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    Hyperpigmented Disorder

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    ضبيان فرحان
    Hyperpigmentation disorder can be classified as epidermal, dermal, or mixed based on the level of excessive melanin deposition in the skin. Epidermal hyperpigmentation like freckles and lentigines appear as light-brown macules on sun-exposed skin. Dermal hyperpigmentation results in blue-gray pigmentation from melanin or its byproducts in the dermis. Mixed hyperpigmentation involves both the epidermis and dermis. Common causes of hyperpigmentation include sun exposure, certain drugs, hormonal influences like pregnancy, and skin conditions such as melasma. Treatment depends on the cause and may include topical creams, chemical peels, laser therapies, and minimizing

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    Hyperpigmented Disorder

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    ضبيان فرحان
    22 views49 pages
    Hyperpigmentation disorder can be classified as epidermal, dermal, or mixed based on the level of excessive melanin deposition in the skin. Epidermal hyperpigmentation like freckles and lentigines appear as light-brown macules on sun-exposed skin. Dermal hyperpigmentation results in blue-gray pigmentation from melanin or its byproducts in the dermis. Mixed hyperpigmentation involves both the epidermis and dermis. Common causes of hyperpigmentation include sun exposure, certain drugs, hormonal influences like pregnancy, and skin conditions such as melasma. Treatment depends on the cause and may include topical creams, chemical peels, laser therapies, and minimizing

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    Hyperpigmentation disorder can be classified as epidermal, dermal, or mixed based on the level of excessive melanin deposition in the skin. Epidermal hyperpigmentation like freckles and lentigines appear as light-brown macules on sun-exposed skin. Dermal hyperpigmentation results in blue-gray pigmentation from melanin or its byproducts in the dermis. Mixed hyperpigmentation involves both the epidermis and dermis. Common causes of hyperpigmentation include sun exposure, certain drugs, hormonal influences like pregnancy, and skin conditions such as melasma. Treatment depends on the cause and may include topical creams, chemical peels, laser therapies, and minimizing

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    © All Rights Reserved
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    22 views49 pages

    Hyperpigmented Disorder

    Uploaded by

    ضبيان فرحان
    Hyperpigmentation disorder can be classified as epidermal, dermal, or mixed based on the level of excessive melanin deposition in the skin. Epidermal hyperpigmentation like freckles and lentigines appear as light-brown macules on sun-exposed skin. Dermal hyperpigmentation results in blue-gray pigmentation from melanin or its byproducts in the dermis. Mixed hyperpigmentation involves both the epidermis and dermis. Common causes of hyperpigmentation include sun exposure, certain drugs, hormonal influences like pregnancy, and skin conditions such as melasma. Treatment depends on the cause and may include topical creams, chemical peels, laser therapies, and minimizing

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    of 49

    Hyperpigmentation disorder

    AL-MURIESH MAHER , MBBS, MSc, M.D


    Dep. Of Dermatology and Venereology, 21 September
    University of Science & Technology
    Learning objectives

    Understand the classify of hyperpigmentation as


    epidermal, dermal, or mixed hyperpigmentation;

    Common pigmented lesions.

    Identify and describe the major cause of


    melasma

    Common treatment methods for


    hyperpigmentation
    Skin color
    • Determined by : melanin ( major determinant )
    hemoglobin
    carotenoids
    • Melanin is synthesized by melanocytes.
    • Skin color – genetically determined
    Melanin synthesis

    Miroslawa Cichorek et al. Open Life Sciences 8(4):315-330


    Influence on melanin synthesis :

    Skin color

    UV radiation

    Hormonal ( melanocyte stimulating


    hormone by pituitary glands)
    Abnormal skin
    pigments
    Hyperpigmentation
    Hyperpigmentation:
    Hyperpigmentation:

    Epidermal Dermal

    Mixed hyperpigmentation

    • Epidermal hyperpigmentation :light-dark brown,


    • Dermal hyperpigmentation: blue-gray coloration due to the Tyndall effect
    ▪ melanin deposition
    Epidermis
    hyperpigmentation: ▪ increased number of
    melanocytes

    • presence of melanin
    Dermis
    hyperpigmentation • melanophages
    • hemosiderin

    Certain drugs and heavy metals can also cause


    hyperpigmentation via the direct deposition of the
    substance in the skin.
    Approach to a patient

    History
    • onset : birth, infancy or later
    • Cause : sun exposure, drug, occupation
    • Systemic complaints
    • Family history: neurofibromatosis, tuberous
    sclerosis, vitiligo
    Examination

    • Type of lesion: brown, blue, hypopigmented


    • ( check sensation), depigmented
    • Shape : ash leaf macules ( tuberous sclerosis)
    Koebner phenomenon (vitiligo)
    • Distribution pattern : linear/segmental,
    symmetric (vitiligo), specific sites (melasma,
    Addison’s disease)
    Examination aids:

