Areas Of Hyperpigmentation Research Articles

Comparison of the Effectiveness of CO2 and Diode Lasers for Gingival Melanin Depigmentation: A Randomized Clinical Trial.

Introduction: Gingival hyperpigmentation is an esthetic concern for some individuals. This study compared the effectiveness of CO2 and diode lasers for gingival depigmentation. Methods: This randomized, split-mouth, clinical trial consisted of 12 patients with the chief complaint of hyperpigmented gingival areas. The upper right and left anterior segments and the mandibular anterior segment were randomly allocated to one of the treatment groups. The segments in group 1 underwent gingival depigmentation with a diode laser (810 nm) at 6 W and pulsed mode, whereas group 2 was ablated with a diode laser at 3 W and continuous mode. The removal of gingival pigments in group 3 was contemplated with a CO2 laser (10600 nm, 3 W, continuous mode). The operation chair time, bleeding during the procedure and post-operative pain were recorded. The gingival color and esthetic appearance were measured before the operation and at 1 week and 6 months later. Results: There was no significant difference in the bleeding scores, pain level, and color alteration values between the groups (P>0.05). The operation chair time was significantly shorter when the diode laser was applied at pulsed mode (P<0.05). The segments treated with the diode laser (pulsed or continuous mode) showed a higher esthetic appearance at the 6-month follow-up compared to those ablated with the CO2 laser (P<0.05). Conclusions: Higher esthetic appearance is expected when using the diode laser for gingival depigmentation compared to the CO2 laser. The application of the diode laser at pulsed mode could be recommended for gingival depigmentation, as it produced pleasing esthetic outcomes at reduced chair time.

Multimodal Imaging, OCT B-Scan Localization, and En Face OCT Detection of Macular Hyperpigmentation in Eyes with Intermediate Age-Related Macular Degeneration.

PurposeMultimodal imaging was used to identify and characterize the cause of hyperpigmentation seen on color fundus images (CFIs) of eyes with intermediate age-related macular degeneration (iAMD).DesignRetrospective review of a prospective study.ParticipantsPatients with iAMD.MethodsColor fundus images with macular hyperpigmentation were compared with same-day images obtained using fundus autofluorescence (FAF), near infrared reflectance (NIR), and swept-source (SS) OCT imaging. Two SS OCT en face slabs were generated: a retinal slab to identify hyperreflective foci within the retina and a slab from beneath the retinal pigment epithelium (RPE; the sub-RPE slab) that was used to detect regions that cause decreased light transmission into the choroid, also known as hypotransmission defects. All images were registered to allow for qualitative comparisons by 2 independent graders.Main Outcome MeasuresComparison between foci of macular hyperpigmentation seen on CFIs with the detection of these regions on FAF, NIR, and SS OCT en face images.ResultsCompared with CFIs, FAF imaging seemed to be the least sensitive method for the detection of hyperpigmentation, whereas NIR and SS OCT imaging reliably detected these hyperpigmented areas. Although NIR imaging detected most of the hyperpigmentation seen in CFIs, SS OCT imaging detected all the areas of hyperpigmentation and anatomically localized these areas by using both en face and B-scan images. En face OCT slabs of the retina and sub-RPE region were registered to the CFIs, and areas of hyperpigmentation were shown to correspond to hyperreflective foci in the retina and regions of thickened RPE seen on OCT B-scans. Although both hyperpigmentation and early atrophic lesions appeared bright on NIR imaging, en face SS OCT imaging was able to distinguish these lesions because hyperpigmentary changes appeared dark and early atrophic lesions appeared bright on the sub-RPE slab.ConclusionsEn face OCT imaging in conjunction with OCT B-scans were able to identify and localize the hyperpigmentation seen in CFIs reliably. This hyperpigmentation was not only associated with intraretinal hyperreflective foci, but also corresponded to areas with a thickened RPE.

Histopathological Changes Induced by Malassezin: A Novel Natural Microbiome Indole for Treatment of Facial Hyperpigmentation.

