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PubMedDate not supplied

Acquired anterior ocular melanocytosis following cataract extraction.

The right eye of a 59-year-old man was the subject of extracapsular cataract extraction and posterior chamber lens implantation. He gradually developed superior sectoral scleral and diffuse iris hyperpigmentation within 7 years postoperatively. The iris was also uniformly thickened. He sustained 20/20 visual acuity in the pseudophakic eye. Despite marked pigmentation of the angle, his right intraocular pressure remained within normal limits. We use the term acquired anterior ocular melanocytosis because the pigmentary changes were confined to the anterior segment and the choroid was not involved. We conclude that surgical injury in the form of cataract extraction can induce episcleral/scleral hyperpigmentation and iris hyperchromia.

Anterior Eye Segment↗
PubMed2001

Adapalene gel 0.1% for topical treatment of acne vulgaris in African patients.

Acne vulgaris is a common dermatologic disease in African patients, as well as in Caucasians. Our report evaluates the safety and efficacy of adapalene gel 0.1% in African patients with acne vulgaris. We used a 12-week, 2-center, open-label, noncomparative study of adapalene gel 0.1% in 65 African patients with acne vulgaris to assess the drug's effect on hyperpigmented lesions in people with dark skin. The study demonstrated that the progressive and significant improvements in lesion counts and global acne grades produced by adapalene in African patients were paralleled by significant improvements in the degree of hyperpigmentation of acne lesions. During treatment with adapalene, less than 5% of patients reported moderate or severe skin irritation at any time during the study, and the incidence of skin oiliness decreased markedly. We conclude that adapalene gel 0.1% was well tolerated and highly effective in African patients with acne vulgaris and was found to reduce hyperpigmentation.

Acne Vulgaris↗
PubMed2001

[Survey in 2000: 3 cases].

BACKGROUND: We report three new cases of patients presenting scurvy. In the year 2000 this rare disease still occurs in France. CASE REPORTS: The three patients, 2 men and a woman respectively 51, 50, and 73 years-old were alcoholics, and lived alone in difficult social conditions. Dietary survey indicated in the 3 cases inadequate vitamin C intake, and a regimen including solely bread, rice, pasta, and packet soup devoid of fresh vegetables and fruit. The cutaneous findings attributed to scurvy were: in the first patient, a woody inflammatory and painful oedema of the left leg associated with perifollicular petechial haemorrhages over the lower limbs, and hyperpigmentation of the facial skin with slate-gray spotty pigmentation of the tongue (pseudo-addisonian hyperpigmentation); in the second patient, an accentuation of a pre-existing acne becoming more inflammatory and extensive; and in the third patient, a diffuse petechial eruption on the abdomen and lower extremities. The diagnosis of scurvy was confirmed by low plasma ascorbic acid levels (< 6 mumol/l). All patients were treated with 1 to 2 g of oral ascorbic acid daily for 2 weeks resulting in rapid and dramatic response. DISCUSSION: Scurvy is a rare disease in industrialized nations. Its incidence is unknown because of absence of total census. Dietary vitamin C deficiency represents the main risk factor exposing for scurvy among adults, often alcoholics and living in social isolation. Cutaneous features supporting the diagnosis of scurvy are described in our observations. The recognition of these cutaneous abnormalities is important because their association can be misleading, and erroneously interpreted as a sign of systemic vasculitis, or connective tissue disease. The diagnosis of scurvy is confirmed by the measurement of plasma ascorbic acid levels. Treatment is simple and based on the administration of vitamin C, which results in dramatic improvement.

Aged↗
PubMedDate not supplied

[Griscelli syndrome in México. Description of a case with neurological manifestations].

INTRODUCTION: Griscelli syndrome is a pathological condition with immunodeficiency and is characterised by hepatosplenomegaly, silvery hair, progressive neurological deterioration, hypogammaglobulinemia and pancytopenia. It is inherited by autosomal recessive transmission and is diagnosed using the histopathological findings from a skin biopsy, characterised by hyperpigmentation with accumulations of melanin, associated to the manifestations described. CASE REPORT: We report on the first case identified in Mexico: the patient, who presented silvery hair, hepatosplenomegaly and pancytopenia, was a member of a family with two children and had no noteworthy antecedents. From the ninth month onwards there was a fast progression of the neurological deterioration, which was characterised by epileptic seizures and flaccid quadriparesis that progressed quickly to a state of coma. Magnetic resonance imaging revealed demyelination of the white matter, mainly in the bilateral frontotemporal area; skin biopsy showed hyperpigmentation with accumulations of melanin. CONCLUSIONS: Immunodeficiencies are serious problems, but associated with dermatological, haematological and neurological data, accompanied by findings obtained by paraclinical haematological explorations, by neuroimaging and skin biopsies, it is possible to establish the proper diagnosis in order to improve quality of life and the progress of the disease. This can be achieved by bone marrow transplant (until now the only therapy available) but it must be performed early and not when the disease is at an advanced stage, when the possibility of recovery becomes more remote

