1
|
Kutlubay Z, Cesur SK, Aşkın Ö, Tüzün Y. The color of skin: brown diseases of the skin, nails, and mucosa. Clin Dermatol 2020; 37:487-506. [PMID: 31896404 DOI: 10.1016/j.clindermatol.2019.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Brown diseases comprise disorders leading to hyperpigmentation in skin and nails. Melasma is an acquired skin disorder that is characterized by brownish macules that typically occur on the face. Schamberg disease, also known as progressive pigmented purpura, is characterized by brown pigmentation with pepper spots on their edges. We summarize the epidemiology, pathogenesis, histologic features, and treatment choices for additional brown diseases, including melasma, pigmented purpuric dermatoses, postinflammatory hyperpigmentation, drug-induced hyperpigmentation, and pigmentations due to systemic or physiologic conditions.
Collapse
Affiliation(s)
- Zekayi Kutlubay
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
| | | | - Özge Aşkın
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Yalçın Tüzün
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| |
Collapse
|
2
|
Abstract
Aging skin is subject to morphological change due to both intrinsic (skin tone, genetics, endogenous hormones) and extrinsic (chronic sun exposure, medications, exogenous pigments) factors. The broad spectrum of transformation includes both hypo- and hyperpigmentation. Although cutaneous pigmentary disorders are common in younger individuals, certain disorders are more prevalent in the geriatric population. This article reviews the epidemiology, pathophysiology, clinical appearance, treatment, and prognosis of pigmentary lesions that are predominant in the elderly.
Collapse
|
3
|
Vashi NA, Wirya SA, Inyang M, Kundu RV. Facial Hyperpigmentation in Skin of Color: Special Considerations and Treatment. Am J Clin Dermatol 2017; 18:215-230. [PMID: 27943085 DOI: 10.1007/s40257-016-0239-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Differences in cutaneous diseases in people of color call for nuanced evaluation and management. One of the most common dermatological complaints from patients with skin of color is dyspigmentation, particularly hyperpigmentation. The challenge for clinicians is to establish correct diagnoses along with consistently successful treatments to meet the needs of the increasingly diverse population served. This review focuses on facial hyperpigmentation and outlines the most common skin disorders and treatment options.
Collapse
Affiliation(s)
- Neelam A Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - Stephen A Wirya
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - Meyene Inyang
- Howard University College of Medicine, Washington, DC, USA
| | - Roopal V Kundu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 1600, Chicago, IL, 60611, USA.
| |
Collapse
|
4
|
Khunkhet S, Wattanakrai P. The possible role of contact sensitization to fragrances and preservatives in poikiloderma of civatte. Case Rep Dermatol 2014; 6:258-63. [PMID: 25520647 PMCID: PMC4264491 DOI: 10.1159/000369489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Numerous mechanisms have been postulated to play an important role in the pathogenesis of poikiloderma of Civatte (PC), including chronic exposure to ultraviolet radiation, menopause-related hormonal changes, contact hypersensitivity and genetic predisposition. Herein, we report a case of contact sensitization to fragrances and commonly used preservatives, methylchloroisothiazolinone and methylisothiazolinone, also widely known as Kathon CG, in a post-menopausal woman with PC, who denied excessive sun exposure and a family history. After abstaining from the use of her personal care products containing the documented allergens, not only the itching and burning symptoms, but also the cutaneous changes appeared to improve partially. This report underlines the possible influence of contact hypersensitivity in the pathogenesis of PC.
Collapse
Affiliation(s)
- Saranya Khunkhet
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Penpun Wattanakrai
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
5
|
Cestari TF, Dantas LP, Boza JC. Acquired hyperpigmentations. An Bras Dermatol 2014; 89:11-25. [PMID: 24626644 PMCID: PMC3938350 DOI: 10.1590/abd1806-4841.20142353] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 03/25/2013] [Indexed: 01/15/2023] Open
Abstract
Cutaneous hyperpigmentations are frequent complaints, motivating around 8.5% of all
dermatological consultations in our country. They can be congenital, with different
patterns of inheritance, or acquired in consequence of skin problems, systemic
diseases or secondary to environmental factors. The vast majority of them are linked
to alterations on the pigment melanin, induced by different mechanisms. This review
will focus on the major acquired hyperpigmentations associated with increased
melanin, reviewing their mechanisms of action and possible preventive measures.