Malassezin is a natural indole compound produced by the fungus Malassezia furfur and preclinical investigations have demonstrated an ability to suppress melanogenesis. To investigate the histopathological effects of malassezin for treatment of facial hyperpigmentation. In this proof-of-concept study, seven subjects with facial hyperpigmentation caused by melasma or photodamage applied topical malassezin twice daily for 14 weeks, followed by eight weeks of observation. At baseline, 2 mm punch biopsies were taken from hyperpigmented areas and adjacent uninvolved skin. Skin biopsies from hyperpigmented areas were repeated at 8, 14, and 22 weeks. Paraffin-embedded sections were cut and stained with H&amp;E, Fontana Masson, and MART 1 and assessed for histopathological changes. Increased epidermal melanin and dermal melanophages were observed in all biopsies at baseline in the hyperpigmented compared to uninvolved skin of all subjects. Eight and 14 week biopsies of involved skin revealed decreased epidermal melanin in all subjects treated with malassezin. Melanocytes appeared less dendritic compared to baseline, and numbers were slightly reduced at eight weeks. Biopsies at 22 weeks showed no significant difference in epidermal melanin levels compared to baseline hyperpigmented skin, and melanocytes were comparable in number and dendricity to baseline. There was no evidence of melanocyte atypia in any of the biopsies. These features were similar in melasma and photo-damaged skin. This study documents the histopathological features and ability of malassezin, a novel agent unique to the skin microbiome, to decrease epidermal pigmentation and the temporary and revisable nature of the process. J Drugs Dermatol. 2022;21(2):141-145. doi:10.36849/JDD.6596.

A Model for Recognizing Structureless Hyperpigmented Areas in Dermato-Oncology

A Model for Recognizing Structureless Hyperpigmented Areas in Dermato-Oncology

A Role for NRF2-Signaling in the Treatment and Prevention of Solar Lentigines

Photoaging is premature skin aging resulting from oxidative stress generated by exposure to solar radiation. A key clinical feature is solar lentigines, areas of hyperpigmentation on sun-exposed skin. Skin pigmentation is determined by cross-talk between keratinocytes and melanocytes, which is exquisitely sensitive to oxidative stress. Toll-like receptor (TLR) signaling and NF-E2-related factor 2 (NRF2) signaling, an endogenous antioxidant system, serve as a bridge between the oxidative stress response and immune regulation. Moreover, TLR-mediated induction of IL-6 production has been shown to prevent ultraviolet (UV)-induced hyperpigmentation. Shave biopsies of solar lentigines were obtained from 14 individuals. An additional 7 subjects applied broccoli sprout extract (BSE) containing sulforaphane daily or vehicle on photodamaged skin. Immunofluorescence staining was used to determine total and phosphorylated NRF2 in the lentiginous skin. Dermoscopy and Fontana & Masson staining were used to assess the effect of topical BSE on UV-induced pigmentation. Similar topical treatments were performed in a mouse model of UVB-induced hyperpigmentation utilizing WT, Nrf2-/-, or K14-Cre-ERT2IL-6Rαfl/fl C57BL/6 mice. NRF2 expression is altered in solar lentigines, and UV-induced skin pigmentation in humans could be ameliorated with topical BSE. Corresponding mouse models replicated the authors' clinical findings and identified a potential mechanistic link to IL-6Rα signaling in keratinocytes. The authors' findings suggest that dysregulation of NRF2 signaling is involved in the pathogenesis of UV-induced skin pigmentation and pharmacological activation of NRF2 may represent a potential therapeutic target in photoaging.

THE EFFICACY OF A COMBINED IPL PROTOCOL AND A HYALURONIC ACID DRUG WITH MANNITOL FOR THE TREATMENT OF HYPERPIGMENTATION

Relevance: Today the world of therapeutic cosmetology is filled with a diverse range of methods, both laser and injection. They are aimed at the correction of various aesthetic problems. The most common complaint of a patient at a doctor-cosmetologist appointment is the presence of areas of hyperpigmentation in the facial area. In order to achieve a satisfactory result, the therapy of this pathology should be based on knowledge of the pathogenesis. In addition, it is necessary to take into account the possibility of side effects after laser treatment, which is the most frequent method chosen by doctors. Also, it is worth minimizing the risk of hyperpigmentation by improving the metabolic function of tissues. That is why the combined protocols open up the most promising horizons for the treatment of such difficult-to-correct pathology as hyperpigmentation. The aim of our study was to create an evidence base for the effectiveness of a combined treatment protocol using an IPL system in combination with a drug based on hyaluronic acid and mannitol. Materials and methods: The study involved female patients aged 18 to 45 years with a diagnosis of melasma Code L81.1; Other melanin hyperpigmentation L81.4. The study included patients who had not previously undergone laser and injection procedures in order to correct hyperpigmentation over the past 5-6 months. To evaluate the results, Antera 3D 3B visualizer in the “melanin” mode was used, as well as a laser Doppler flowmetry device Lazma-D. Results: A positive clinical result on the Antera 3D imager was observed in all study groups. It was statistically revealed that the variable Anadn did not differ between the control and experimental groups F (1.30) = 4.031, p = 0.050, ns), as well as before and after treatment (F (1.30) = 0.825, p = 0.368, ns ); the variable Afad did not differ between the control and experimental groups (F (1.30) = 2.483, p = 0.121, ns), as well as before and after treatment (F (1.30) = 3.142, p = 0.082, ns); the variable Mpm increased (p = 0.002) in the experimental group F (1.30) = 5.366, p = 0.024) after the exposure (F (1.30) = 4.718, p = 0.034); the Mpl variable did not differ between the control and experimental groups (F (1.30) = 0.61, p = 0.436, ns), as well as before and after treatment (F (1.30) = 0.028, p = 0.868, ns); The POM variable increased (p = 0.003) in the experimental group F (1.30) = 7.778, p = 0.007) after the treatment (F (1.30) = 8.541, p = 0.005). Conclusions: A significant improvement in the index of oxidative metabolism in tissues suggests that the combined protocol of hyperpigmentation therapy is the most effective and safe. In addition, such therapy allows physiological skin support during IPL therapy in combination with a preparation based on hyaluronic acid and mannitol.

