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Tobaigy MF, AlBloushi AF, Al-Dhibi HA. Reversal of Peripheral Iris Depigmentation Associated with Vogt-Koyanagi-Harada Disease. Ocul Immunol Inflamm 2024; 32:424-428. [PMID: 36657743 DOI: 10.1080/09273948.2022.2161917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To describe the reversal of peripheral iris depigmentation associated with Vogt-Koyanagi-Harada (VKH) disease. METHODS A retrospective report of two cases. RESULTS Both patients were diagnosed with a chronic recurrent VKH disease and developed bilateral peripheral iris depigmentation (BPID). The first patient is an 8-year-old girl who was treated with systemic corticosteroids, methotrexate and adjuvant rituximab infusions that induced complete remission of uveitis and reversal of peripheral iris depigmentation at the last follow-up. The second was a 6-year-old who was treated with topical and systemic corticosteroids and oral methotrexate that induced complete remission of uveitis and reversal of peripheral iris depigmentation at the last follow-up. CONCLUSIONS Adequate control of uveitis associated with chronic recurrent VKH disease with appropriate immunomodulatory agents and perhaps adjuvant rituximab can reverse BPID and improve the outcomes.
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Affiliation(s)
- Mohannad F Tobaigy
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabai
| | - Abdulrahman F AlBloushi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabai
| | - Hassan A Al-Dhibi
- Vitreoretinal & Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Medical Education Department, Alfaisal University, Riyadh, Saudi Arabia
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2
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Fernandez JK, Guo EL, Richmond H, Friedman PM. The 730 nm picosecond titanium sapphire laser for treatment of café-au-lait macules in all skin types. Lasers Surg Med 2024; 56:257-262. [PMID: 38414118 DOI: 10.1002/lsm.23769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES Café-au-lait macules (CALM) are benign birthmarks presenting as uniformly pigmented, well demarcated, brown patches that can be distressing to patients, especially when located in cosmetically sensitive areas. As with all pigmentary lesions in skin of color patients, CALMs have been particularly challenging to treat. Here we present the first case series characterizing treatment parameters and clinical outcomes utilizing the 730-nm picosecond titanium sapphire laser for the treatment of CALMs. This device provides an additional safe and effective treatment option for these challenging cases. METHODS We performed a retrospective review of patients treated at a single institution between April 2021 and December 2023. Clinical photographs were graded by 3 outside board-certified dermatologists using a 5-point visual analog scale. RESULTS Fourteen patients (age range: 10 months-66 years, mean age: 27.4 years, Fitzpatrick skin types II-VI) were treated for CALM on the face (11) or body (3). On average, patients received 4.3 treatments, with treatment intervals ranging from 4 to 40 weeks. Treatment remains ongoing with the 730-nm picosecond laser for eight patients. Overall, patients were rated to have a mean improvement of 26%-50%. Two patients (FST III and VI) achieved 100% clearance after 4-5 treatment sessions. Our study included four patients whose CALM were of the smooth bordered "coast of California" subtype, three of whom had a mean improvement rating of only 1%-25%. The fourth patient had near complete resolution. Follow up for these patients has ranged from 6 weeks to 1.5 years. Of the patients treated, one patient experienced transient post-inflammatory hyperpigmentation and another transient post-inflammatory hypopigmentation, while a third patient experienced mild persistent guttate hypopigmentation. Three patients experienced partial recurrence indicating that maintenance treatments may be needed in some patients. CONCLUSION The 730-nm picosecond titanium sapphire laser is a safe and efficacious treatment option, in the right morphologic setting, to improve the cosmetic appearance of CALMs in a wide range of ages and skin types. To our knowledge, this is the first reported treatment of CALMs with picosecond lasers in FST V and VI patients. Our study also supports prior studies which have found that CALM with smooth-bordered "coast of California" morphology have a poor response to laser therapy as compared to those with jagged or ill-defined bordered "coast of Maine" morphology.
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Affiliation(s)
| | - Emily L Guo
- Dermatology & Laser Surgery Center, Houston, Texas, USA
| | | | - Paul M Friedman
- Dermatology & Laser Surgery Center, Houston, Texas, USA
- Department of Dermatology, McGovern Medical School, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Dermatology, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
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Mildner LS, Zhu J, Navarini AA, Itin P, Mühleisen B, Müller SM. Periocular hypopigmentation of the elderly (POHE): A case series. J Eur Acad Dermatol Venereol 2024; 38:e188-e190. [PMID: 37728534 DOI: 10.1111/jdv.19526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023]
Affiliation(s)
- L S Mildner
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - J Zhu
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - A A Navarini
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - P Itin
- Private Practice, Basel, Switzerland
| | - B Mühleisen
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - S M Müller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
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Molina EA, Travis TE, Hussein L, Oliver MA, Keyloun JW, Moffatt LT, Shupp JW, Carney BC. Treatment of hypopigmented burn hypertrophic scars with short-term topical tacrolimus does not lead to repigmentation. Lasers Surg Med 2024; 56:175-185. [PMID: 38225772 DOI: 10.1002/lsm.23754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVES Dyschromia is an understudied aspect of hypertrophic scar (HTS). The use of topical tacrolimus has successfully shown repigmentation in vitiligo patients through promotion of melanogenesis and melanocyte proliferation. It was hypothesized that HTSs treated with topical tacrolimus would have increased repigmentation compared to controls. METHODOLOGY Full-thickness burns in red Duroc pigs were either treated with excision and meshed split-thickness skin grafting or excision and no grafting, and these wounds formed hypopigmented HTSs (n = 8). Half of the scars had 0.1% tacrolimus ointment applied to the scar twice a day for 21 days, while controls had no treatment. Further, each scar was bisected with half incurring fractional ablative CO2 laser treatment before topical tacrolimus application to induce laser-assisted drug delivery (LADD). Pigmentation was evaluated using a noninvasive probe to measure melanin index (MI) at Days 0 (pretreatment), 7, 14, and 21. At each timepoint, punch biopsies were obtained and fixed in formalin or were incubated in dispase. The formalin-fixed biopsies were used to evaluate melanin levels by H&E staining. The biopsies incubated in dispase were used to obtain epidermal sheets. The ESs were then flash frozen and RNA was isolated from them and used in quantitative reverse transcription polymerase chain reaction for melanogenesis-related genes: Tyrosinase (TYR), TYR-related protein-1 (TYRP1), and dopachrome tautomerase (DCT). Analysis of variance test with Šídák's multiple comparisons test was used to compare groups. RESULTS Over time, within the grafted HTS and the NS group, there were no significant changes in MI, except for Week 3 in the -Tacro group. (+Tacro HTS= pre = 685.1 ± 42.0, w1 = 741.0 ± 54.16, w2 = 750.8 ± 59.0, w3 = 760.9 ± 49.8) (-Tacro HTS= pre = 700.4 ± 54.3, w1 = 722.3 ± 50.7, w2 = 739.6 ± 53.2, w3 = 722.7 ± 50.5). Over time, within the ungrafted HTS and the NS group, there were no significant changes in MI. (+Tacro HTS= pre = 644.9 ± 6.9, w1 = 661.6 ± 3.3, w2 = 650.3 ± 6.2, w3 = 636.3 ± 7.4) (-Tacro HTS= pre = 696.8 ± 8.0, w1 = 695.8 ± 12.3, w2 = 678.9 ± 14.0, w3 = 731.2 ± 50.3). LADD did not lead to any differential change in pigmentation compared to the non-LADD group. There was no evidence of increased melanogenesis within the tissue punch biopsies at any timepoint. There were no changes in TYR, TYRP1, or DCT gene expression after treatment. CONCLUSION Hypopigmented HTSs treated with 0.1% tacrolimus ointment with or without LADD did not show significantly increased repigmentation. This study was limited by a shorter treatment interval than what is known to be required in vitiligo patients for repigmentation. The use of noninvasive, topical treatments to promote repigmentation are an appealing strategy to relieve morbidity associated with dyschromic burn scars and requires further investigation.