Particularly prominent aspects of diagnosis and therapy will be emphasized, with
focus on melasma, post-inflammatory hyperpigmentation, periorbital pigmentation,
dermatosis papulosa nigra, phytophotodermatoses, flagellate dermatosis, erythema
dyschromicum perstans, cervical poikiloderma (Poikiloderma of Civatte), acanthosis
nigricans, cutaneous amyloidosis and reticulated confluent dermatitis
Collapse
Affiliation(s)
- Tania Ferreira Cestari
- Rio Grande do Sul Federal University, Internal Medicine Department, Porto Alegre(RS), Brazil, PhD - Associate Professor at the Internal Medicine Department, at Rio Grande do Sul Federal University (UFRGS). Teaching Professor at the Child and Adolescent Health Sciences and the Surgical Post-Graduation Programs at Rio Grande do Sul Federal University (UFRGS). Chief of the Dermatology Department at Porto Alegre Clinics Hospital - Rio Grande do Sul Federal University (HCPA-UFRGS) - Porto Alegre (RS), Brazil
| | - Lia Pinheiro Dantas
- Rio Grande do Sul Federal University, Medical Sciences Post Graduation program, Porto AlegreRS, Brazil, MD, Dermatologist, MSc (in course) at the Medical Sciences Post Graduation program at Rio Grande do Sul Federal University (UFRGS) - Porto Alegre (RS), Brazil
| | - Juliana Catucci Boza
- Rio Grande do Sul Federal University, Child and Adolescent Health Sciences Post Graduation Program, Porto AlegreRS, Brazil, MD, Dermatologist, PhD (in course) at the Child and Adolescent Health Sciences Post Graduation Program at Rio Grande do Sul Federal University (UFRGS) - Porto Alegre (RS), Brazil
| |
Collapse
|
6
|
Abstract
Pigmentation disorders include a large number of heterogeneous conditions that are usually characterized by altered melanocyte density, melanin concentration, or both, and result in altered pigmentation of the skin. Some of these disorders are extremely common (melasma, vitiligo), whereas others are rare. In this contribution, we review the most common pigmentation disorders that appear on the face. These lesions, even though mostly asymptomatic, have a great impact on a patient's quality of life.
Collapse
Affiliation(s)
- Electra Nicolaidou
- 1st Department of Dermatology, University of Athens School of Medicine, "Andreas Sygros" Hospital, 5 I. Dragoumi str, GR-16121, Athens, Greece
| | | |
Collapse
|
7
|
Katoulis A, Makris M, Gregoriou S, Rallis E, Kanelleas A, Stavrianeas N, Rigopoulos D. Poikilodermatous changes on the forearms of a woman practicing aroma-therapy: extracervical poikiloderma of Civatte? An Bras Dermatol 2014; 89:655-6. [PMID: 25054757 PMCID: PMC4148284 DOI: 10.1590/abd1806-4841.20142925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 09/11/2013] [Indexed: 11/22/2022] Open
Abstract
We report the case of a 48-year-old, Caucasian female who presented with slowly
progressing asymptomatic poikilodermatous changes of the extensor aspects of the
forearms. She also had typical Poikiloderma of Civatte on the V of the neck and
erythemato-telangiectatic rosacea of the central face. The patient had been
practicing aroma-therapy for many years. Histologic examination revealed
findings consistent with PC. Patch-testing revealed positive reactions to
Fragrance mix and Nickel sulphate. Based on clinical and histological findings,
a diagnosis of extracervical PC was suggested. PC with extra-cervical or
extra-facial involvement is rare. In addition, this case supports the theory
that contact sensitization to fragrances may contribute to the development of
PC.
Collapse
Affiliation(s)
- Alexandros Katoulis
- "Attikon" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michalis Makris
- "Attikon" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatis Gregoriou
- "Attikon" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eustathios Rallis
- "Attikon" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Kanelleas
- "Attikon" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicolaos Stavrianeas
- "Attikon" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Rigopoulos
- "Attikon" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
8
|
Nofal A, Salah E. Acquired poikiloderma: Proposed classification and diagnostic approach. J Am Acad Dermatol 2013; 69:e129-40. [DOI: 10.1016/j.jaad.2012.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 05/25/2012] [Accepted: 06/11/2012] [Indexed: 02/08/2023]
|
9
|
A persistent discoloration of the neck sparing the submental area. JAAPA 2013; 26:17-8. [DOI: 10.1097/01.jaa.0000432577.75054.2b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
RUSCIANI ANTONIO, MOTTA ANGELA, FINO PASQUALE, MENICHINI GIULIO. Treatment of Poikiloderma of Civatte Using Intense Pulsed Light Source: 7 Years of Experience. Dermatol Surg 2008; 34:314-9; discussion 319. [DOI: 10.1111/j.1524-4725.2007.34064.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
Treatment of Poikiloderma of Civatte Using Intense Pulsed Light Source. Dermatol Surg 2008. [DOI: 10.1097/00042728-200803000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Abstract
The Mediterranean area represents the area of land that borders the Mediterranean basin. It is composed of several countries that share many geographic and racial characteristics. Although Mediterraneans seem to share common skin type and are subjected to similar enviromental factors, they still represent a genetic and socioeconomic diversity. True prevalence of pigmentary disorders in this area depends on large epidemiologic studies, including countries that are not available. This article, however, highlights and classifies the most important developmental (heritable-genetic) and acquired pigmentary disorders seen and reported in this important area of the world.