Progressive Dysmorphia of Retinal Pigment Epithelium in Age-Related Macular Degeneration Investigated by Fluorescence Lifetime Imaging.

PurposeThe purpose of this study was to observe changes of the retinal pigment epithelium (RPE) on the transition from dysmorphia to atrophy in age-related macular degeneration (AMD) by fluorescence lifetime imaging ophthalmoscopy (FLIO).MethodsMultimodal imaging including color fundus photography (CFP), optical coherence tomography (OCT), fundus autofluorescence (FAF) imaging, and FLIO was performed in 40 eyes of 37 patients with intermediate AMD and no evidence for geographic atrophy or macular neovascularization (mean age = 74.2 ± 7.0 years). Twenty-three eyes were followed for 28.3 ± 18.3 months. Seven eyes had a second follow-up after 46.6 ± 9.0 months. Thickened RPE on OCT, hyperpigmentation on CFP, hyper-reflective foci (HRF) on OCT, attributed to single or clustered intraretinal RPE, were identified. Fluorescence lifetimes in two spectral channels (short-wavelength spectral channel [SSC] = 500–560 nm, long-wavelength spectral channel [LSC] = 560–720 nm) as well as emission spectrum intensity ratio (ESIR) of the lesions were measured by FLIO.ResultsAs hyperpigmented areas form and RPE migrates into the retina, FAF lifetimes lengthen and ESRI of RPE cells increase. Thickened RPE showed lifetimes of 256 ± 49 ps (SSC) and 336 ± 35 ps (LSC) and an ESIR of 0.552 ± 0.079. For hyperpigmentation, these values were 317 ± 68 ps (p < 0.001), 377 ± 56 ps (P < 0.001), and 0.609 ± 0.081 (P = 0.001), respectively, and for HRF 337 ± 79 ps (P < 0.001), 414 ± 50 ps (P < 0.001), and 0.654 ± 0.075 (P < 0.001).ConclusionsIn the process of RPE degeneration, comprising different steps of dysmorphia, hyperpigmentation, and migration, lengthening of FAF lifetimes and a hypsochromic shift of emission spectra can be observed by FLIO. Thus, FLIO might provide early biomarkers for AMD progression and contribute to our understanding of RPE pathology.

Repigmentation of nipple-areola complex after ReCell® treatment on breast vitiligo.

Nipple-areola complex is a naturally hyperpigmented skin area which can be involved in vitiligo. But limited study focused on the treatment of nipple-areola complex vitiligo, and few methods were proven to be effective. In this study, we aimed to explore the feasibility and efficacy of ReCell® on vitiligo in the nipple-areola complex area. Medical records of patients with vitiligo involving nipple-areola complex and underwent ReCell® treatment from October 2016 to April 2020 were retrospectively reviewed. The repigmentation rate of the nipple-areola complex and other breast area were calculated under the Wood's light at each follow-up. The grade of repigmentation and patient-reported satisfaction rate were also evaluated to prove the effect of ReCell® on vitiligo of breast and especially in the nipple-areola complex area. A total of 18 patients were included in this study. No surgical complications were reported. The mean postoperative repigmentation rate in the nipple-areola complex area (3rd-month, 78.7±5.8%; 6th-month, 87.6±5.1%; and 12th-month, 96.1±3.5%) was significantly higher than that in the other breast treatment area (3rd-month, 70.4±6.9%; 6th-month, 84.2±5.7%, and 12th-month, 93.2±3.6%). All patients showed good or excellent grades at the last follow-up, and 94.4% of them considered the overall treatment results satisfactory. ReCell® is a feasible and efficient treatment strategy in the nipple-areola complex vitiligo.