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Affiliation(s)
- Esteban A Molina
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Taryn E Travis
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Lou'ay Hussein
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Mary A Oliver
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - John W Keyloun
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Lauren T Moffatt
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Department of Biochemistry and Molecular Biology, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Jeffrey W Shupp
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
- Department of Biochemistry and Molecular Biology, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Bonnie C Carney
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Department of Biochemistry and Molecular Biology, Georgetown University School of Medicine, Washington, District of Columbia, USA
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Moumen M, McMichael AJ. Atypical Dyschromia in Skin of Color. J Drugs Dermatol 2024; 23:100-102. [PMID: 38306129 DOI: 10.36849/jdd.7683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Dyschromia is a concern for many patients, especially persons of color. Postinflammatory hypopigmentation and depigmentation can affect all skin types; however, it is more apparent in those with darker skin. Some members of the dermatology community may not comprehensively understand the mechanisms of these reactions and the extent of the psychosocial effect they have on persons of color. Skin of color patients experiencing a decrease or loss of pigmentation are left with few treatment options, with no available evidence-based treatment established from a sufficient sample size. Several diseases may present with hypopigmentation and/or depigmentation despite this not being a major criterion for these conditions, including atopic dermatitis, lichen planus, discoid lupus erythematosus, polymorphous light eruption, and scleroderma. Here, we present three cases of atypical dyschromia in skin of color to highlight the underlying hypo- and depigmentation that may present with active disease and persist despite appropriate treatment. Practice Points: 1. These cases foreground the potential for a range of dermatologic conditions to result in atypical pigment changes in persons of color. 2. Postinflammatory hypopigmentation or depigmentation may persist in skin of color despite the regression of active disease.J Drugs Dermatol. 2024;23(2):100-102. doi:10.36849/JDD.7683.
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Mazzoletti V, Sonego B, Zelin E, Bazzacco G, Conforti C, Cavallo F, Zacchi A, Di Meo N, Zalaudek I. Hypopigmentation as a diagnostic clue in primary extramammary Paget disease: Case report and short literature review. Australas J Dermatol 2023; 64:e388-e391. [PMID: 37776096 DOI: 10.1111/ajd.14167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Vanessa Mazzoletti
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - Benedetta Sonego
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Enrico Zelin
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Giulia Bazzacco
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Claudio Conforti
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Francesco Cavallo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Alberto Zacchi
- Department of Histopathology, Cattinara Hospital of Trieste, Trieste, Italy
| | - Nicola Di Meo
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
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Post NF, Van Broekhoven NX, Lommerts A, Bae JM, Bekkenk MW, de Castro CCS, Eleftheriadou V, Esmat S, Ezzedine K, van Geel N, Hamzavi I, Leone G, Pandya AG, Passeron T, Rodrigues MA, Seneschal J, Th'ng S, Wolkerstorfer A. Expert opinion about laser and intense pulsed light (IPL)-induced leukoderma or vitiligo: a cross-sectional survey study. Arch Dermatol Res 2023; 315:2289-2294. [PMID: 36964767 PMCID: PMC10462531 DOI: 10.1007/s00403-023-02611-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/06/2023] [Accepted: 03/14/2023] [Indexed: 03/26/2023]
Abstract
Vitiligo patients may desire laser hair removal, skin rejuvenation, vascular treatments, and other laser or intense pulsed light (IPL) assisted treatments. However, there is a risk of inducing new depigmented patches (Koebner phenomenon). In absence of guidelines on the safe use of laser or IPL in vitiligo patients, dermatologists tend to be reluctant to administer these treatments. The aim of this survey study was to provide an estimation of the occurrence and related risk factors of laser/IPL-induced leukoderma or vitiligo. A cross-sectional survey study was performed among 15 vitiligo experts from 11 countries, with 14 questions about affected patients, involved laser/IPL treatments and the physicians' approach. In a total of 11,300 vitiligo patients, laser/IPL-induced leukoderma or vitiligo was reported in 30 patients (0.27%). Of these, 12 (40%) patients had a medical history of vitiligo and seven (58%) of these patients had stable (> 12 months) vitiligo before the treatment. Most frequently reported were hair removal procedures and localization of the face and legs. Side effects like blistering, crusting, and erosions occurred in 56.7% of the cases. These vitiligo experts based their advice on the risk of the laser treatment on stability of the vitiligo (43%) and activity signs (50%), and 50% discuss the risks before starting a laser treatment. Relevant activity signs are the Koebner phenomenon (57.1%), confetti-like lesions (57.1%) and hypochromic borders (50%). Laser-induced leukoderma or vitiligo is an uncommon phenomenon. Remarkably, a minority had a medical history of vitiligo of which 58% were stable. Consequently, most cases could not have been prevented by not treating vitiligo patients. However, a majority had laser/IPL-induced skin damage. Therefore, caution is advised with aggressive settings and test-spots prior to the treatment are recommended. This study showed significant variation in the current recommendations and approach of vitiligo experts regarding laser/IPL-induced leukoderma or vitiligo.
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Affiliation(s)
- Nicoline F Post
- Department of Dermatology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Noah X Van Broekhoven
- Department of Dermatology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Annelies Lommerts
- Department of Dermatology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jung M Bae
- Department of Dermatology, St. Vincent's Hospital, Seoul, South Korea
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | | | | | - Samia Esmat
- Department of Dermatology, Cairo University, Giza, Egypt
| | - Khaled Ezzedine
- Department of Dermatology, Université Paris-Est Créteil Val de Marne-Université Paris, Paris, France
| | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | | | - Amit G Pandya
- Department of Dermatology, Palo Alto Foundation Medical Group, Sunnyvale, CA, USA
| | - Thierry Passeron
- Department of Dermatology and INSERM U1065, University Hospital of Nice, Nice, France
| | | | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, University Hospital, Bordeaux, France
| | - Steven Th'ng
- Department of Dermatology, Skin Research Institute of Singapore, Singapore, Singapore
| | - Albert Wolkerstorfer
- Department of Dermatology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Holzman R, Hackett A, Pavlovsky L, Feuerman H, Hodak E, Didkovsky E, Segal R, Atzmony L. Facial hypopigmentation as an unusual manifestation of Demodex infestation - a case series. Int J Dermatol 2023; 62:1289-1291. [PMID: 37162494 DOI: 10.1111/ijd.16703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/11/2023]
Affiliation(s)
- Roie Holzman
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Petah Tiqva, Israel
| | - Asher Hackett
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Petah Tiqva, Israel
| | - Lev Pavlovsky
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Petah Tiqva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Feuerman
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Petah Tiqva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmilia Hodak
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Petah Tiqva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elena Didkovsky
- Institute of Pathology, Rabin Medical Center, Beilinson Hospital, Petah Tiqva, Israel
| | - Rina Segal
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Petah Tiqva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lihi Atzmony
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Petah Tiqva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Feng J, Shen S, Song X, Xiang W. Efficacy and safety of picosecond laser for the treatment of melasma: a systematic review and meta-analysis. Lasers Med Sci 2023; 38:84. [PMID: 36897459 DOI: 10.1007/s10103-023-03744-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
Multiple laser modalities have been used for melasma treatment. However, the effectiveness of picosecond laser in treating melasma remains unclear. This meta-analysis investigated the effectiveness and safety of picosecond laser for melasma treatment. Randomized controlled trials (RCTs) comparing picosecond laser with conventional treatment for melasma were searched through five databases. The melasma area severity index (MASI)/modified MASI (mMASI) was used to quantify the degree of melasma improvement. Standardized mean differences and 95% confidence intervals were calculated using Review Manager for result standardization. Six RCTs, which used picosecond laser at 1064, 755, 595, and 532 nm wavelengths, were included herein. Picosecond laser significantly reduced the MASI/mMASI, but the results were highly heterogeneous (P = 0.008, I2 = 70%). In the subgroup analysis of 1064 and 755 nm picosecond lasers, 1064 nm picosecond laser significantly reduced the MASI/mMASI with no significant side effects (P = 0.04). Meanwhile, 755 nm picosecond laser did not significantly improve the MASI/mMASI compared with topical hypopigmentation agents (P = 0.08) and caused post-inflammatory hyperpigmentation. Other laser wavelengths could not be used in the subgroup analysis owing to an insufficient sample size. Picosecond laser at 1064 nm is safe and effective for melasma treatment. Picosecond laser at 755 nm is not superior to topical hypopigmentation agents in treating melasma. The exact efficacy of other wavelengths of picosecond laser for melasma treatment remains to be verified in large-scale RCTs.