Brain↗
PubMed2003

Photorejuvenation of the forearms by treating hyperpigmented lesions with intense pulsed light source: a case report.

UNLABELLED: A 55 year old Spanish patient, photo type III, wanted a cosmetic improvement of her forearms. She disliked the hyperpigmentation which made her look older. METHOD: After having tried several chemical peelings (50% glycolic acid plus 10% kojic acid followed by 15% MM TCA), there was no improvement in the patients's condition and it was decided to initiate intense pulsed light (IPL) treatment. RESULTS: Improvement was noted after the first session, with a slight pink coloration. At two months post treatment, we noted more than 90% clearance of the hyperpigmentation on the treated areas. CONCLUSION: This case report confirms that photorejuvenation, by treating hyperpigmented lesions with intense pulsed light source on extra-facial zones can be very effective and safe.

Female↗
PubMed1992

Hemodynamic deterioration in chronic venous disease.

Clinical deterioration of patients with chronic venous disease (CVD) has been well described and a standardized classification has been proposed. The progressive hemodynamic deterioration producing these clinical findings is less well appreciated. This study examines and correlates venous hemodynamics with clinical severity in patients with CVD. Two hundred seventy-four extremities from 149 patients with varying degrees of CVD and 56 extremities from 28 symptom-free volunteers were evaluated clinically and hemodynamically. Each limb was assessed for functional venous volume, degree of valvular insufficiency, efficiency of the calf muscle pump, and noninvasive estimate of ambulatory venous pressure. In addition, exercise venous pressures were recorded in 56 extremities from 36 patients and 9 extremities from 6 volunteers. As CVD progresses from class 0 to class 2, venous volume expands, valvular function deteriorates, the calf muscle pump becomes inefficient, and ambulatory venous hypertension develops. However, once extremities develop brawny edema or hyperpigmentation, further deterioration of limb hemodynamics does not occur. Patients with deep venous obstruction have more severe valvular insufficiency, calf muscle pump dysfunction, and ambulatory venous hypertension than have patients without evidence of obstruction. Residual volume fraction offers a reliable noninvasive estimate of ambulatory venous pressure (r = 0.76), although its correlation was significantly better for patients without venous obstruction (r = 0.86) than for those with obstruction (r = 0.40; p < 0.05). Deterioration in venous hemodynamics parallels clinical severity through class 2. Once brawny edema and hyperpigmentation occur, ulceration develops without additional deterioration of venous hemodynamics.

Adult↗
PubMed2004

Mucocutaneous complications of chemotherapy in 74 patients from Maharaj Nakorn Chiang Mai Hospital.

BACKGROUND: There have been many reports about mucocutaneous complications of chemotherapy from western countries, but they are only small case series. Until now, there had been no such report in Thailand. OBJECTIVE: We assessed mucocutaneous complications in patients who received chemotherapy. PATIENTS AND METHOD: A total of 74 patients, admitted for chemotherapy from October 2001 to January 2002 in the Internal Medicine Department, Maharaj Nakhon Chiang Mai Hospital, were studied. RESULTS: Of 74 patients (53 male and 21 female), we found a statistically significant relation between gemcitabine and alopecia (p = .020), bleomycin and hyperpigmentation (p = .030), and cytarabine and ichthyosis (< .001). The most common findings were alopecia (76.68%), hyperpigmentation (31.08%), transverse white bands of the nails (22.97%), and ichthyosis (20.27%). Other notable findings included oral mucositis, acne, acral erythema, flushing, onycholysis, urticaria, pruritus, phlebitis and cutaneous infections (including tinea corporis, tinea ungium, and warts). CONCLUSION: Mucocutaneous complications are common in patients who have received chemotherapy. However, a further study with a larger sample size and specified chemotherapy regimen would be valuable.