Treatment of medium-sized facial nevus spilus with a dual-wavelength copper vapor laser

Nevus spilus (NS; synonym: speckled lentiginous nevus) − benign congenital or, more often, acquired melanocytic nevus − is characterized by numerous foci of hyperpigmentation located on a light brown background with possible transformation into malignant tumors. Its prevalence is ∼2% among the general population. NS sizes vary from 2 to 10 cm in diameter, but more extensive lesions have been described. Patients turn to a dermatologist when NS is located in aesthetically significant areas owing to cosmetic problems. Surgical methods for removing NS are associated with a risk of scarring. The use of various types of lasers for the treatment of NS has allowed successful results. However, it is accompanied by adverse effects such as scars, postinflammatory hyperpigmentation, and relapses. Our experience in treating benign melanocytic skin lesions using copper vapor laser (CVL) radiation, which allows selective heating of the pigment and blood vessels, gives us grounds for using CVL to treat NS. For the first time, we describe an innovative method of treating NS with dual-wavelength CVL radiation. A case of NS (medium size 50×40 mm) located in the cheek area was treated in a 39-year-old fair-skinned patient with type II skin, according to Fitzpatrick. NS treatment was carried out with the following parameters of the CVL (Yakhroma-Med model, P.N. Lebedev Physical Institute of the Russian Academy of Sciences): average power 0.6–0.8 W, with a power ratio of 3:2, at wavelengths of 511 and 578 nm. The pulse duration is 20 ns, the repetition rate is 16.6 kHz, the exposure time is 0.2–0.3 s, and the diameter of the light spot on the skin is 1 mm. After six treatments, the color of the hyperpigmented area, dark macules, and papules were eliminated. The follow-up period was 24 months. Medium-sized NS treatment with CVL provided complete elimination of the pathological focus and provided excellent cosmetic results. No relapse was observed within 24 months after treatment.

Dermatoscopy of melanoma according to type, anatomic site and stage.

The indisputable contribution of dermatoscopy in early diagnosis of melanoma is widely recognized. In the last quinquennium, new data concerning specific melanoma subtypes have come to light. The dermatoscopic morphology of superficial spreading melanoma (SSM) has been extensively investigated in the literature. Atypical network, irregular dots, irregular globules, irregular streaks and irregular blotch correspond to histopathologic alterations at the level of the junction, blue-white veil and atypical vessels suggest intradermal growth, whereas regression structures, negative network and white shiny streaks might reflect junctional or dermal alterations. The list of melanoma specific criteria has been recently updated to include features that typify early melanoma, such as irregular hyperpigmented areas and prominent skin markings and features seen in melanoma on sun damaged skin such as angulated lines. Nodular melanoma lacks most of the aforementioned criteria and is typified by the coexistence of blue and black color, atypical vessels and pink color. Lentigo maligna dermatoscopic criteria mainly develop at the outline of the follicular openings. However, at an early stage these features might be very subtle and the diagnosis should be based on the exclusion of benign tumors (inverse approach). Acral lentiginous melanoma is typified by a parallel ridge pattern, but also SSM criteria should be taken into consideration. The diagnosis of subungual melanoma is based on the assessment of the color and characteristics of the pigmented nail band. For the diagnosis of mucosal melanoma, the assessment of colors is more informative than the assessment of structures and the detection of blue, white or gray should raise the suspicion of melanoma. White shiny streaks and regression structures are the most common features of desmoplastic melanoma. The diagnosis of nevoid melanoma might be highly challenging and require information on the lesion's history. Melanoma on small- and medium-sized congenital nevi is typified by an eccentric location of the suspicious area, negative network and gray angulated lines. Recent advances in knowledge on the dermatoscopic characteristics of peculiar subtypes of the tumor significantly enrich the diagnostic armamentarium of clinicians. The challenge of the forthcoming years is to better characterize biologically aggressive melanomas and to optimize the screening strategies so as to identify them.

