[Dyschromic forms of erythema].
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The analysis shows that apart from the relative hyperpigmentation of the "black" skin (genetically determined and variable according to ethnic group, age, sex and solar exposure), which determines the secondary dyschromic reactions to the majority of the dermatosis, and, except the differences of frequency of diseases related especially to geographical or epidemiologic determinisms, there is no true specificity although some entities are little or not described on "white" skin (dermatosis papulosa nigra, acral punctuated hyperkeratosis, progressive macular hypomelanosis of the trunk, acne keloidalis, pseudofolliculitis barbae, aïnhum...).
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Laser beams have been in common use for the treatment of hyperpigmented skin lesions. However, therapeutic efficacy has been limited mainly because the output is circular with a Gaussian distribution of intensity, which makes it difficult to apply a uniformly distributed dose to the lesions. We have developed a technique whereby a laser beam is converted to have a square and uniform output intensity distribution. The principle of this technique is that the divergent laser beam enters a glass square pillar, propagates through the pillar repeating the total reflection and emerges with a uniform intensity distribution over the cross-section at the end of the pillar. The device applied this technique is incorporated in a hand-piece and both ruby and argon laser systems have been developed. The ruby laser has been used for the treatment of the melanistic skin lesions such as nevus cell nevus and nevus spilus. In clinical application, 36 of 67 cases have shown remarkably effective results with an improvement rate of 53.7%. The argon laser has been used for the treatment of vasogenic skin lesions such as portwine stain. In clinical application, 44 of 66 cases have shown effective results and the improvement rate is 66.7%. These results are excellent when compared with the other methods of treatment and with laser therapy previously used.
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Recent evidence suggests that pigmentary dispersion syndrome is a result of the mechanical abrasion of the posterior iris surface and the anterior zonular fibers causing pigmentary release onto the ocular structures. Irreversible glaucomatous changes may be the result of the inability of the endothelial cells lining the trabecular beams to continue to phagocytize the release pigment. Glaucomatous field changes may occur despite low intraocular pressures and no clinically observable cupping. Visual field testing is indicated in any patient presenting with pigmentary dispersion syndrome since pressure spikes inducing nerve damage occur with stress, exercise, or prolonged mydriasis. Treatment may include miotics to prevent further abrasion rather than typical pressure-lowering medication.
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A maculo-hypochromic condition is not rarely seen in brown-skinned adolescents and young adults, that may spread over the skin of the trunk, specially the lumbar, sacral and epigastric regions assuming a considerable psychologic important. It is generally confused with pityriasis versicolor or its hypochromic sequelae. The histologic and genetic study of the condition remains undone. It is provisionally considered among genodermatoses and the name cutis trunci variata is being proposed for it.
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A neonate born of black parents displayed a congenital, dramatic deficiency of most of his normal pigmentation. This was accompanied by a markedly dilated colon and various other defects. Light- and electron-microscopic examination revealed a deficiency in melanin content in the hypopigmented skin as compared to the normally pigmented areas. No other defects were noted. The possibility exists that a single aberration in neural crest development, a neurocristopathy, might be responsible for our patient's multiple congenital defects. Similar conditions in veterinary medicine and human disease are reviewed and compared to this case.
The color of an individual's skin is an inherited trait, poorly understood in any real genetic sense and likely to remain so in the outbred populace. Pigmentary anomalies are assignable either to hyperpigmentation (melanoderma, ceruloderma) or hypopigmentation (leukoderma). This article briefly reviews such anomalies.
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A case characterized by a dark pigmentation of the skin with an initial hypotension and a lung tuberculosis in the remote anamnesis is described. The skin pigment was formed by lipofuscin and emosiderin, but only the former was found in the liver biopsy. Anyway, the pigment was not melanine and the surrenalic function of the patient was completely normal; therefore, an Addisonism syndrome is excluded. The patient was treated for a very long time with DOCA: this caused hypertension, probably supported by the hypervolemia triggered by the DOCA depending retenction of sodium and water. A sure diagnosis of the case was not made, but an Addisonism syndrome was certainly excluded.
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A case of incontinentia pigmenti achromians syndrome with associated abnormalities occurring in a 21-year-old woman is reported. Since birth she has had whorling macular, hypopigmented areas on the skin of the lateral, anterior, and posterior aspects of the trunk. Histopathological picture: the melanocytes in the depigmented areas are slightly reduced in number. Some of the associated abnormalities that she exhibits, such as coarse curly hair on her scalp, and pigmented spots in her left iris, have never before been described. Other of her symptoms--thick lips and myopia--have been reported earlier. The patient's mother, 15-year-old sister and 9-year-old brother showed, from birth, brown hyperpigmented maculae on the left halves of their bodies.
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