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Affiliation(s)
- Jiangfeng Feng
- Department of Dermatology, Hangzhou Third People's Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Sihao Shen
- Department of Dermatology, Hangzhou Third People's Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiuzu Song
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenzhong Xiang
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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10
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Reilly JM, Spektor P, De La Torre M, Paranandi S, Bogner J. Tattoo Removal in People of Color Who Were Formerly Incarcerated or Were Gang Members: Complications and Best Practices. J Health Care Poor Underserved 2023; 34:1414-1426. [PMID: 38661764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
There are limited data about the tattoo removal process in formerly gang-involved and incarcerated people of color. This single center retrospective study was conducted on patients treated at Homeboy Industries' Ya'Stuvo Tattoo Removal Clinic between January 2016-December 2018. It reviewed data on 2,118 tattoos, and a representative sample of 502 patients was used to conduct our analysis. Treatment on 118 of the tattoos (5.57%) resulted in at least one complication (hypo-or hyper-pigmentation, keloids, or scarring). Patients who experienced tattoo removal complications (7.3%) were less likely to return to complete the removal process. More complications were experienced with higher fluences of energy, on tattoos placed by professional artists, on colored tattoos, and tattoos on clients who had a greater number of treatments. The study highlights complications and best practices in tattoo removal in people of color, a process critical to the reintegration and gang disengagement of this vulnerable population.
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Arora V, Tandon R, Puri RD, Lall M, Noorani I, Suman P. Hypomelanosis of Ito. Indian J Pediatr 2022; 89:1117-1119. [PMID: 35731502 DOI: 10.1007/s12098-022-04208-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/22/2022] [Indexed: 11/25/2022]
Abstract
Hypomelanosis of Ito is a rare neurocutaneous syndrome characterized by presence of hypopigmented skin lesions arranged in whorls and streaks following the lines of Blaschko and are often accompanied by abnormalities of the central nervous system, skeletal system, eyes and teeth. Additional symptoms include deafness, hemihypertrophy, cardiac abnormalities, renal malformations, and abnormalities of the genitourinary tract.
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Affiliation(s)
- Veronika Arora
- Institute of Medical Genetics & Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Rinky Tandon
- Child Development Clinic, Sir Ganga Ram Hospital, New Delhi, 110060, India.
| | - Ratna Dua Puri
- Institute of Medical Genetics & Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Meena Lall
- Institute of Medical Genetics & Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Imran Noorani
- Child Development Clinic, Sir Ganga Ram Hospital, New Delhi, 110060, India
| | - Praveen Suman
- Child Development Clinic, Sir Ganga Ram Hospital, New Delhi, 110060, India
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12
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Leszczynski R, da Silva CA, Pinto ACPN, Kuczynski U, da Silva EM. Laser therapy for treating hypertrophic and keloid scars. Cochrane Database Syst Rev 2022; 9:CD011642. [PMID: 36161591 PMCID: PMC9511989 DOI: 10.1002/14651858.cd011642.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hypertrophic and keloid scars are common skin conditions resulting from abnormal wound healing. They can cause itching, pain and have a negative physical and psychological impact on patients' lives. Different approaches are used aiming to improve these scars, including intralesional corticosteroids, surgery and more recently, laser therapy. Since laser therapy is expensive and may have adverse effects, it is critical to evaluate the potential benefits and harms of this therapy for treating hypertrophic and keloid scars. OBJECTIVES To assess the effects of laser therapy for treating hypertrophic and keloid scars. SEARCH METHODS In March 2021 we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL EBSCO Plus and LILACS. To identify additional studies, we also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses, and health technology reports. There were no restrictions with respect to language, date of publication, or study setting. SELECTION CRITERIA We included randomised controlled trials (RCTs) for treating hypertrophic or keloid scars (or both), comparing laser therapy with placebo, no intervention or another intervention. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted the data, assessed the risk of bias of included studies and carried out GRADE assessments to assess the certainty of evidence. A third review author arbitrated if there were disagreements. MAIN RESULTS We included 15 RCTs, involving 604 participants (children and adults) with study sample sizes ranging from 10 to 120 participants (mean 40.27). Where studies randomised different parts of the same scar, each scar segment was the unit of analysis (906 scar segments). The length of participant follow-up varied from 12 weeks to 12 months. All included trials had a high risk of bias for at least one domain: all studies were deemed at high risk of bias due to lack of blinding of participants and personnel. The variability of intervention types, controls, follow-up periods and limitations with report data meant we pooled data for one comparison (and only two outcomes within this). Several review secondary outcomes - cosmesis, tolerance, preference for different modes of treatment, adherence, and change in quality of life - were not reported in any of the included studies. Laser versus no treatment: We found low-certainty evidence suggesting there may be more hypertrophic and keloid scar improvement (that is scars are less severe) in 585-nm pulsed-dye laser (PDL) -treated scars compared with no treatment (risk ratio (RR) 1.96; 95% confidence interval (CI): 1.11 to 3.45; two studies, 60 scar segments). It is unclear whether non-ablative fractional laser (NAFL) impacts on hypertrophic scar severity when compared with no treatment (very low-certainty evidence). It is unclear whether fractional carbon dioxide (CO2) laser impacts on hypertrophic and keloid scar severity compared with no treatment (very low-certainty evidence). Eight studies reported treatment-related adverse effects but did not provide enough data for further analyses. Laser versus other treatments: We are uncertain whether treatment with 585-nm PDL impacts on hypertrophic and keloid scar severity compared with intralesional corticosteroid triamcinolone acetonide (TAC), intralesional Fluorouracil (5-FU) or combined use of TAC plus 5-FU (very low-certainty evidence). It is also uncertain whether erbium laser impacts on hypertrophic scar severity when compared with TAC (very low-certainty evidence). Other comparisons included 585-nm PDL versus silicone gel sheeting, fractional CO2 laser versus TAC and fractional CO2 laser versus verapamil. However, the authors did not report enough data regarding the severity of scars to compare the interventions. As only very low-certainty evidence is available on treatment-related adverse effects, including pain, charring (skin burning so that the surface becomes blackened), telangiectasia (a condition in which tiny blood vessels cause thread-like red lines on the skin), skin atrophy (skin thinning), purpuric discolorations, hypopigmentation (skin colour becomes lighter), and erosion (loss of part of the top layer of skin, leaving a denuded surface) secondary to blistering, we are not able to draw conclusions as to how these treatments compare. Laser plus other treatment versus other treatment: It is unclear whether 585-nm PDL plus TAC plus 5-FU leads to a higher percentage of good to excellent improvement in hypertrophic and keloid scar severity compared with TAC plus 5-FU, as the certainty of evidence has been assessed as very low. Due to very low-certainty evidence, it is also uncertain whether CO2 laser plus TAC impacts on keloid scar severity compared with cryosurgery plus TAC. The evidence is also very uncertain about the effect of neodymium-doped yttrium aluminium garnet (Nd:YAG) laser plus intralesional corticosteroid diprospan plus 5-FU on scar severity compared with diprospan plus 5-FU and about the effect of helium-neon (He-Ne) laser plus decamethyltetrasiloxane, polydimethylsiloxane and cyclopentasiloxane cream on scar severity compared with decamethyltetrasiloxane, polydimethylsiloxane and cyclopentasiloxane cream. Only very low-certainty evidence is available on treatment-related adverse effects, including pain, atrophy, erythema, telangiectasia, hypopigmentation, regrowth, hyperpigmentation (skin colour becomes darker), and depigmentation (loss of colour from the skin). Therefore, we are not able to draw conclusions as to how these treatments compare. AUTHORS' CONCLUSIONS: There is insufficient evidence to support or refute the effectiveness of laser therapy for treating hypertrophic and keloid scars. The available information is also insufficient to perform a more accurate analysis on treatment-related adverse effects related to laser therapy. Due to the heterogeneity of the studies, conflicting results, study design issues and small sample sizes, further high-quality trials, with validated scales and core outcome sets should be developed. These trials should take into consideration the consumers' opinion and values, the need for long-term follow-up and the necessity of reporting the rate of recurrence of scars to determine whether lasers may achieve superior results when compared with other therapies for treating hypertrophic and keloid scars.