Bilateral idiopathic choroidal hyperpigmentation

To report a series of cases showing bilateral circumpapillary hyperpigmentation on routine fundus examination. In this observational case series, three patients showing bilateral circumpapillary hyperpigmentation on routine fundus examination were included. Multimodal retinal imaging was done for these cases. Multimodal imaging of the lesion showed the hyper pigmentation to be confined to the choroid. The optical coherence tomography scans described the features through the hyperpigmented area, adjacent hypopigmented area and the normally pigmented area of the fundus as suggestive of choroidal hyper melanosis. Follow-up of these lesions over a period of 2-6 years showed no change in the vision or characteristics of the lesion. Bilateral circumpapillary hyperpigmentation needs to be considered as a differential for bilateral peripapillary pigmented lesions.

AB023. An atypical clinical presentation of alopecia in two patients with systemic lupus erythematosus

Alopecia in varying patterns is a common feature of lupus erythematosus (LE). Several forms of alopecia that are not specific to LE can occur in the setting of lupus, such as alopecia areata, telogen effluvium, and anagen effluvium. LE-specific alopecias are defined as those with histology consistent with LE, and include forms of acute, subacute, and chronic cutaneous lupus erythematosus (CCLE). Common patterns of LE-specific alopecia include the non-scarring diffuse hair thinning and fragility of acute LE and the scarring, erythematous scaly plaques with follicular keratotic plugs, peripheral hyperpigmentation, and central hypopigmentation of discoid lupus erythematosus (DLE). Lupus erythematosus tumidus (LET) may also present on the scalp as well-defined, non-scarring alopecia without overlying scale, atrophy, and dyspigmentation. We report two male patients with large circular non-scarring alopecic plaques on the scalp without overlying scale or erythema, but with central hyperpigmentation and scarring – findings reminiscent of but also distinct from both DLE and LET. Punch biopsy from the hyperpigmented area of alopecia revealed peri-follicular lymphocytic infiltrate, follicular dropout, and increased dermal mucin consistent with LE; further workup and serologic testing revealed systemic lupus in both patients. These two cases demonstrate a unique clinical presentation of central scarring alopecia within a larger non-scarring alopecic plaque in the setting of SLE that deviates from typical lupus-related alopecia. Teaching point: these two cases underscore the morphologic heterogeneity of CCLE and need for thorough evaluation of systemic disease in patients presenting with both scarring and non-scarring alopecia.

A Case of Thrombotic Vasculopathy in the Setting of High-Dose Hydroxyurea Use

This case study describes the presentation of a 76-year-old male with a past medical history that included atrial fibrillation, essential hypertension, coronary artery disease status post cardiac stent placement, heart failure, hyperlipidemia, thyroid cancer (with thyroid resection resulting in hypothyroidism), prostate cancer status post brachytherapy (in remission), and a history of JAK2-positive myeloproliferative disease. He presented with painful areas of hyperpigmentation appearing as purple discoloration to his neck, lower abdominal skinfold, and bilateral groin areas that progressed to painful ulcerations a few weeks after a myocardial infarction. Due to the patient’s multiple medical conditions and uncommon presentation of wounds, a multidisciplinary team was involved in his care. Differential diagnosis included antiphospholipid syndrome, symmetrical drug-related intertriginous and flexural exanthema, warfarin-induced necrosis, cutaneous thrombotic vasculopathy, myeloproliferative disorder, and high-dose hydroxyurea therapy. It was determined by the authors that the high-dose hydroxyurea therapy was the cause of the wounds. Because of the patient’s initial health status, treatment of the wounds included use of collagenase and sodium hypochlorite solution to reduce the risk of infection and attempt to promote autolytic debridement until surgical wound debridement could be done. The patient required multiple hospital stays, but ultimately his health status improved and the wounds resolved with the assistance of the combined efforts of the multidisciplinary team to diagnose and treat this complex patient and his uncommon wound presentation.

Ki67/MART1 and p63/SOX10 Dual Immunohistochemistry Allows a Correct Interpretation of the Melanocytic Component in the Diagnosis of Pigmented Pilomatricoma.

Pilomatricoma is a relatively common benign cutaneous adnexal tumor and a well-recognized entity, while its pigmented variant is far less common and less reported. Its estimated frequency ranges from 11 to 24%, according to a limited number of published case series. This article describes the case of a 42-year-old man presenting a firm subcutaneous nodule of the periareolar region. Histopathologic examination revealed a cystic lesion composed of matrical and supramatrical cells accompanied by a foreign body granulomatous cell reaction. Interestingly, a hyperpigmented area with numerous hyperplastic melanocytes and few mitoses was detectable. In order to assess the cell lineage of the mitotically active component in the hyperpigmented area, double immunohistochemistry with Ki67/Mart1 and p63/SOX10 was performed. Pigmented pilomatricoma is an underrecognized, underreported variant, and double immunohistochemistry stain is an effective tool in providing the correct interpretation of the proliferative activity in the different cellular populations.

