Hyperpigmentation

Description:

 

Darkening patches on the skin can result in great distress for the patient. However, definitive diagnosis between the many possible causes and effective treatment can be very hard for the medical practitioner to achieve. This is the first major professional reference with systematic coverage of diagnosis and the various treatment options, and it will be an indispensable clinical reference.

 

Table of Contents:

 

Section I Histology, Physiology, and Pathophysiology of Skin Pigmentation

Chapter 1 Color of skin

Introduction

Biology of skin color

Mechanism of melanin synthesis

Melanosome transport and transfer to keratinocytes

Racial and ethnic differences in skin color

Geographic variation

Genetics of skin color

Sexual dysmorphism

Skin color and skin typing

Measurement of skin color

Skin color and vitamin D

Skin color and folate

Skin color and photoaging

Skin color and cancer

Skin color and tanning

Skin color and discrimination

Disorders of skin color

References

Chapter 2 The melanocyte and melaninogenesis

The melanocyte

Melaninogenesis

Pathways regulating melaninogenesis

Regulatory proteins

Ultraviolet radiation

Paracrine melanogenic regulators

Other melanogenic stimulators

Melanogenic inhibitors

References

Chapter 3 Melanin

Historical background

Melanin

Chemical and physical properties

Site of melanin synthesis and storage

Extracutaneous melanin

Melanin metabolism

Detection of melanin (Special Stains for melanin)