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Affiliation(s)
| | | | - Ana Carolina Pereira Nunes Pinto
- Cochrane Brazil, Health Technology Assessment Center, São Paulo, Brazil
- Post-graduation program in Evidence-Based Health, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Biological and Health Sciences Department, Federal University of Amapa, Macapá, Brazil
| | | | - Edina Mk da Silva
- Emergency Medicine and Evidence Based Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
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Abstract
BACKGROUND Despite history of multiple treatment modalities, repigmentation of hypopigmented scars remains a difficult clinical problem. OBJECTIVE The purpose of this review is to evaluate the literature on laser and combination laser plus adjunct topical therapy for hypopigmented burn and traumatic scars. MATERIALS AND METHODS A search on PubMed and on Oxford Academic was conducted with additional relevant literature obtained from reference lists. RESULTS Treatment regimens that address hypopigmentation within scars were reviewed. A combination of nonablative fractional or ablative fractional laser treatment with topical prostaglandin analogue with or without topical retinoid were found to result in superior repigmentation. CONCLUSION Reliable improvement of hypopigmentation in scars after laser treatment is challenging. Laser can achieve success in some cases. Ultraviolet laser can achieve modest repigmentation; however, results are short-lived and require continued re-treatment. Modest improvement in pigmentation is seen with nonablative fractional laser or ablative fractional laser alone and enhanced repigmentation is demonstrated when combining fractional laser resurfacing with topical application of synthetic prostaglandin analogues and other known modulators of melanogenesis.
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Affiliation(s)
- Erica G Baugh
- Department of Dermatology, University of California, Irvine, California
| | - Olive Anagu
- Department of Dermatology, University of California, Irvine, California
| | - Kristen M Kelly
- Department of Dermatology, University of California, Irvine, California
- Beckman Laser Institute, Laser Microbeam and Medical Program, University of California Irvine, Irvine, California
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15
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Colquhoun M, Penn H. Salt-and-Pepper Skin Changes in Systemic Sclerosis. N Engl J Med 2021; 385:357. [PMID: 34289279 DOI: 10.1056/nejmicm2103390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Henry Penn
- Northwick Park Hospital, Harrow, United Kingdom
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Fernandez-Somoza JM, Ginarte M, Otero E, Tomé S, Soutullo C, Martínez-Ulloa A, Gonzalez-Quintela A. Clinical and capillaroscopic findings in patients with liver disease and proximal apparent leukonychia (Terry nails and its variants). Medicine (Baltimore) 2021; 100:e26207. [PMID: 34087892 PMCID: PMC8183706 DOI: 10.1097/md.0000000000026207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 05/10/2021] [Indexed: 01/04/2023] Open
Abstract
Terry nails and Lindsay nails are similar forms of proximal apparent leukonychia (PAL). A change in nail bed vascularity is thought to be responsible for PAL. The study was aimed at investigating the frequency of PAL in patients attending a liver disease clinic, the factors associated with its presence, its value for detecting cirrhosis, its prognostic value for mortality, and associated capillaroscopic findings.A total of 521 patients were included (age range, 18-94 years; 69% men). Systematic nail photographs were evaluated by 2 independent investigators. Disease-related data were obtained from the medical records. Mortality was evaluated after 7 years of follow-up. Nailfold capillaroscopy was performed on a subset of 80 patients.PAL was present in 228 patients (43.8%; Terry nails in 205, Lindsay nails in 20, and both in 3). The kappa-coefficient of interobserver agreement was 0.82. The presence of PAL was associated with cirrhosis and, accordingly, with portal hypertension and hepatocellular dysfunction. The positive likelihood ratio of PAL for the diagnosis of cirrhosis was 1.6 (95% CI 1.3-1.92). PAL was independently associated with chronic alcohol abuse and was not a significant predictor of mortality. Venous loop dilatation and prominence of the venous plexus were observed on capillaroscopy in patients with cirrhosis but were not significantly associated with PAL.In summary, PAL is a common finding in patients from a liver clinic; it is associated with liver cirrhosis and with alcohol abuse. PAL is not associated with specific capillaroscopic findings. We propose the generic term proximal apparent leukonychia instead of classic eponymous titles to avoid confusion in the literature.
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Affiliation(s)
| | - Manuel Ginarte
- Department of Dermatology, Hospital Clínico Universitario, Santiago de Compostela, Spain
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17
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Sharma P, Ramesh V. Hypopigmented atrophic plaques in a young woman. BMJ 2021; 373:n1012. [PMID: 33952444 DOI: 10.1136/bmj.n1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Prateek Sharma
- Department of Dermatology, Safdarjung Hospital, New Delhi, India
| | - V Ramesh
- Department of Dermatology, Safdarjung Hospital, New Delhi, India
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Bhattarai D, Jindal AK, Patra PK. Hypopigmentation in the Medial Angle of Eyes in a Young Boy With Juvenile Dermatomyositis. J Clin Rheumatol 2021; 27:e120. [PMID: 31977652 DOI: 10.1097/rhu.0000000000001294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Dharmagat Bhattarai
- From the Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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19
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Lipp MB, Angra K, Wu DC, Goldman MP. Intense Pulsed Light: A Methodical Approach to Understanding Clinical Endpoints. J Drugs Dermatol 2021; 20:203-207. [PMID: 33538557 DOI: 10.36849/jdd.5638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Intense Pulsed Light (IPL) is a non-coherent polychromatic broadband filtered flashlamp that emits light in the spectrum of approximately 400–1200 nm. Its effects on photorejuvenation are well documented. The goal of this study is to help practitioners better conceptualize and fine tune IPL device settings in order to produce the most effective and safest clinical outcome. MATERIALS/METHODS This was a prospective study testing several filters (515 nm; 560 nm; 590 nm and 530–650; 900–1200 nm vascular filter), fluences, pulse durations, and pulse numbers (ie, multiple sequence pulsing or MSP) with a new IPL system. RESULTS Post-procedure erythema response was more pronounced with increasing fluence, decreasing wavelength, fewer pulses and shorter pulse duration. The exception was the 515 nm filter with regard to pulse duration, which was observed to have a more pronounced response with longer pulse durations. The overall clinical outcome at the 4-week follow-up visit demonstrated greatest improvement in erythema and pigmentation using the 515 nm filter on a Fitzpatrick Skin Type III individual. CONCLUSION Greatest clinical endpoint response at 4-week follow-up was observed with more robust initial responses. This was most apparent at higher fluence levels and fewer pulse counts. However, when the IPL is pushed to aggressive parameters, there is risk of hypopigmentation and hair loss as seen in this case study. Skin type is an important consideration when using IPL and MSP adds to its safety profile. J Drugs Dermatol. 2021;20(2):203-207. doi:10.36849/JDD.5638.