Clinical and Dermoscopic Features of Follicular Becker's Nevus: A Rare Variant.

Sir, Becker's nevus is a cutaneous hamartoma, typified by the presence of macular pigmentation, hypertrichosis, and smooth muscle proliferation. Herein, we report a rare follicular variant of Becker's nevus. An 18-year-old man presented with asymptomatic lesions over the right chest and supraclavicular area for a year and a half, gradually progressive in nature. There were no lesions elsewhere. There was no history of seizures, developmental delay, or any neurological complaints. On examination, there was unilateral involvement of the right upper chest and supraclavicular area in the form of numerous, well-defined, folliculocentric macules tending to coalesce at one side [Figure 1a and b]. There was no evidence of scaling, and scratch sign was negative. There was presence of terminal hair in the patch located at the centre of each hyperpigmented macule. There was no evidence of thickening or nodularity over the lesion. There was no limb or breast hypoplasia or asymmetry.Figure 1: (a and b) Numerous, hyperpigmented, folliculocentric macules seen over the right side of the chest, extending onto the neck as well as the shoulder. They tend to be coalescing towards the centerDermoscopy (Dermlite DL200 Hybrid M; polarized mode) showed a well-defined network-like pigmentation. There was immediate perifollicular hypopigmentation., visible dermoscopically. Surrounding this, there were well-defined areas of darker pigment network. These corresponded clinically to the folliculocentric macules [Figures 2 and 3].Figure 2: Dermoscopy (Dermlite DL200 Hybrid M; polarized mode) showed islands of well-defined network-like pigmentation. Interspersed between these islands were areas of normal skin with a normal skin pigment networkFigure 3: Dermoscopy (Dermlite DL200 Hybrid M; polarized mode) showing immediate perifollicular hypopigmentation, surrounding which there is a hyperpigmented area around each individual follicle. This corresponds clinically to hyperpigmented macules, thus, representing the follicular variantHistopathology demonstrated hyperpigmentation of the basal layer with regular elongation of rete ridges. There was acanthosis present. This hyperpigmentation corresponds clinically to the hyperpigmented macules. There was no evidence of dermal smooth muscle proliferation. Thus, a final diagnosis of follicular Becker's nevus was made. The patient was counselled about the nature and course of the condition and advised treatment with Q-switched NDYAG laser. However, because of the lack of facilities in the government institute where he presented and him not being able to afford private treatment, the patient did not opt for this. Becker's nevus is a cutaneous hamartoma, presenting as a unilateral patch of hyperpigmentation, with hypertrichosis and smooth muscle proliferation. The exact etiology of Becker's nevus is unknown. Beta-actin (ACTB) mutations amplify Hedgehog signaling leading to interference with the development of hair follicles and arrector pili muscles. This explains lesions being perifollicular, to begin with.[1] Androgens play a role in this condition as seen by peri-pubertal development, hypertrichosis, acneiform lesions in the involved area, and hypertrichosis, with an increase in androgen receptors in the involved skin noted.[2] Several morphological variants of Becker's nevus reported include the presence of only pigmentation (Becker's melanosis), giant Becker's nevus, blaschkoid Becker's nevus, bilateral involvement, and presence of multiple lesions. Becker's nevus syndrome is an association of Becker's nevus with unilateral breast hypoplasia and muscle, skin, and/or skeletal abnormalities.[3] There is a case series on follicular Becker's nevus by Y Manchanda et al.,[4] describing predominantly follicular involvement. It is suggested that the presence of folliculocentric macules at the periphery of evolved lesions, and the center of early lesions points to an etiopathological role of the follicular epithelium. In contrast to the dermoscopy of classical Becker's nevus in which a continuous sheet of pigmentation is seen, islands of pigmentation are seen in the case of follicular Becker's nevus. On dermoscopy of classical Becker's, the well-defined pigment network is present in a continuous sheet, with uniform thickness and color of lines throughout the lesion. In follicular Becker's, the pigmentation is patchy – occurring in circles around each follicle. Interspersed between these circles are areas of normal pigment network i.e., normal skin. It can often pose a diagnostic conundrum, being misdiagnosed as pityriasis versicolor. It is important to note that early and evolving lesions of Becker's nevus can present with only predominantly follicular lesions. The lack of scaling and unilateral location along with the dermoscopic findings can help differentiate the two. A variety of lasers have been used alone or in combination to treat the hyperpigmentation and hypertrichosis of Becker's nevus, with wavelengths ranging from 504 to 10,600 nm.[5] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Dermatoscopy of melanoma according to type, anatomic site and stage: a 2020 update