Melanin pigment functions in health and diseases

Normal variations and differences in skin melanization

Gender

Age

Health

Melanin role in pigmentary and nonpigmentary disorders

References

Chapter 4 Pathophysiology of hyperpigmentation

References

SectionIIDisorders of Hyperpigmentation

Chapter 5 Melasma

Introduction

Pathogenesis

Clinical presentation

Diagnosis and differential diagnosis

Treatments for melasma

General measures and sun protection

Topical bleaching agents

Hydroquinone

Nonphenolic compounds

Combination formulas

Lasers and other therapies

Experimental therapies (

Maintenance treatment for melasma

References

Chapter 6 Erythema dyschromicum perstans

Introduction

History

Epidemiology

Pathophysiology

Clinical presentation

Histology

Laboratory findings

Differential diagnosis

Treatment

References

Chapter 7 Lichen planus pigmentosus

Introduction

Epidemiology

Etiology: Pathogenesis

Clinical manifestation

Histopathology

Dermatoscopy

Diagnosis

Differential diagnosis

Therapy

Prognosis

References

Chapter 8 Primary localized cutaneous amyloidosis

Introduction

Etiology: Pathogenesis

Clinical manifestations

Histopathology

Macular and lichen amyloidosis

Nodular amyloidosis

Use of special stains

Treatment

References

Chapter 9 Mastocytosis

Terminology and classification of mastocytosis

Pathogenesis

Molecular mechanisms

Heritability

Clinical manifestations

Skin signs and symptoms

Maculopapular cutaneous mastocytosis

Diffuse cutaneous mastocytosis

Skin mastocytomas

Symptoms rising from mediator release

Allergic reactions and anaphylaxis

Gastrointestinal symptoms

Neuropsychiatric symptoms

Musculosceletal symptoms

Therapeutical interventions in cutaneous mastocytosis

General measures

Pharmacological treatment

Prognosis

Infants and young children of

Older children and adults

References

Chapter 10 Pityriasis versicolor

Introduction

Microbiology (

Pathogenesis

Clinical features

Diagnosis

Confirmation of the diagnosis

Role of culture

Differential diagnosis

Treatment

Topical treatments

Nonspecific antifungal agents

Specific topical antifungal agents

Oral treatments

Prophylactic treatment

References

Chapter 11 Atrophoderma of Pasini Pierini

Introduction

Causes: Pathogenesis

Physical

Histological features

Laboratory studies

Differential diagnosis

Comorbidities

Treatment

Follow-up

References

Chapter 12 Poikiloderma of Civatte

Introduction

Epidemiology

Etiology and pathogenesis

Clinical presentation and course

Histopathology and electron microscopy

Differential diagnosis

Treatment

Prevention

References

Chapter 13 Pigmented nonmelanocytic skin lesions

Introduction

Lentigo

Lentigo simplex

Solar lentigo

Ink-spot lentigo

Oral and labial melanotic macules

Vulvar and penile lentigo

Syndromes characterized by the development of multiple lentigines

Xeroderma pigmentosum

LEOPARD syndrome

Peutz–Jeghers syndrome

Laugier–Hunziker syndrome

Myxoma syndrome

Carney syndrome

Dermoscopy features

Seborrheic keratosis

Clinical features

Histopathology

Dermoscopy features

Acanthotic type

Reticulated type

Verrucous type

Clonal SK

Melanoacanthoma

Lichen planus–like keratosis

Irritated SK

Pigmented basal cell carcinoma

Nevoid basal cell carcinoma syndrome

Bazex syndrome

Histopathology

Clinical presentation

Dermoscopy

Pigmented actinic keratosis

Clinical presentation

Histopathology

Dermoscopy

Pigmented squamous cell carcinoma

Clinical presentation

Histopathology

Dermoscopy

Pigmented intraepidermal carcinoma

Dermoscopy of invasive squamous cell carcinoma

Dermatofibroma

Clinical presentation

Histopathology

Dermoscopy

References

Chapter 14 Drug-induced hyperpigmention

Introduction

Pathogenesis

Clinical manifestation and course

Main drugs implicated in causing skin pigmentation

Tetracycline and tetracycline group

Retrovirals

NSAIDs

Antimalarials

Antiarrhythmics

Cytotoxic drugs

Metals and heavy metals

Psychotropic drugs

Anticonvulsants

ACTH

Carotene

Diagnostic points

Morphology

Treatment (

References

Chapter 15 Postinflammatory hyperpigmentation

Background

Epidemiology

Etiology

Pathogenesis

Clinical features

Diagnosis

Differential diagnoses

Therapy

Conclusion

References

Chapter 16 Linear hyperpigmentation

Pigmentary demarcation lines (futcher’s line and voigt’s line)

Definition

Epidemiology

Pathophysiology

Clinical features

Classification and location

Extracutaneous signs

Histopathology

Differential diagnoses

Treatment

Linear and whorled nevoid hypermelanosis

Definition

Epidemiology

Pathophysiology

Clinical features

Extracutaneous signs

Histopathology

Differential diagnoses

Treatment

Linear morphea or en coup de sabre

Definition

Epidemiology

Pathophysiology

Clinical features

Extracutaneous signs

Histopathology

Differential diagnoses

Treatment

Acquired Blaschkoid dermatitis

Definition

Epidemiology

Pathophysiology

Clinical features

Extracutaneous signs

Histopathology

Differential diagnoses

Treatment

Linear epidermal nevus

Definition

Epidemiology

Pathophysiology

Clinical features

Epidermal nevus syndromes

Complications of epidermal nevi

Extracutaneous signs

Histopathology

Differential diagnoses

Treatment

Becker’s nevus

Definition

Epidemiology

Pathophysiology

Clinical features

Malignancy

Extracutaneous signs

Histopathology,

Differential diagnoses

Treatment

Linear lichen planus

Definition

Epidemiology

Pathophysiology

Clinical features

Extracutaneous signs

Histopathology

Differential diagnoses

Treatment

Linea nigra

Definition

Epidemiology

Pathophysiology

Clinical features

Extracutaneous signs

Histopathology

Differential diagnoses

Treatment

Linea fusca

Definition

Epidemiology

Pathophysiology

Clinical features

Extracutaneous signs

Histopathology

Differential diagnoses

Treatment

Lichen striatus

Definition

Epidemiology

Pathophysiology

Clinical features

Extracutaneous signs

Histopathology

Differential diagnoses

Treatment

Linear postinflammatory hyperpigmentation

Definition

Epidemiology

Pathophysiology

Clinical features

Extracutaneous signs

Histopathology

Differential diagnoses

Treatment

Linear hyperpigmentation following chemotherapy

Epidemiology

Pathophysiology

Clinical features

Extracutaneous signs

Histopathology

Differential diagnoses

Treatment

Pigmentary lines of the newborn

Definition

Epidemiology

Pathophysiology

Clinical features

Extracutaneous signs

Histopathology

Differential diagnoses

Treatment

Heel-line or sock-line hyperpigmentation

Definition

Epidemiology

Pathophysiology

Clinical features

Extracutaneous signs

Histopathology

Differential diagnoses

Treatment

References

Chapter 17 Flagellate hyperpigmentation

Introduction

Bleomycin-induced flagellate dermatitis

Flagellate dermatitis associated with dermatomyositis

Shiitake dermatitis (toxicoderma): flagellate dermatitis triggered by shiitake mushroom ingestion