    •Hand lens
    •Dermatoscopy
    •Wood’s lamp 360nm
    •Histology
    J AM ACAD DERMATOL
    VOLUME 88, NUMBER 2
    EPIDERMAL
    HYPERPIGMENTATION
    Ephelis:
    • Ephelis (singular) or ephelides (plural), also
    known as freckles
    ▪ light-brown macules occurring on sun-
    exposed areas of the face, forearms, and
    dorsal hands associated with light skin and
    blonde or red hair
    • appear until 2 to 3 years of age and can be
    induced by sun exposure
    Lentigo:
    • Lentigo (singular) or lentigines (plural) are
    brown macules, of which several clinical
    variants have been described, including:
    early age of onset
    no predilection for sun-
    exposed areas

    lentigo
    simplex
    solar lentigo: also known as
    senile lentigines or liver spots
    acquired later in adulthood
    arise from accumulated
    photodamage of
    the skin

    solar
    simplex
    Multiple lentigines
    can also be seen in many syndromes with
    associated systemic anomalies, including
    Noonan syndrome with multiple lentigines,
    Carney complex, and Peutz-Jeghers syndrome
    Café au lait macule
    • characterized by
    uniform, light-brown,
    well-demarcated
    macules or patches.
    • solitary lesions and
    are typically larger in
    size than ephelides or
    lentigines.
    • maybe present at
    birth or first year of
    life
    DERMAL HYPERPIGMENTATION
    Hori’s nevus, Sun’s Nevus:
    congenital dermal
    melanocytosis (CDMs):
    Mongolian spot, is a congenital
    blue-gray patch that is usually
    present at birth.
    The majority of CDMs
    spontaneously regress during
    childhood and rarely persist
    beyond the age of 6 years.
    Nevus of Ota

    • blue-black or slate-gray macules coalescing into


    irregular patches
    • favors the distribution of the ophthalmic or maxillary
    division of the trigeminal nerve usually unilateral,
    rarely bilateral
    • commonly seen in Asian or Black individuals The age of
    onset is bimodal: infancy and puberty. Dose not
    spontaneously regress Ocular involvement may be
    present
    https://healthjade.net/nevus-of-ota/
    •Features similar to
    nevus of Ota
    Nevus •The deltoid and
    of Ito acromioclavicular
    regions.
    Mukhopadhyay AK. Indian J Dermatol 2013;58:286-9
    • Hori’s nevus, also known
    as acquired bilateral
    nevus of Ota-like macules.
    Hori’s • occurs bilaterally on the
    face, most commonly on
    nevus, the malar regions
    • A unilateral variant,
    Sun’s known as Sun’ nevus
    Nevus: • has also been described.
    In contrast to nevus of
    Ota, Hori’s nevus does not
    involve ocular or mucosal
    surfaces.
    Park JM, Tsao H, Tsao S. JAAD. 2009 Jul 1;61(1):88-93.
    Xinjun Yang et al. March 2023Skin Research and Technology 29(3)
    MIXED EPIDERMAL DERMAL
    HYPERPIGMENTATION
    Post inflammatory
    hyperpigmentation (PIH)
    common
    condition that more commonly
    occurs because varying shades in dark skin
    presents as
    of excess of brown, if individual
    hyperpigmented
    melanin epidermal, to exacerbated by
    macules and
    following blue gray, if exposure to UV
    patches.
    inflammation or dermal. radiation or
    injury to the visible light
    skin.
    Drug-induced hyperpigmentation

    occur due to several pharmacologic agents,


    resulting in cutaneous, mucosal, and/or nail
    hyperpigmentation or discoloration.
    Jain, Avina, Sathish Pai, and Shrutakirthi
    Shenoi. "Exogenous ochronosis." Indian
    Journal of Dermatology, Venereology, and
    Leprology 79.4 (2013): 522-522.
    Melasma

    Light-to-dark-brown macules and patches in sun


    exposed areas.Most commonly seen in young-to-
    middle-aged women with skin phototypes III to
    VI
    Three classic patterns have been described,
    which are as follows: (1) Centro-facial: the most
    common pattern, involving the forehead, cheeks,
    nose, upper lip, and chin,
    (2) malar :involving the cheeks and nose, and
    (3) mandibular :involving the jawline.
    Etiology:

    hormonal
    influences, including
    UV radiation
    pregnancy and
    oral contraceptives.

    phototoxic drugs or
    Less commonly,
    antiepileptics, have
    other medications,
    also been
    such as
    associated.
    Melasma
    Physical modalities

    Use Q
    chemical switched
    laser:
    peel and pico
    second Alex laser IPL laser
    Nd:YAG
    laser
    Thanks

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