The indisputable contribution of dermatoscopy in early diagnosis of melanoma is widely recognized. In the last quinquennium, new data concerning specific melanoma subtypes have come to light. The dermatoscopic morphology of superficial spreading melanoma (SSM) has been extensively investigated in the literature. Atypical network, irregular dots, irregular globules, irregular streaks and irregular blotch correspond to histopathologic alterations at the level of the junction, blue-white veil and atypical vessels suggest intradermal growth, whereas regression structures, negative network and white shiny streaks might reflect junctional or dermal alterations. The list of melanoma specific criteria has been recently updated to include features that typify early melanoma, such as irregular hyperpigmented areas and prominent skin markings and features seen in melanoma on sun damaged skin such as angulated lines. Nodular melanoma lacks most of the aforementioned criteria and is typified by the coexistence of blue and black color, atypical vessels and pink color. Lentigo maligna dermatoscopic criteria mainly develop at the outline of the follicular openings. However, at an early stage these features might be very subtle and the diagnosis should be based on the exclusion of benign tumors (inverse approach). Acral lentiginous melanoma is typified by a parallel ridge pattern, but also SSM criteria should be taken into consideration. The diagnosis of subungual melanoma is based on the assessment of the color and characteristics of the pigmented nail band. For the diagnosis of mucosal melanoma, the assessment of colors is more informative than the assessment of structures and the detection of blue, white or gray should raise the suspicion of melanoma. White shiny streaks and regression structures are the most common features of desmoplastic melanoma. The diagnosis of nevoid melanoma might be highly challenging and require information on the lesion's history. Melanoma on small- and medium-sized congenital nevi is typified by an eccentric location of the suspicious area, negative network and gray angulated lines. Recent advances in knowledge on the dermatoscopic characteristics of peculiar subtypes of the tumor significantly enrich the diagnostic armamentarium of clinicians. The challenge of the forthcoming years is to better characterize biologically aggressive melanomas and to optimize the screening strategies so as to identify them.

At-home Cosmeceutical Application and Outpatient Treatments: A 3D Stepwise Facial Rejuvenation Approach

BACKGROUND: Aging affects the 3-dimensional structure of all the facial tissues: Bones, muscles, ligaments, adipose tissue, and skin.&#x0D; AIM: To customize minimally invasive treatments for facial rejuvenation, we present a standardized holistic approach characterized by at-home treatments in associations with outpatient procedures.&#x0D; METHODS: Forty-four patients underwent 3-dimensional stepwise facial rejuvenation and were evaluated prospectively. Each patient received a customized treatment plan based on a clinical examination and consultation. Treatment outcomes were evaluated from patient photographs with and skin analysis was performed with an A-One Smart automated skin analysis system.&#x0D; RESULTS: The mean age of the patients was 41.7 years and the approximate mean duration of treatment was 160 days. Patients applied cosmeceuticals such as retinoic acid. Outpatient procedures included the delivery of botulinum toxin or dermal fillers, thread lifting, chemical peels, etc. Upon treatment completion, significant improvements were noted in multiple domains: Skin elasticity and hydration increased, areas of hyper-pigmentation were less extensive, and there were fewer visible wrinkles and pores.&#x0D; CONCLUSION: Outcomes of the present article suggest how important is to customize facial anti-aging treatments. Nonsurgical treatments carried out progressively, involving the patient to perform at-home treatments in associations with outpatient procedures, let to achieve facial improvements in terms of increased skin elasticity and hydration, reduction of hyperpigmentation, wrinkles, and pores.