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Boos MD, Briggs S. Scaly Dermatitis and Edema in an Irritable Child. JAMA 2021; 325:393-394. [PMID: 33410860 DOI: 10.1001/jama.2020.10429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Markus D Boos
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle
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Affiliation(s)
- Satoshi Ide
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
- Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Japan
| | - Shinichiro Morioka
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
- Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Japan
| | - Makoto Inada
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
- Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Japan
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Jha N. Phototoxic reaction to Bakuchi seeds tried as home remedy in a patient of Vitiligo. Dermatol Online J 2020; 26:13030/qt6h30b05d. [PMID: 33342189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/22/2020] [Accepted: 07/03/2020] [Indexed: 06/12/2023] Open
Affiliation(s)
- Niharika Jha
- Department of Dermatology, Acharya Shree Bhikshu Hospital, Moti Nagar, New Delhi.
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Gailson T, Pandit S, Chandrasekaran S. Griscelli syndrome type 2. QJM 2020; 113:137. [PMID: 31199490 DOI: 10.1093/qjmed/hcz144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Gailson
- Department of Pediatrics, Government Multi-Specialty Hospital, Sector 16, Chandigarh, India
| | - S Pandit
- Department of Pediatrics, Government Multi-Specialty Hospital, Sector 16, Chandigarh, India
| | - S Chandrasekaran
- Department of Pediatrics, Government Multi-Specialty Hospital, Sector 16, Chandigarh, India
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ICHIKI T, SUGITA K, FURUE M, YAMAMOTO O. An Intimate Relationship Between Intralesional Depigmentation and Peripheral Nervous System in Lichen Simplex Chronicus. Acta Derm Venereol 2020; 100:adv00042. [PMID: 31821517 PMCID: PMC9128931 DOI: 10.2340/00015555-3390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2019] [Indexed: 12/03/2022] Open
Affiliation(s)
- Toshio ICHIKI
- Department of Medicine of Sensory and Motor Organs, Division of Dermatology, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, Tottori 683-8504
- Department of Dermatology, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan. E-mail:
| | - Kazunari SUGITA
- Department of Medicine of Sensory and Motor Organs, Division of Dermatology, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, Tottori 683-8504
| | - Masutaka FURUE
- Department of Dermatology, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan. E-mail:
| | - Osamu YAMAMOTO
- Department of Medicine of Sensory and Motor Organs, Division of Dermatology, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, Tottori 683-8504
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Abstract
The Woronoff ring is a ring-like hypopigmentation zone around regressing psoriasis lesions. Although it was first described more than 100 years ago, its aetiology has remained a mystery. Recent insights into the pathogenesis of psoriasis can now explain the origin of the Woronoff ring. Psoriasis involves an HLA-class I-restricted autoimmune response of CD8+ T cells against melanocytes in the epidermis. The pathogenic CD8+ T cells are not cytotoxic, but are characterized by the production of interleukin-17, interleukin-22 and tumour necrosis factor-α. Interleukin-17 and tumour necrosis factor-α act synergistically on melanocytes by increasing proliferation while inhibiting melanogenesis. This reduces the cellular melanin content despite an increased number of melanocytes in psoriatic lesions. As a consequence, during healing the prior influence of interleukin-17 and tumour necrosis factor-α, despite the increased density of melanocytes, leaves a hypopigmented zone at the edge of regressing psoriasis lesions, which becomes visible as the Woronoff ring. This mechanism can explain a long-discussed puzzling phenomenon in dermatology.
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Affiliation(s)
- Jörg C Prinz
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, D-80337 München, Germany.
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Abstract
BACKGROUND Krabbe disease, or globoid cell leukodystrophy, is an autosomal recessive disease caused by the deficiency of lysosomal galactocerebrosidase. The most common form is infantile Krabbe disease, which is usually diagnosed within the first year of life and has high morbidity and mortality. Patients usually present with irritability, progressive neurodegeneration, spasticity, and peripheral neuropathy. This report is of a 6-year-old girl who had Krabbe disease since she was 5 weeks of age. CASE REPORT A 6-year-old female Saudi patient had initially presented at 5 weeks of age with hypoventilation, recurrent attacks of fever, and failure to thrive. The patient also skin hypopigmentation involving the face, neck, upper extremities, and lower extremities. Peripheral blood galactocerebrosidase enzyme activity was normal but was reduced in tissue fibroblasts. Whole exome sequencing (WES) and whole genome sequencing (WGS) showed a homozygous mutation in the GALC gene c.334A>G (p.Thr112Ala), which was previously reported in a compound heterozygous state with another mutation. CONCLUSIONS This case report describes a patient with homozygous mutation status Krabbe disease. Although this patient had the phenotype of early infantile-onset Krabbe disease, which usually has high morbidity and mortality, her condition is now relatively stable at 6 years of age, which could be due to relatively higher enzyme activity. This case also expanded the presentation or typical phenotype of infantile Krabbe disease as the patient also presented with hypoventilation and skin hypopigmentation.
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Affiliation(s)
- Marwan Nashabat
- King Abdullah International Medical Research Centre, King Saud bin Abdulaziz University for Health Sciences, Genetic Division, Department of Pediatrics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Sultan Al-Khenaizan
- King Abdullah International Medical Research Centre, King Saud bin Abdulaziz University for Health Sciences, Department of Dermatology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Majid Alfadhel
- King Abdullah International Medical Research Centre, King Saud bin Abdulaziz University for Health Sciences, Genetic Division, Department of Pediatrics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
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Saleem MD, Oussedik E, Picardo M, Schoch JJ. Acquired disorders with hypopigmentation: A clinical approach to diagnosis and treatment. J Am Acad Dermatol 2018; 80:1233-1250.e10. [PMID: 30236514 DOI: 10.1016/j.jaad.2018.07.070] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/09/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023]
Abstract
Acquired hypopigmented skin changes are commonly encountered by dermatologists. Although hypopigmentation is often asymptomatic and benign, occasional serious and disabling conditions present with cutaneous hypopigmentation. A thorough history and physical examination, centered on disease distribution and morphologic findings, can aid in delineating the causes of acquired hypopigmented disorders. The second article in this 2-part continuing medical education series focuses on conditions with a hypopigmented phenotype. Early diagnosis and appropriate management of these disorders can improve a patient's quality of life, halt disease progression, and prevent irreversible disability.