Adult↗
PubMedDate not supplied

Enhanced full-face skin rejuvenation using synchronous intense pulsed optical and conducted bipolar radiofrequency energy (ELOS): introducing selective radiophotothermolysis.

BACKGROUND: The authors previously reported their experience achieving non-ablative skin enhancement with serial, full-face, intense pulsed light treatments in a large series of patients. A new method for skin renewal electro-optical synergy (ELOS), which combines intense pulsed optical energy and conducted bipolar radiofrequency (RF) energy into a single pulse, has been recently introduced. Intense pulsed optical energy and bipolar RF energy have been used in dermatologic surgery for many years; however, this study represents the therapeutic impact of the combined energies. OBJECTIVE: The authors report their experience using an ELOS system (Aurora SR, Syneron, Yokneam, Israel) on 108 consecutive patients treated with a series of full-face procedures. METHODS: Patients received 5 full-face treatments every 3 weeks. Each treatment consisted of 1 to 8 full-face and segmental passes. The number of passes, specific wavelength of pulsed optical energy, and RF energy were determined by the patient's skin type, dyschromia, wrinkle pathology, and presence of a tan. A total of 540 treatments were performed on 108 subjects. All patients had pre- and post-procedural photographs. Results were assessed by double-blinded physician photographic evaluation and patient satisfaction scales. RESULTS: Overall skin improvement was rated at 75.3%. Overall average wrinkle improvement was 41.2%, with an average Class 1 wrinkle improvement of 64.7%, Class 2 wrinkle improvement of 38.6%, and Class 3 wrinkle improvement of 20.4%. Improvement in skin laxity was rated at 62.9%. Skin texture was reported to improve 74.1%. Improvement in the appearance of pore size was rated at 65.1%. Average improvement in erythema and telangiectasia was 68.4%. Average improvement in hyperpigmentation and dyschromia was 79.3%. Overall patient satisfaction was 92%. The overall minor complication rate, including blistering, crusting, and stripping was 8.3%, and the major complication rate was less than 1%. One small, depressed nasal scar was observed in one patient. CONCLUSIONS: This study demonstrates the safety and efficacy of a new technology using combined optical and conducted bipolar RF energies for noninvasive skin rejuvenation. The results show improvement in wrinkle reduction and amelioration of erythema, telangiectasia, and hyperpigmentation comparable to that reported for other intense pulsed light technologies.

Adult↗
PubMed2005

Dental anomalies in two patients with incontinentia pigmenti.

Incontinentia pigmenti (IP) is a rare X-linked dominant inherited disorder which has a variety of ectodermal aberrations. Skin hyperpigmentation is the most characteristic feature of IP. However, extracutaneous anomalies involving dentition, hair, eyes, and central nervous system are also found. The dental anomalies reported include peg-shaped or malformed teeth, hypodontia, delayed eruption, and impacted tooth. This report describes the dental anomalies in 2 IP patients who had the characteristic features of skin hyperpigmentation. One was a 13-year-old girl who had slender cone-shaped permanent anterior teeth, hypodontia, and delayed eruption of teeth which are characteristic dental anomalies in an IP patient. The other was a 10-year-old girl who only had 2 tulip-shaped maxillary permanent central incisors with shorter tapering roots but no congenital missing teeth or delayed eruption of teeth. Our findings suggest that IP may present a broad variation of dental anomalies individually. However, the characteristic finding of permanent anterior teeth with a longer crown and a shorter root found in both of our IP patients may be worthy of consideration in the differential diagnosis of IP.

Adolescent↗
PubMed1992

Pigmented lesions of the vulva.

Pigmented vulvar lesions, including diffuse hyperpigmentation, are present in 10% to 12% of white women. About 2% of them are nevocellular nevi. In general, nevi on the vulva are identical by morphologic and histopathologic criteria to nevi elsewhere on the body, with the exception of a small subset of nevi in younger women. Nevi in this subset have the unusual features of enlarged junctional nests that are variable in size, shape, and position. The long-term biologic behavior of these nevi has not been determined. Other benign pigmented lesions include lentigines, melanosis, postinflammatory hyperpigmentation, seborrheic keratoses, and warts. Malignant pigmented lesions include some cases of vulvar intraepithelial neoplasia and melanoma. Melanoma of the vulva has a poorer prognosis overall than melanoma on the torso, apparently because of the extent of the disease at the time of diagnosis. Therefore, improving mortality rates depends to some extent on earlier diagnosis. Management of female patients includes careful inspection of the vulva with each full-skin or gynecologic examination, followed by biopsy of any suspicious lesion. The need for excision of benign nevocellular and melanocytic lesions is dependent on the histopathology. Because there are no long-term prospective studies of vulvar melanosis and the group of unusual vulvar nevi, treatment must be individualized.