A comparative study of topical 5% cysteamine versus 4% hydroquinone in the treatment of facial melasma in women

To assess the efficacy and safety of topical 5% cysteamine versus 4% hydroquinone in the treatment of facial melasma in women. Topical 5% cysteamine is an antioxidant and tyrosinase inhibitor that has been shown to be effective in the treatment of melasma. However, to date, no study has compared the performance of topical cysteamine to hydroquinone for facial melasma. A quasi-randomized, multicenter, evaluator-blinded clinical trial was conducted on 40 women with facial melasma who were submitted to the nightly application of 5% cysteamine (CYS) or 4% hydroquinone (HQ) on hyperpigmented areas for 120days. Both groups were required to use tinted sunscreen (SPF 50; PPD 19). Subjects were assessed at the inclusion and after 60 and 120days of treatment for mMASI, MELASQoL, and the difference in colorimetric luminosity between melasma and the adjacent unaffected skin. The Global Aesthetic Improvement Scale was used to assess the difference in the appearance of the skin through standardized photographs. The mean reduction of the mMASI scores was 24% for CYS and 41% for HQ (P=0.015) at 60days, and 38% for CYS and 53% for HQ (P=0.017) at 120days. The photographic evaluation revealed up to 74% improvement for both groups, without statistically significant difference between them (P=0.087). The MELASQoL score showed a progressive decrease for both groups over time, despite the greater reduction for HQ after 120days (P=0.018). Colorimetric assessment disclosed progressive depigmenting in both groups, without statistically significant difference between them (P>0.160). No severe adverse effects were identified in either group. Erythema and burning were the most important local adverse effects with cysteamine, although their frequency did not differ between groups (P>0.170). Cysteamine proved to be safe, well-tolerated, and effective, despite its inferior performance to hydroquinone in decreasing mMASI and MELASQoL in the treatment of melasma.

Autophagy Declines with Premature Skin Aging resulting in Dynamic Alterations in Skin Pigmentation and Epidermal Differentiation.

Autophagy is a membrane traffic system that provides sustainable degradation of cellular components for homeostasis, and is thus considered to promote health and longevity, though its activity declines with aging. The present findings show deterioration of autophagy in association with premature skin aging. Autophagy flux was successfully determined in skin tissues, which demonstrated significantly decreased autophagy in hyperpigmented skin such as that seen in senile lentigo. Furthermore, an exacerbated decline in autophagy was confirmed in xerotic hyperpigmentation areas, accompanied by severe dehydration and a barrier defect, which showed correlations with skin physiological conditions. The enhancement of autophagy in skin ex vivo ameliorated skin integrity, including pigmentation and epidermal differentiation. The present results indicate that the restoration of autophagy can contribute to improving premature skin aging by various intrinsic and extrinsic factors via the normalization of protein homeostasis.

Reducing hyperpigmentation after sclerotherapy: A randomized clinical trial

ObjectiveSclerotherapy for the treatment of varicose veins is one of the most common medical procedures performed in the Western world, and hyperpigmentation is one of the most frequent, dreaded, minor adverse events. There has recently been some interest in investigating the inflammatory response of the local endothelium after sclerotherapy and the possible benefits of venoactive drugs because of their pleiotropic properties. The aim of this study was to evaluate whether adding a venoactive drug (sulodexide) to the standard sclerotherapy treatment protocol for patients with varicose veins can reduce the occurrence of postsclerotherapy hyperpigmentation. MethodsWe carried out a prospective, multicenter, randomized controlled trial with a parallel group design. It included 720 patients with telangiectasia, reticular veins, or varicose veins who were candidates for sclerotherapy. Patients with reflux in deep system or saphenous veins were excluded. Group A consisted of 354 patients who received an oral dose of sulodexide twice a day for 7 days before scheduled sclerotherapy; the treatment then continued for 3 months. Group B consisted of 366 patients who received the standard sclerotherapy protocol. Polidocanol was used as the sclerosing agent, and 20 to 30 mm Hg compression stockings were used in both groups for 7 days. Control photographs were taken, and a follow-up examination took place after 1 month and 3 months. Computer software was used to analyze the treated area for incidence of hyperpigmentation, total area of hyperpigmentation, skin tone increase in the hyperpigmented area, vein disappearance, and incidence of major bleeding. The sample size was calculated to give a statistical power of 80%. Student t-test and the χ2 test were used for comparative analyses, as appropriate. The level of significance was set at P < .05. ResultsA total of 609 patients completed the 3-month follow-up: 312 in group A and 297 in group B. After 1 month, the incidence of hyperpigmentation was 8.7% in group A and 14.8% in group B (P = .01). Group A developed an average area of hyperpigmentation of 10.7% compared with 18.2% in group B (P = .01), and the skin tone of the hyperpigmented area was lower in group A than in group B (P = .02). However, the latter difference was not significant after 3 months. The overall vein disappearance rate was similar in both groups. ConclusionsOur analysis shows that by adding a venoactive drug (sulodexide) to the standard sclerotherapy protocol, the occurrence of hyperpigmentation is reduced without affecting the desired therapeutic vein elimination response.