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Affiliation(s)
- Mohammed D Saleem
- Department of Internal Medicine, University of Florida College of Medicine and University of Florida Health, Gainesville, Florida.
| | | | - Mauro Picardo
- Department of Dermatology and Pediatric Dermatology, Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Jennifer J Schoch
- Department of Dermatology, University of Florida, Gainesville, Florida; Department of Pediatrics, University of Florida, Gainesville, Florida
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Mori S, Adar T, Kazlouskaya V, Alexander JB, Heilman E, Glick SA. Cutaneous Langerhans cell histiocytosis presenting with hypopigmented lesions: Report of two cases and review of literature. Pediatr Dermatol 2018; 35:502-506. [PMID: 29691886 DOI: 10.1111/pde.13509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Langerhans cell histiocytosis is a rare group of disorders that results from the abnormal proliferation and accumulation of dendritic-derived cells in various organs of the body, such as the skin and bones. Hypopigmented macules are a rare cutaneous presentation of Langerhans cell histiocytosis that may pose a diagnostic dilemma when no other findings of Langerhans cell histiocytosis are present at the time of examination. We present 2 cases of the hypopigmented variant of Langerhans cell histiocytosis, including a case with histopathologic features of regression, and a review of the literature. These cases highlight the importance of including Langerhans cell histiocytosis in the differential diagnosis of an infant with hypopigmented macules and papules.
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Affiliation(s)
- Shoko Mori
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Tony Adar
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Viktoryia Kazlouskaya
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Jaime B Alexander
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Edward Heilman
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Sharon A Glick
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
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Potter K, Konda S, Ren VZ, Wang AL, Srinivasan A, Chilukuri S. Techniques for Optimizing Surgical Scars, Part 3: Erythema, Hyperpigmentation, and Hypopigmentation. Skinmed 2018; 16:113-117. [PMID: 29911529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Surgical management of benign or malignant cutaneous tumors may result in noticeable scars that are of great concern to patients, regardless of sex, age, or ethnicity. Techniques to optimize surgical scars are discussed in this three-part review. Part 3 focuses on scar revision for erythema, hyperpigmentation, and hypopigmentation. Scar revision options for erythematous scars include moist exposed burn ointment (MEBO), onion extract, silicone, methyl aminolevulinate-photodynamic therapy (MAL-PDT), pulsed dye laser, intense pulsed light (IPL), and nonablative fractional lasers. Hyperpigmented scars may be treated with tyrosinase inhibitors, IPL, and nonablative fractional lasers. Hypopigmented scars may be treated with needle dermabrasion, medical tattoos, autologous cell transplantation, prostaglandin analogues, retinoids, calcineurin inhibitors, excimer laser, and nonablative fractional lasers.
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Affiliation(s)
- Kathryn Potter
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL
| | - Sailesh Konda
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL
- Department of Dermatology, Loma Linda University Medical Center, Loma Linda, CA
| | - Vicky Zhen Ren
- Department of Dermatology, Baylor College of Medicine, Houston, TX
| | - Apphia Lihan Wang
- Department of Dermatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL
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Abstract
Abnormal colouring of the nails may be a sign of underlying systemic or local disorders. This study investigated the prevalence and causes of chromonychia as a whole, as well as of each subtype. Among 163 patients with chromonychia, trauma was the pathogenesis in up to 20.9% (34/163) of cases. The most common subtype was melanonychia (54.0%; 88/163), followed by leukonychia (23.9%), red (8.6%), green (6.7%), yellow (4.9%) and blue (1.8%) nails. Nail matrix naevus (33.3%; 29/88) was the most common cause of melanonychia, while skin diseases (41.0%; 16/39), such as psoriasis (75%, 12/16) and alopecia areata (18.8%; 3/16), in addition to systemic diseases (33.3%; 13/39) including anaemia (38.5%, 5/13) and chronic renal failure (15.4%; 2/13) were the dominant causes of leukonychia. As chromonychia may be the first or only sign of an underlying disorder, it should alert physicians and patients to the need for a prompt and thorough evaluation.
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Affiliation(s)
- Soo Hyeon Bae
- Department of Dermatology, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, Korea
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Ward SC, Savage SA, Giri N, Alter BP, Cowen EW. Progressive reticulate skin pigmentation and anonychia in a patient with bone marrow failure. J Am Acad Dermatol 2017; 77:1194-1198. [PMID: 29033247 PMCID: PMC5685909 DOI: 10.1016/j.jaad.2017.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 11/24/2022]
Abstract
KEY TEACHING POINTS.
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Affiliation(s)
- Suzanne C Ward
- Dermatology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sharon A Savage
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Neelam Giri
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Blanche P Alter
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Edward W Cowen
- Dermatology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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Garg T, Marak A, Ahmed R, Chander R, Jain M. An unusual presentation of primary cutaneous amyloidosis. Dermatol Online J 2017; 23:13030/qt38f676n9. [PMID: 29469741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 08/18/2017] [Indexed: 06/08/2023] Open
Abstract
Primary localized cutaneous amyloidosis refers to a group of disorders characterized by deposition of amyloid in the dermis without any systemic involvement. It comprises the following clinical types: macular, lichenoid, nodular, and biphasic. There are also rare variants such as amyloidosis cutis dyscromica and poikiloderma-like cutaneous amyloidosis. We report a case of primary cutaneous amyloidosis in a 17-year-old boy with unusual pigmentation of various patterns (reticulate and diffuse pigmentation with mottling and rippling at places) and hypopigmented atrophic macules. Our patient also had nail, oral, and mucosal pigmentation that have not been described. Amyloid deposits were shown histopathologically in both hyperpigmented and hypopigmented macules.
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Affiliation(s)
| | - Anita Marak
- Department of Dermatology and STD, Lady Hardinge Medical College. New Delhi, India.
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Hadi A, Stern D. Acquired Idiopathic True Transverse Leukonychia. Skinmed 2017; 15:315-317. [PMID: 28859750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 34-year-old man from Djibouti presented with a 14-year history of relapsing and remitting transverse white bands on the fingernails with sparing of the toenails. Examination revealed several transverse, white bands following the contour of the lunula on seven of his fingernails that did not fade upon compression of the digits (Figure). There was no onycholysis. No other skin lesions were noted. The patient reported having lived for 4 years (2000-2004) in a house that had well water as its primary water supply. This 4-year period was a stressful point in our patient's life. During that time, he had been a student at university. He had had no reported occupational exposure to arsenic. He reported being a cigarette smoker since 1996 but denied any illicit drug use or alcohol consumption. His past medical history was significant for hepatitis A infection, but he denied any history of systemic illness, including renal disease, heart disease, and lung disease. He denied any family history of leukonychia. He denied any trauma or participation in activities that require excessive use of his hands, and also denied manipulation of the cuticles. The patient's liver function tests, lipid panel, complete blood count, and urinalysis were all within normal limits. A blood test revealed normal arsenic levels. Histologic examination of the nail plate showed segmental parakeratosis, with no evidence of fungal organisms upon PAS staining.
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Affiliation(s)
- Ali Hadi
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY;
| | - Dana Stern
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
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Loh TY, Cohen PR. An unusual presentation of seborrheic keratoses in a man with hereditary hemochromatosis. Dermatol Online J 2017; 23:13030/qt0xn124r8. [PMID: 28541873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/19/2017] [Indexed: 06/07/2023] Open
Abstract
Hereditary hemochromatosis is an autosomal recessive disorder that disturbs iron metabolism and results in iron deposition throughout the body. Iron accumulation in various organs may cause a wide range of systemic symptoms and cutaneous manifestations of the disease are particularly striking. Classically, hereditary hemochromatosis has been termed "bronze diabetes." Although diffuse hyperpigmentation is a well-described feature of this disease, other cutaneous symptoms may also occur, and a variety of anomalies may be observed. We present a case of long-standing hereditary hemochromatosis associated with hypopigmented plaques, which were found to be seborrheic keratoses on histologic examination. The cutaneous findings in hereditary hemochromatosis are summarized and an unusual case of seborrheic keratosis manifesting as hypopigmented plaques in a man with hereditary hemochromatosis is described. PubMed was used to search the following terms: hemochromatosis, hereditary, hyperpigmentation, hypopigmentation, keratosis, melanin, seborrheic, siderosis. Despite the generalized hyperpigmentation that is usually observed in hereditary hemochromatosis, seborrheic keratosis may present rarely as hypopigmented lesions in individuals affected by this disease. Therefore, seborrheic keratoses should be considered in the differential diagnosis in hemochromatosis patients who present with uncharacteristic pigmentation.