Diagnosis, Differential↗
PubMed2005

Anterior esthetic gingival depigmentation and crown lengthening: report of a case.

Excessive gingival display space and gingival hyperpigmentation are major concerns for a large number of patients visiting the dentist. Melanin hyperpigmentation usually does not present a medical problem, but patients usually complain of dark gums as unaesthetic. This problem is aggravated in patients with a "gummy smile" or excessive gingival display while smiling. Esthetic periodontal plastic surgery is especially rewarding in such individuals with compromised esthetics. A case is reported here on the cosmetic correction of "black gums" and "gummy smile." Periodontal plastic surgery combining gingival depigmentation and esthetic crown lengthening was performed in a single appointment using scalpel surgical technique. The outline of steps involved in the surgical procedure is demonstrated and a brief review of the various gingival depigmentation techniques is depicted here.

Adult↗
PubMed2006

Prevalence of oral lesions in HIV patients related to CD4 cell count and viral load in a Venezuelan population.

AIM: To determine the prevalence of oral lesions in a HIV+ group of patients, related to CD4 cell count and viral load in a Venezuelan population. MATERIALS AND METHODS: In the present study, we evaluated 75 HIV+ adult patients, attended at the Center of Infectious Diseases, at the Faculty of Dentistry, Central University of Venezuela. Each patient was clinically examined for detection of oral mucosal lesions. In addition, CD4 cell count was determined by flow cytometry, as well as viral load by RT-PCR (Amplicor HIV-RNA, TM test 1.5, Roche). RESULTS: 85% (64/75) of HIV/AIDS patients showed associated HIV lesions. Oral Candidiasis constituted the most common lesion representing a 61% (39/64), followed by Oral Hairy Leukoplakia 53% (34/64); Oral Leukoplakia 34% (22/64), Melanic Hyperpigmentation 38% (18/64); Papilloma 13 (6/64), Lineal Gingival Erythema 8% (5/64); Aphtous Recurrent Stomatitis 5% (4/64) and Kaposi's Sarcoma 5% (3/64). Only one case of the following lesions were represented by Non Hodgkin Lymphoma, Multifocal Epithelial Hyperplasia, Recurrent Herpes, Histoplasmosis and Molluscum Contagiosum. The patients with a viral load of 30.000 copies/mm3 exhibited oral lesions related with HIV, independent of CD4 cell count, although patients with CD4+ levels of 200 cel/mm3 were more susceptible to develop these lesions. CONCLUSIONS: The most common oral lesion was Oral Candidiasis followed by Oral Hairy Leukoplakia, Oral Leukoplakia and Melanic Hyperpigmentation. A high viral load was strongly associated to the oral lesions occurrence independently of CD4+ cell count.

Adult↗
PubMed2005

Acute effects of postmastectomy radiotherapy after immediate TRAM flap reconstruction in breast cancer patients.

OBJECTIVES: To study the acute effects of radiotherapy after mastectomy and immediate transverse rectus abdominis myocutaneous (TRAM) flap reconstruction in breast cancer patients treated at Ramathibodi Hospital. MATERIAL AND METHOD: Between January 2004 and March 2005, ten breast cancer patients (age 32-51 years) were treated with postoperative radiotherapy after mastectomy and immediate TRAM flap reconstruction. Medical records of these patients were retrospectively reviewed. Radiotherapy was delivered to the chest wall and reconstructed TRAM flap using 6-MV x-ray or Cobalt-60. The total dose was 45 to 50.4 Gy delivered in 25 to 28 fractions. Patients were evaluated weekly during the course of radiation and then at 1 and 2 months after treatment completion to determine acute effects or toxicities of radiation. RESULTS: During radiation, 3 patients developed erythema or mild hyperpigmentation of the skin, and 4 developed moderate hyperpigmentation. Three patients who were treated with Cobalt-60 and/or bolus to the chest wall developed skin desquamation (1 dry desquamation, 2 moist desquamation). No patient required a treatment break because of acute side effects. One patient who received chemotherapy after radiation developed recalled moist desquamation. CONCLUSION: Radiotherapy after mastectomy and immediate TRAM flap reconstruction is well tolerated and is not associated with increased acute complication or radiation interruption. The authors have noticed that chemotherapy given after radiation was related to severe skin reaction, so it should be used with caution.