Other etiologies

Treatment

References

Chapter 18 Reticular hyperpigmentation

Introduction

Histopathogy

Diseases presenting with reticular hyperpigmentation in childhood

Diseases presenting with localized distribution of reticulate hyperpigmentation

Reticulate acropigmentation of Dohi (OMIM: 127400)

X-linked reticulate pigmentary disorder (OMIM: 301220)

Incontinentia pigmenti (OMIM: 308300)

Diseases presenting with widespread distribution of reticulate hyperpigmentation

Dyschromatosis universalis hereditaria

Epidermolysis bullosa simplex with mottled pigmentation (OMIM: 131960)

Dermatopathia pigmentosa reticularis (OMIM: 125595)

Naegeli–Franceschetti–Jadassohn syndrome (OMIM: 161000)

Dyskeratosis congenita

Diseases presenting with reticular hyperpigmentation in adolescence or adulthood

Diseases presenting with localized distribution of reticulate hyperpigmentation

Acropigmentation of Kitamura (OMIM: 615537)

Dowling–Degos disease (OMIM: 179850)

Galli–Galli disease

Lichen planus pigmentosus

Confluent and reticulate papillomatosis of Gougerot and Carteaud (OMIM: 167900)

Ashy dermatosis: Erythema dyschromicum perstans

Prurigo pigmentosa

References

Chapter 19 Genodermatoses

Introduction

Disorders with Increased Number of Epidermal Melanocytes

Disorders with increased number of dermal melanocytes

Disorders with Increased Melanin Levels

Disorders With Pigment Incontinence

References

SectionIIIDiagnosis and Differential Diagnosis

Chapter 20 Clinical examination

Introduction

Clinical Exam in Hyperpigmentations

Acquired hyperpigmentations

Melasma

Riehl melanosis: Toxic melanodermatitis

Poikiloderma of Civatte

Infraorbital dark circles

Acanthosis nigricans

Confluent and reticulated papillomatosis

Postinflammatory hyperpigmentation

Conclusion

References

Chapter 21 Wood’s lamp

Introduction

Mechanism of Action

Disorders of Pigmentation

Hypocromic and acromic disorders

Hypercromic disorders

Porphyrias

Skin Infections

Fungi

Bacteria

Other Uses

Conclusion

References

Chapter 22 Dermoscopy

Melanotic macules

Solar lentigo

Ink-spot lentigo

Labial melanotic macule

Mucosal melanotic macule

Cutaneous mastocytosis

Primary cutaneous amyloidosis

Regressing lichen ruber planus: ashy dermatosis

Melasma

Pigmentation within a scar

Tinea nigra

Onychomycosis

Nevoid lentigo of the nail unit

Laugier–hunziker syndrome

Subungual hemorrhage and subungual hematoma

Drug-induced nail pigmentation

Exogenous blue pigmentation

References

Chapter 23 Histopathology

Introduction

Hyperpigmentation in the cornified layer

Self-tanning products

Terra firma-forme dermatosis (dermatosis neglecta)

Tinea nigra

Pityriasis versicolor

Pigmented cornification above melanocytic neoplasms

Hyperpigmentation of the epidermis

Melanotic macule of the lip and benign melanosis of the vulva and penis

Ink-spot lentigo

Café-au-lait macule

Ephelides

Melasma

Becker’s nevus

Acanthosis nigricans

Confluent and reticulate papillomatosis (Gougerot–Carteaud)

Dowling–Degos disease

Galli–Galli disease

Solar lentigo

Seborrheic keratosis

Dermatosis papulosa nigra

Epidermal nevus

Late-stage morphea

Dermatofibroma

Mastocytosis

Notalgia paraesthetica

Pigmentation in the dermis or deeper tissues

Postinflammatory hyperpigmentation

Ashy dermatosis (erythema dyschromicum perstans)

Prurigo pigmentosa, late

Macular amyloidosis

Incontinentia pigmenti, late

Pigmented purpuric dermatoses

Hemochromatosis

Nevus of Ota, nevus of Ito, and Mongolian spot

Ochronosis (alkaptonuria)