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Affiliation(s)
- Tiffany Y Loh
- School of Medicine, University of California San Diego, La Jolla, California.
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Hudson A, Carroll B, Kim SJ. Folliculocentric tinea versicolor. Dermatol Online J 2017; 23:13030/qt5kj574bd. [PMID: 28329492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 02/16/2017] [Indexed: 06/06/2023] Open
Abstract
Tinea versicolor (TV) is typically an asymptomatic fungal infection of the stratum corneum owing to Malassezia overgrowth. It presents as hypo or hyperpigmented macules with fine scale that coalesce into patches on the trunk, neck, and/or arms. Presented in this report is a 34-year-old man with an interesting case of folliculocentric tinea versicolor manifesting as perifollicular hypopigmented macules on the lower back.
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Affiliation(s)
- Andrew Hudson
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock.
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Marinello E, Dan G, Linder DM, Fortina AB, Peserico A, Piaserico S. Symmetrical, Hypopigmented Papules and Plaques on the Palms Induced by Contact with Water: A Quiz--Aquagenic Wrinkling of the Palms. Acta Derm Venereol 2016; 96:575-6. [PMID: 26576727 DOI: 10.2340/00015555-2293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sami L, Changzheng H, Yan L. Factors affecting response, number of laser sessions and complications in nevus of Ota treated by Q-switched alexandrite laser: a retrospective study. GIORN ITAL DERMAT V 2016; 151:160-168. [PMID: 25747257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The aim of this study was to study and analyze the factors influencing the treatment response to Q-switched alexandrite laser in patients with nevus of Ota and the factors influencing the number of laser sessions. METHODS Forty-eight patients treated with Q-switched alexandrite between 2009 and 2013 for nevus of Ota were enrolled in this retrospective, single-center study. The subjects (13 male, 35 female) were divided into three groups according to the number of treatment sessions. Patients were then called back to the hospital for a follow-up interview and examination. Single and multiple variate analyses of various factors were performed. RESULTS The 48 patients were predominantly female (35 female, 13 male, F:M ratio = 2.7:1), mean age 17.2±10.41. Twenty-five (52.1%) had lesion on the right side of the face, 22 (45.8%) on the left side, and one (2.1%) on both sides. The predominant color was brown (41.7%), followed by cyan (39.6%) and lividity (18.8%). Satisfactory result was observed in all patients, after 3 to 11 treatment sessions (mean 5.37±2); 19 of these (39.6%) needed three to four sessions (short treatment sessions), 22 (45.8%) needed five to seven sessions (intermediate treatment sessions), and 7 (14.6%) needed nine to eleven sessions (long treatment sessions). The clinical response and treatment sessions of the young-age group were significantly better than the adult group. Those with higher Tanino's classification needed more treatment sessions. Dark-colored lesions, which reflect deep melanosis of the lesion, needed more sessions than lighter-colored lesions. As for skin color, better response was obtained in light-skinned patients than in dark-skinned ones. Two patients showed transient hypopigmentation that lasted for less than six months, and recurrence has been seen in one child with dark-colored lesion. CONCLUSIONS Q-switched alexandrite laser is an ideal minimally-invasive method for treating nevus of Ota. Fewer treatment sessions are needed for children and younger patients, whereas brown lesion, lower Tanino's classification and light skin patients.
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Affiliation(s)
- Loai Sami
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China -
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Gualandri L, Boccardi D, Menni S. A different approach for identifying hypomelanotic macules in tuberous sclerosis complex. GIORN ITAL DERMAT V 2015; 150:501-503. [PMID: 26333551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM Tuberous sclerosis complex is a neurocutaneous syndrome with an autosomal dominant pattern of inheritance and a high percentage of sporadic cases. One of the most interesting thing about tuberous sclerosis complex is the earliest skin manifestation represented by the hypomelanotic patches. These lesions may be difficult to diagnose. In our article we provide a different diagnostic tool in order to increase the likely of right identification of these lesions. METHODS We used a modified starch-iodine, applied on the hypomelanotic patches of the patient and on the normal skin. It allowed to show a decreased sweat production by eccrine glands in hypomelanotic macules in TSC. This test has not been standardized yet, but it is simple and inexpensive. RESULTS Three patients of pediatric age and 1 adult patient affected by tuberous sclerosis complex were enrolled. The test put in evidence a decreased activity of the sweat glands. CONCLUSION The hypomelanotic patches are very common in tuberous sclerosis complex, and sometimes are the only earliest sign with few elements of this syndrome. There are different diagnostic tools like skin biopsies, but they are invasive and not always easy to perform. The opportunity of a simple and unexpensive test for helping in the right diagnosis of this syndrome should be considered.
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Affiliation(s)
- L Gualandri
- Dermatologic Clinic, University of the Study of Milan San Paolo Hospital, Milan, Italy -
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Eke U, Bailey K, Gach JE. Linear scleroderma associated with neurofibromatosis type I. Cutis 2015; 96:E17-E18. [PMID: 26367758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Ure Eke
- University Hospital Birmingham, Edgbaston, Birmingham B15 2TH, United Kingdom.
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Moser A, Lautenschlager S. [CME Dermatology. Pruritus and white lesions of the trunk. Lichen sclerosus]. Praxis (Bern 1994) 2015; 104:760-761. [PMID: 26135730 DOI: 10.1024/1661-8157/a002048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Andreas Moser
- 1 Dermatologisches Ambulatorium, Stadtspital Triemli, Zürich
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Tejera-Vaquerizo A, Arias-Santiago S, Nagore E, Martín-Cuevas P, Orgaz-Molina J, Traves V, Herrera-Acosta E, Naranjo-Sintes R, Guillén C, Herrera-Ceballos E. Defining the dermoscopic characteristics of fast-growing cutaneous melanomas. Melanoma Res 2015; 25:269-72. [PMID: 25919929 DOI: 10.1097/cmr.0000000000000157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A high growth rate in melanomas has been associated with a more aggressive phenotype and worse survival. The aim of this study was to define the dermoscopic characteristics associated with this type of cutaneous melanoma. We carried out a retrospective study of 132 cutaneous melanomas, analyzing certain clinical characteristics and the most important dermoscopic variables related to the melanomas. Fast-growing melanomas were considered to be those with a growth rate of more than 0.5 mm per month. Fast-growing melanomas more often lacked an atypical network, were symmetrical, presented ulceration, and were hypopigmented. The dermoscopic vascular pattern often showed atypical irregular vessels and milky-red areas. The association of these two is a specific characteristic. Fast-growing melanomas have a characteristic phenotype and dermoscopy can be useful for their identification.