Collapse
Affiliation(s)
- Medhat A El-Mofty
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | | | | |
Collapse
|
13
|
Nicolaidou E, Antoniou C, Katsambas AD. Origin, Clinical Presentation, and Diagnosis of Facial Hypermelanoses. Dermatol Clin 2007; 25:321-6, viii. [PMID: 17662897 DOI: 10.1016/j.det.2007.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Facial hypermelanosis is a clinical feature of a diverse group of disorders, the most common of which is melasma. Exposure to sunlight, genetic predisposition, the use of cosmetics, and certain drugs are implicated in the pathogenesis of most facial hypermelanoses. A detailed personal and family history and the histopathologic findings are, in most cases, enough for establishing the correct diagnosis. Systemic disorders such as Addison's disease should always be suspected and excluded in clinically relevant cases.
Collapse
Affiliation(s)
- Electra Nicolaidou
- 1st Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital, 5 I. Dragoumi Street, GR-16121 Athens, Greece
| | | | | |
Collapse
|
14
|
Photoallergic Contact Sensitization to 6-Methylcoumarin in Poikiloderma of Civatte. Dermatitis 2005. [DOI: 10.1097/01206501-200509000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Katoulis AC, Stavrianeas NG, Georgala S, Bozi E, Kalogeromitros D, Koumantaki E, Katsambas AD. Poikiloderma of Civatte: a clinical and epidemiological study. J Eur Acad Dermatol Venereol 2005; 19:444-8. [PMID: 15987290 DOI: 10.1111/j.1468-3083.2005.01213.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although a common dermatosis, idiopathic poikiloderma of the face and neck has not been studied in depth for decades. OBJECTIVES To reassess the clinical and epidemiological characteristics of poikiloderma of Civatte (PC). MATERIAL AND METHODS Fifty consecutive patients with PC. Evaluation included history taking and physical examination. Epidemiological and clinical parameters were recorded and analysed. The literature from 1923 until today, was reviewed thoroughly. RESULTS The frequency of PC among dermatologic patients was estimated to be 1.4%. There were 34 females (68%) and 16 males in the present study. The mean age at diagnosis was 47.8 years for females and 61.7 years for males. The majority (88%) had skin phototype II or III. Among females, 26 were at their peri-menopausal stage, including three cases of iatrogenic menopause. Four patients reported that other blood-related family members also had PC. The v and the sides of the neck and the upper chest were most often affected in a symmetric distribution. The face (preauricular and parotid region) was involved in 19 patients (38%). The erythemato-telangiectatic clinical type predominated (58%), followed by the mixed (22%) and the pigmented type (20%). Almost half of the patients (46%) were symptomatic (itching, burning and 'flushing'). The mean duration from onset to diagnosis was 6.2 years according to the patients' report. The course was usually slowly progressive (82%) and irreversible. CONCLUSIONS PC shows characteristic features, supporting the theory that it represents a distinct entity. It is rather common in Greece. Although menopausal women predominated in our cohort, men were not uncommonly affected and were diagnosed at an older age. Based on the predominating clinical feature, PC can be classified into three clinical forms. Symmetry and sparing of the anatomically shaded areas of the neck are highly characteristic for PC. Face involvement was not as common and as severe as it had been considered in the past. Recognition of clinical type is important for the selection of the most appropriate treatment, which, despite the advent of novel modalities, remains problematic.
Collapse
Affiliation(s)
- A C Katoulis
- National Kapodistrian University of Athens, 2nd Department of Dermatology and Venereology, Attikon Hospital.