Exogenous ochronosis

Minocycline hyperpigmentation

Argyria

Tattoo

References

Chapter 24 Reflectance confocal microscopy

Introduction

RCM findings in melasma

Conclusions

References

Chapter 25 Spectrophotometry

Introduction

Tristimulus reflectance colorimetry

Narrowband spectrophotometers

Tristimulus colorimetry versus narrowband spectrophotometers

Siascopy

Spectrophotometry and hyperpigmentary disorders

Conclusions

References

Chapter 26 Diagnostic algorithms

Introduction

Epidemiology

Clinical findings

Localized hyperpigmentation

Diffuse hyperpigmentation

History

Histopathology

Wood’s lamp examination

Dermoscopy

Conclusions

References

Chapter 27 Differential diagnoses of circumscribed and diffuse hyperpigmentation

Introduction

Taking steps toward diagnosis in disorders of color

Step 1: Demarcation

Step 2: Presence at birth

Step 3: Clinical morphology

Distribution

Color

Infiltration

Border or margin

Step 4: Dermoscopic features

Dermoscopic structures

Vascular patterns in dermoscopy

Step 5: History

Medical history

History of the lesion

Describing color

Features and clues for the diagnosis: Assessment of the hyperpigmented lesions or disorders and differential diagnoses

References

SectionIVTreatment

Chapter 28 Cosmetic camouflage for pigmentation issues

Introduction

Skin Color Issues

Cosmetics and Camouflaging

Facial Foundation Formulations

Oil-based foundations

Water-based foundations

Oil-free foundations

Anhydrous foundations

Facial Foundation Pigments and Specialty Additives

Facial Foundation Camouflaging Properties

Facial Foundation Application Varieties

Camouflage cosmetic application

Adverse Reactions to Camouflage Cosmetics

Camouflage Cosmetics for Skin of Color

Summary

References

Chapter 29 Sunscreens

UV Light

Sunscreens

Mechanism

Agents

Organic screens

Para-aminobenzoic acid and derivatives

Cinnamates

Salicylates

Benzophenones

Other organic screens

Inorganic screens

Other agents

Side Effects

Use of sunscreens after treatment for hyperpigmentation

Sunscreen after laser treatment

Sunscreen and depigmenting cream

Sunscreen after chemical peels

Sunscreen as monotherapy for hyperpigmentation

Sunscreen as prevention after treatment for melasma

References

Chapter 30 Medical therapy

The Principles of Medical Therapy

Introduction

The process of melanin formation

Principles of therapy

Medical Therapy

Sunscreens and sun protection

Sunscreen agents

Topical therapies

Phenolic compounds

Hydroquinone

Mequinol

Retinoids

Tretinoin

Adapalene

Tazarotene

Corticosteroids

Combination therapies and galenic formulations

Azelaic acid

Kojic acid

Ascorbic acid

Undecylenoyl phenylalanine

Arbutin

Other topical depigmenting agents

Chemical peels

Alpha hydroxy peels

Beta hydroxy peels

Conclusions

References

Chapter 31 Chemical peels

Introduction

Definition and Classification of Chemical Peels

Peeling Procedure

Peeling Agents

Alpha-hydroxy acid/GA peels

Beta-hydroxy acids

TCA peels

Phenol peels/peels for photoaging

Conclusions

References

Chapter 32 Cryotherapy

Introduction

Principles Of Cryobiology

Cryogen Selection

Equipment

Dewars

Cryosurgical units

Attachments for cryosurgical units

Other equipment

Cryosurgical Techniques

Preoperative Care

Common Hyperpigmented Skin Conditions Amenable to Cryosurgical Treatment

Benign

Seborrheic keratosis (SK)

Postoperative care

Lentigo simplex, ephelides

Postoperative care

Premalignant Lesions

Actinic keratosis

Postoperative care

Field cancerization

Postoperative care

Malignant Lesions

Where Not To Use Cryosurgery

Possible Complications

References

Chapter 33 Electrosurgery

Introduction

Terminology

Monopolar vs. bipolar

Monoterminal vs. biterminal

Frequencies

Preoperative Evaluation and Preparation

Electrocautery

Types of electrosurgeries (

Electrodesiccation and electrofulguration

Electrocoagulation

Electrosection

Safety Concerns

Cardiac pacemakers/ICDs

Postoperative Management

Complications

Dyschromia and scarring

Thermoelectric burn

Smoke plume

Fire

References

Chapter 34 Lasers

Introduction

Melasma

Photoaging

Nevus of ota

Post-inflammatory hyperpigmentation

Acknowledgments

References

Chapter 35 Intense pulsed light

What is intense pulsed light?

IPL as a therapy for hyperpigmentation

Melasma

Lentigines and ephelides

Poikiloderma of Civatte

Melanocytic lesions and others

Advantages and disadvantages of IPL

Clinical considerations before treatment with IPL

Adverse effects and safety of IPL

References

Index