Acute Disease↗
PubMed1991

Phytophotodermatitis due to figs.

Phytophotodermatitis is an acute skin reaction that may be easily confused with other causes of contact dermatitis. It is characterized by sunburn, blisters, and/or hyperpigmentation. The reaction takes place when certain plant substances known as psoralens, after being activated by ultraviolet light from the sun, come in contact with the skin. The condition is usually mild and self-limited but hyperpigmentation may persist for many weeks. Failure to recognize phytophotodermatitis in a child may lead to a mistaken diagnosis of child abuse. It is also important to be aware of perfumes and grocery products as causes of this phenomenon.

Acute Disease↗
PubMed1990

Treatment of a pigmented lesion induced by a Pelagia noctiluca sting.

A young man had persistent hyperpigmentation on the face following a jellyfish (Pelagia noctiluca) sting four years previously. This localized lesion resolved within forty days after topical hydroquinone (1.8 percent) therapy was instituted. This case is presented to demonstrate that persistent hyperpigmentation occurring after coelenterate stings can be treated with a topical bleaching agent.

Administration, Cutaneous↗
PubMed1988

Spreading pigmented actinic keratosis. An electron microscopic study.

Spreading pigmented actinic keratosis is a rarely reported premalignant, pigmented, epidermal tumor that can be difficult to distinguish clinically from other benign and malignant pigmented lesions. In an attempt to determine the cause of clinical hyperpigmentation, seven lesions from five patients were examined by light microscopy. Three of these lesions were also examined using electron microscopy. Findings from these studies indicate that hyperpigmentation is due to enhanced melanosome formation and distribution and not to a melanocyte-keratinocyte melanosome transfer block.

Aged↗
PubMed1989

Hexachlorobenzene episode in Turkey.

During the period 1955-1959, approximately 4000 people in southeast Anatolia developed porphyria due to the ingestion of hexachlorobenzene (HCB), a fungicide added to wheat seedlings. These HCB exposures subsequently led to the development of bullae on sun-exposed areas, hyperpigmentation, hypertrichosis, and porphyrinuria. The condition was called kara yara or "black sore." Many of the breast-fed children under the age of 2 years whose mothers had ingested HCB-treated grain died from a disease known as pembe yara or "pink sore." In this follow-up study of 252 patients, 20-30 years postexposure, there were 162 males and 90 females, with an average current age of 35.7 years, an average of onset of 7.6 years, and a duration of 2.2 years. Many patients had dermatologic, neurologic, and orthopedic symptoms and signs. The observed clinical findings include scarring of the face and hands (83.7%), hyperpigmentation (65%), hypertrichosis (44.8%), pinched facies (40.1%), painless arthritis (70.2%), small hands (66.6%), sensory shading (60.6%), myotonia (37.9%), cogwheeling (41.9%), enlarged thyroid (34.9%), and enlarged liver (4.8%). Urine and stool porphyrin levels were determined in all patients, and 17 have at least one of the porphyrins elevated. A total of 56 specimens of human milk obtained from mothers with porphyria were analyzed for HCB. The average value was 0.51 ppm in HCB-exposed patients compared to 0.07 ppm in unexposed controls. Offspring of mothers with three decades of HCB-induced porphyria appear normal.

Adolescent↗
PubMed1989

[Adrenoleukodystrophy. Diagnosis of a typical case using magnetic resonance].

A case of a two and a half year old boy with unexplained repeated episodes of hyponatremic dehydration and hyperkalemia, as well as noticeable psychomotor retardation and hyperpigmentation is presented. His neurologic development was considered normal until he was two, when he progressively began to regress. Magnetic resonance imaging of the brain showed white matter demyelination and cortical atrophy as well as primary adrenal insufficiency when stimulated with ACTH. Both magnetic resonance imaging and the ACTH stimulation test are useful for the diagnosis of adrenoleukodystrophy. Adrenoleukodystrophy; hyponatremic dehydration; cutaneous hyperpigmentation; white matter degenerative disease; magnetic resonance imaging.

Adrenoleukodystrophy↗