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Affiliation(s)
- Antonio Tejera-Vaquerizo
- aUnidad de Gestión Clínica de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Málaga bServicio de Dermatología, Hospital Universitario San Cecilio cServicio de Dermatología dServicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, Spain
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Beutler BD, Cohen PR. Tobacco-associated yellow discoloration of upper lip hair: smoker's mustache. Dermatol Online J 2015; 21:13030/qt8ck911z0. [PMID: 26295850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 05/18/2015] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Hair is susceptible to exogenous sources of discoloration. There are several exogenous etiologies for yellow hair discoloration, including tobacco. PURPOSE We describe the clinical features of five men with tobacco-associated yellow discoloration of their mustache, a condition known as "smoker's mustache." We also review the characteristics of men with tobacco-associated yellow discoloration of their scalp or mustache hair. MATERIALS AND METHODS The features of five men with smoker's mustache are presented. Using PubMed, the following terms were searched and relevant citations assessed: 4-4'-methylenedianiline, acid, dithranol, MDA, mustache, nicotine, picric, resorcin, smoker, tar, tobacco, and yellow. In addition, the literature on smoker's mustache is reviewed. RESULTS Smoker's mustache was an incidental finding and not the reason for patients presenting for medical attention. The condition was asymptomatic. In our patients, 60% (3 of 5) also had tobacco-related clinical findings on the distal soft tissue and/or nails of their fingers. CONCLUSION Smoker's mustache refers to tobacco-associated discoloration of the hair of the upper lip of men. It is an asymptomatic condition that usually presents as an incidental finding. Indeed, patients tend to be unaware of the condition until it is brought to their attention. In addition to hair manifestations, patients may also demonstrate other tobacco-associated skin and nail findings, particularly brown or yellow-brown discoloration of their fingertip and/or fingernail. We postulate that discontinuation of smoking would eventually result in spontaneous resolution of the condition. However, all of our patients were determined to continue smoking.
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Affiliation(s)
- Bryce D Beutler
- University of Nevada, Las Vegas, School of Allied Health Sciences
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Tolkachjov SN, Comfere NI. Hypopigmented mycosis fungoides: a clinical mimicker of vitiligo. J Drugs Dermatol 2015; 14:193-194. [PMID: 25689815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hypopigmented mycosis fungoides (HMF) is a rare variant of cutaneous T-cell lymphoma (CTCL) that often manifests in younger patients with darker skin types in a centripetal distribution.(1) Average age of diagnosis is often 14 years.(2) The diagnosis is often missed due to its low incidence and lack of clinical suspicion. Misdiagnosis and failure to obtain biopsies lead to a long latency period from onset of hypopigmented patches to diagnosis and treatment. HMF has a clinically benign course and responds well to therapy; however, relapse is common.(3) We report a case of HMF misdiagnosed as vitiligo in order to illuminate diagnostic, histopathological, and treatment modalities.
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Al-Dawsari NA, Shahab RK. Amyloidosis cutis dyschromia: a rare form of primary cutaneous amyloidosis. Dermatol Online J 2014; 20:22328. [PMID: 24746296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 04/11/2014] [Indexed: 06/03/2023] Open
Abstract
Amyloidosis cutis dyschromia is a rare form of primary cutaneous amyloidosis. Amyloid deposition in the skin occurs without systemic manifestations and produces hypopigmented and hyperpigmented macules. A 19-year-old woman is presented with progression of this condition over 16 years.
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Al Mohizea S. The effect of menstrual cycle on laser induced hyperpigmentation. J Drugs Dermatol 2013; 12:1335-1336. [PMID: 24301233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Laser induced post inflammatory hyperpigmentation PIH, is a complication seen mostly in dark skinned patients, it is not known whether giving the laser treatment at specific menstrual period days, may predispose to PIH. METHODS Seven volunteers underwent fixed fractionated CO2 laser treatments at four predetermined days spanning the menstrual cycle. RESULTS Two volunteers developed hypopigmentation while the rest had hyperpigmentation. In those who developed PIH, the pigmentation was most severe when done just before or after menstruation. CONCLUSIONS Laser induced PIH risk may be influenced by the menstrual cycle.
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García-Romero MT, Taylor G, Laxer R, Pope E. Hypopigmented micropapules in apparently quiescent morphea lesions: a manifestation of disease activity. Dermatol Online J 2013; 19:19268. [PMID: 24021446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/13/2013] [Indexed: 06/02/2023] Open
Abstract
We present two young patients with morphea or localized scleroderma undergoing systemic treatment, who developed papular lesions on pre-existing sclerotic plaques. Histology was compatible with a papular presentation of morphea and other entities in the differential diagnosis were ruled out. We believe this is a very uncommon presentation of activity in lesions of morphea and should be made known to clinicians so that activity and progression of the disease can be recognized and treated to avoid complications.
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Affiliation(s)
- Elizabeth Juhas
- Department of Dermatology, University of Pittsburgh, 200 Lothrop St, Pittsburgh, PA 15213, USA
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49
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Sehgal VN, Sharma S. Borderline tuberculoid evolving across the leprosy spectrum. Skinmed 2013; 11:49-50. [PMID: 23540078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Virendra N Sehgal
- Dermato-Venereology (Skin/VD) Center, Sehgal Nursing Home, Panchwati, Delhi, India.
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Patrizi A, Raone B, Raboni R, Neri I. Efficacy and tolerability of a cream containing AR-GG27® (sorbityl furfural palmitate) in the treatment of mild/moderate childhood atopic dermatitis associated with pityriasis alba. A double-blind, placebo-controlled clinical trial. GIORN ITAL DERMAT V 2012; 147:1-8. [PMID: 23007324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM Pityriasis alba (PA) is a skin disorder characterized by finely scaly, hypopigmented patches, typical of childhood, that also represents an atopic dermatitis (AD) minor sign according to Hanifin and Rajka criteria. It may be isolated or associated with AD representing, sometimes an atypical manifestation of AD during the long-term follow-up of the disease. Aim of the study was to evaluate of the efficacy and tolerability of AR-GG27® (sorbityl furfural palmitate) cream in the treatment of childhood mild or moderate AD associated with PA. METHODS The trial is a single center, double-blind, randomized, placebo-controlled study. The study included patients of both sexes, aged between two months and 15 years, suffering from mild and moderate AD always associated with PA. Xerosis was present in all patients. The treatment with topical steroids or topical calcineurin inhibitors (TIMs) had to be suspended for at least 15 days. Any systemic therapy and phototherapy or sun exposure were withdrawn at least 30 days before. Emollients were stopped at least seven days before. During the trial, no other local or systemic treatments were allowed, as well as sun exposure. Patients affected by AD with viral, bacterial or fungal overinfection or patients with diabetes mellitus, severe systemic diseases or intolerance to one or more components of the product were excluded. The primary endpoint was the evaluation of the average change in the Investigator Global Assessment (IGA) after 15 and 30 days of treatment. The second endpoint was the evaluation of severity of three different clinical signs: erythema, excoriation desquamation, using a subjective five-point scale. Changes in pruritus severity was also considered during the entire period of treatment, through the use of a Visual Analogue Scale (VAS). A P<0.05, two tailed was considered as statistically significant. RESULTS After 15 and 30 days there was a statistically significant difference in the group treated with AR-GG27®, compared to the placebo (respectively, P=0.0007 and P=0.005). After 15 days of treatment, itching was clearly reduced in AR-GG27® treated group compared with the placebo, both in the study population (P=0.01) and in patients where the symptom was present from the beginning (P=0.05). CONCLUSION AR-GG27® showed a beneficial action associated with high compliance and tolerability in dermatological skin conditions characterized by inflammation and tissue oxidative stress in children, as PA with mild and moderate AD.
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Affiliation(s)
- A Patrizi
- Department of Internal Medicine, Aging and Nephrology, Policlinico S. Orsola Malpighi, Bologna, Italy.
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