| | | | | | | | | | | | | |
Collapse
|
16
|
Katoulis AC, Stavrianeas NG, Katsarou A, Antoniou C, Georgala S, Rigopoulos D, Koumantaki E, Avgerinou G, Katsambas AD. Evaluation of the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte. Br J Dermatol 2002; 147:493-7. [PMID: 12207589 DOI: 10.1046/j.1365-2133.2002.04993.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Poikiloderma of the face and neck (Civatte) is a rather common, indolent, chronic dermatosis, most often affecting menopausal females. Cumulative excessive sun exposure, a phototoxic or a photoallergic reaction, hormonal changes of menopause and genetic factors have all been incriminated in its obscure aetiopathogenesis. OBJECTIVE To evaluate the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte (PC). METHODS Thirty-two patients (24 females and eight males, age range 38-74 years) with PC were patch tested with the European standard series and the fragrance series, and were photopatch tested with the photoallergens series. Additionally, photo-testing with a monochromator was performed. RESULTS Thirteen of 32 patients (40.62%) had one or more positive reactions to allergens of the standard series. Eight patients (25%) had positive reactions to fragrance mix and/or Balsam of Peru, which are included in the standard series, or to allergens of the fragrance series. Nickel sulphate was the single most common cause of contact sensitization (18.75%) among our patients. Ninety-seven subjects, who were patch tested with the standard series for suspected allergic contact dermatitis of the face and/or neck, served as age, sex and site controls. Of these, nine (9.27%) had one or more positive reactions to fragrance compounds. Statistical analysis showed a statistically significant difference in the frequency of positive reactions to fragrances between the PC group and the control group (chi2 value = 3.91, P < 0.05). In contrast, none of the PC patients had a positive photopatch test for the allergens included in the photoallergens series. The estimated minimal erythemal dose for the PC group was in all cases within normal limits for all wavelengths of ultraviolet (UV) radiation examined. CONCLUSIONS Contact sensitization, mostly to perfume ingredients, may develop in PC, possibly playing a pathogenetic part, at least in a subset of patients. Despite negative results of photopatch testing, an allergic photo-contact reaction cannot be definitely excluded. PC seems not to be a photosensitivity disorder of the type of chronic actinic dermatitis. UV radiation-induced dermal connective tissue changes are the predominant histological feature of PC, leading to telangiectasia due to loss of vascular support. Reticular pigmentation may result from a delayed hypersensitivity reaction to perfume and/or cosmetic ingredients. Patch testing with the standard series and avoidance of documented allergens may be of value in patients with PC.
Collapse
Affiliation(s)
- A C Katoulis
- National and Kapodistrian University of Athens, Department of Dermatology and Venereology, 'A. Sygros' Hospital, Athens, Greece
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Goldman MP, Weiss RA. Treatment of poikiloderma of Civatte on the neck with an intense pulsed light source. Plast Reconstr Surg 2001; 107:1376-81. [PMID: 11335804 DOI: 10.1097/00006534-200105000-00009] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Effective treatment of poikiloderma of Civatte is difficult. The ideal treatment combines elimination of both the vascular and pigmented components simultaneously. Treatment with a broad-spectrum noncoherent intense pulsed light source delivers multiple wavelengths with software-controlled pulse durations and sequencing that permit treatment of both vascular and pigmented lesions simultaneously. The objective of this study was to determine the response and side effects of treating this condition with intense pulsed light. In the study, 66 patients with typical changes of poikiloderma of Civatte on the neck were treated with intense pulsed light at various settings every 4 weeks until the desired improvement occurred. A 50 to 75 percent improvement in the extent of telangiectasias and hyperpigmentation was observed after an average of 2.8 treatments. The incidence of hypopigmentation was 5 percent. It was concluded that intense pulsed light is an effective mode of therapy for poikiloderma of Civatte. It seems to offer a reduction in both pigmentation and telangiectasia-associated erythema, with minimal side effects.
Collapse
Affiliation(s)
- M P Goldman
- Division of Dermatology, Department of Medicine/Dermatology, University of California, San Diego, USA.
| | | |
Collapse
|
18
|
Sahoo B, Kumar B. Rôle of methylchloroisothiazolinone/methylisothiazolinone (Kathon CG) in poikiloderma of Civatte. Contact Dermatitis 2001; 44:249. [PMID: 11336003 DOI: 10.1034/j.1600-0536.2001.440409-4.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- B Sahoo
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | |
Collapse
|
19
|
Weiss RA, Goldman MP, Weiss MA. Treatment of poikiloderma of Civatte with an intense pulsed light source. Dermatol Surg 2000; 26:823-7; discussion 828. [PMID: 10971554 DOI: 10.1046/j.1524-4725.2000.00060.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Effective treatment of poikiloderma of Civatte combines elimination of both the vascular and pigmented components simultaneously. A broad spectrum, noncoherent, intense pulsed light (IPL) source delivers multiple wavelengths with software controlled pulse durations and sequencing, which permits treatment of both vascular and pigmented lesions simultaneously. OBJECTIVE To determine response and side effects of poikiloderma of Civatte of the neck and chest when treated by IPL. METHODS One hundred and thirty-five patients randomly selected with typical changes of poikiloderma of Civatte on the neck and/or upper chest were treated with one to five treatments using IPL. RESULTS Clearance of more than 75% of telangiectasias and hyperpigmentation comprising poikiloderma was observed. The incidence of side effects was 5%, including pigment changes. In many cases, improved skin texture was noted both by physician and patient. CONCLUSION IPL is an effective mode of therapy for poikiloderma of Civatte. It offers a reduction of pigment and telangiectasias with a low risk profile. Additional benefits include subjective changes of improvement in skin texture.
Collapse
Affiliation(s)
- R A Weiss
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | | | | |
Collapse
|