volunteers. In addition, subjects reported reduced intensity and improved appearance of ''dark circles.'' A dose-dependent decreased production of inflammatory mediators, concomitant to increased antioxidant enzyme levels, was observed in our in vitro studies, under basal and lipopolysaccharide-stimulated conditions. Conclusions Although the precise mechanisms related to PPLAC remain to be clarified, our results indicate that the reduction in the inflammatory process as well as the antioxidant protection against deleterious elements may be considered as an integral approach to preserve the integrity of vascular endothelium, preventing the hemodynamic congestion that culminates in the formation of ''dark circles'' around the eyes.

- by Maria Pereda
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- Brazil, Treatment Outcome, Cosmetic, Antioxidants

The rash persisted, with a waxing and waning course. The patient normally had > 100 lesions at a time, with each lesion lasting for 1-3 months, in keeping with the typical nature of LP of sudden appearance and spontaneous regression. Most of these lesions healed with varioliform scars. The lesions did not show any signs of malignant evolution; none were > 30 mm in diameter, all regressed spontaneously and there was no associated lymphadenopathy.

- by Müge Ozden
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- Biopsy, Epidermis, Clinical Sciences, Aged

A 14-year-old boy had a history of asymptomatic, unilateral brown streaks of 5 years' duration on the left side of the trunk and left upper limb. No prior inflammation or any preceding eruption was observed. The streaks extended in distribution during the first few months but then stabilized. His medical and family history was unremarkable.

- by E. Obreshkova
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- Dermatology, Adolescent, Skin, Clinical Sciences

Solitary cafe´-au-lait spots are quite common in the general population but multiple cafe´-au-lait macules (CALM) are often indicative of an underlying genetic disorder. The frequency of having more than five CALM is rare in normal individuals and is therefore considered as a cut-off for the diagnosis of neurofibromatosis type 1 (NF1). The etiopathogenesis of these macules is still very obscure. In this study we compared epidermal melanocyte and dermal mast cell numbers between four groups: control normal and control CALM skin, and NF1 normal and NF1 CALM skin and elaborated a possible role for stem cell factor (SCF) in CALM formation. The groups were analyzed by immunohistochemistry for numerical analysis of the melanocyte and mast cell population and by ELISA, western blot analysis and real-time quantitative PCR for further determination of the role of SCF. We found a significant increase in melanocyte density in NF1 CALM skin compared with the isolated CALM in control individuals. However, both groups displayed a similar increase in mast cell density. In addition, we found increased levels of soluble SCF in NF1 CALM and in NF1 normal fibroblast supernatant. We conclude that SCF is an important cytokine in NF1 skin, but that additional (growth) factors and/or genetic mechanisms are needed to induce NF1-specific CALM hyperpigmentation.

- by Ludwine Messiaen
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- Genetics, Archives, Numerical Analysis, Immunohistochemistry
- by Corrado Romano
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- Dermatology, Adolescent, Child, Young Adult

Drug-induced hair colour and texture changes have been reported rarely. We describe a 70-year-old woman with psoriasis who noticed darkening of her previously white hair, which also gained a curly appearance after 6 months of acitretin treatment. We present this case to emphasize that acitretin can be added to the list of drugs that induce changes in hair colour and texture.

- by ayfer yıldız
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- Treatment, Dermatology, Hair, Follow-up studies

Background: Ablative laser resurfacing is considered to be the main therapeutic option for the treatment of wrinkles and acne scarring. However, in Asians, postinflammatory hyperpigmentation (PIH) is a common adverse effect of laser resurfacing. Fractional resurfacing is a new concept of skin rejuvenation whereby zones of micro thermal injury are generated in the skin with the use of a 1,540-nm laser. The risk and prevalence of hyperpigmentation in dark-skinned patients using this approach have not been studied. Objective: To assess the prevalence and risk factors of PIH that is associated with the use of fractional resurfacing in Asians. Method: A retrospective study of 37 Chinese patients who were treated with fractional resurfacing for acne scarring, skin rejuvenation, and pigmentation was carried out. In all of the cases, pre-and post-treatment clinical photographs (from standardized and cross-polarized views) were taken using the Canfield CR system. Two independent observers assessed the photographs. A prospective study of treatments of nine different density and energy levels that were applied to the forearms of 18 volunteers was also performed. Clinical photographs were assessed pre-and post-treatment for evidence of PIH. Result: In the retrospective study, 119 treatment sessions were performed. Sixty-eight treatment sessions were high energy, low density; 51 sessions were low energy, high density. Patients who underwent a high energy but lowdensity treatment (range of energy 7-20 mJ; average energy 16.3 mJ, 1,000 MTZ) were associated with a lower prevalence of generalized PIH (7.1% vs. 12.4%) than those who underwent a low energy but high-density (range of energy 6-12 mJ; average energy 8.2 mJ, 2,000 MTZ) treatment. However, the difference was not statistically significant. Localized PIH occurred in the peri-oral area among patients who did not receive air cooling as an adjunctive therapy. Conclusion: Both the density and energy of the treatment determines the risk of PIH in dark-skinned patients. Density may be of more important but further studies are necessary to determine this. Cooling to prevent bulk tissue heating is also important, especially in small anatomical areas. By using adequate parameters, the risk of PIH in dark-skinned patients can be significantly reduced. Lasers Surg. Med. 39:381-385, 2007. ß 2007

- by Dietmar Manstein
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- Phototherapy, Cryotherapy, Prospective studies, Acne Vulgaris

- by Sema Aytekin
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- Differential Diagnosis, Clinical Sciences, Lichen Planus, Mouth Diseases

Bazex syndrome is a paraneoplastic dermatosis characterized by acral psoriasiform lesions associated with an underlying neoplasm. We present the case of a 64-year-old patient that was diagnosed with squamous cell lung carcinoma after being evaluated for lesions compatible with paraneoplastic acrokeratosis. With a high frequency Bazex syndrome is the earliest marker of an underlying subclinical neoplasm. An early suspicion is of the outmost importance in order to perform a prompt diagnosis of an underlying malignancy. We propose a diagnostic algorithm upon suspicion of acrokeratosis paraneoplastica and review the pathogenesis of this entity.

- by alireza taheri
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- Gastroenterology, Face, Dermatology, Fluconazole