Blue-black Pigmentation Research Articles

Unilateral nevus of ota: A case report of oculodermal melanocytosis!

Hulke first described nevus of Ota in 1860, but a detailed description was made first by Ota in 1939 wherein the typical pattern of the bluish black pigmentation along with the cutaneous distribution of the trigeminal nerve were described. This condition is most prevalent in Japanese population but comparatively rare among Indians. Nevus of Ota is a nonhereditary pigmentation disorder, more commonly seen in females. The authors present, yet another case of unilateral nevus of Ota in a young Indian girl.

Towards a better understanding of Tetrapyrgos (Basidiomycota, Agaricales): new species, type studies, and phylogenetic inferences

Tetrapyrgos (Basidiomycota, Agaricales) is recognized as a genus characterized by basidiomes with a central or eccentric, well-developed stipe with a black to bluish black stipe base arising from a basal pad or disc; hyaline, inamyloid, distinctly tetrahedral basidiospores; non-gelatinous or weakly gelatinous pileipellis and pileus tramal tissues; and apically bulbous cheilocystidia with diverticulate central axis. It is distinguished from Campanella, which has basidiomes that are sessile or with a pseudostipe that lacks black or bluish black pigmentation, and does not arise from a pad or basal disc; basidiospores ellipsoid or bulging slightly on one side; strongly gelatinous pileipellis and pileus tramal tissues; and cheilocystidia typically with central portion of axis non-diverticulate. Analyses and taxonomic status of 16 species placed in Tetrapyrgos (and their reported synonyms) are provided, based on examinations of 80 recently collected specimens and 85 exsiccata. Nine species are recognized here in Tetrapyrgos, supported by morphological and molecular data, including two new species, T. longicystidiata and T. parvispora. The remaining 7 species are recognized as belonging in Campanella or are of uncertain taxonomic placement. Comprehensive descriptions for all accepted species, type studies, and phylogenetic inferences derived from ITS analyses are provided.

Five Cases of Alkaptonuria Among Two Generations of Single Family in Dharwad, Karnataka (India)

Alkaptonuria (AKU) is a disorder of tyrosine metabolism. A rare disorder due to accumulation of homogentisic acid leading to progressive deposition of grey to bluish black pigment causing degenerative changes in cartilage. Medical interest of AKU is due to medical triad arthropathy, Ochronosis and Homogentisic aciduria. A 38 ½ years old male presented with complain of back pain, which persisted since last 8 months. Hyper-pigmentation of skin of chick, discolouration on ear cartilage and pigmentation of the conjunctiva on both eyes were observed. X-ray findings were normal except inter-vertebral disc calcification. Based on the results obtained from Clinical examination, X-ray findings and Biochemical investigations, diagnosis was confirmed as AKU. On screening family members additional four persons have been detected positive but, without any clinical symptoms. AKU, though rare it may occur in cluster among the family members.

Bilateral Sturge-Weber and Phakomatosis Pigmentovascularis with Glaucoma, an Overlap Syndrome.

Aim. To report a case of bilateral Sturge-Weber and Phakomatosis pigmentovascularis with secondary glaucoma in a child. Method. Case report. Results. A 4-year-old male child was referred to us for control of intraocular pressure (IOP). Sleeping IOP was 36 mm Hg in right eye and 28 mm Hg in the left eye. The sclera of both the eyes showed bluish black pigmentation—melanosis bulbi. Fundus examination of both eyes showed diffuse choroidal hemangiomas with glaucomatous cupping. Nevus flammeus was present on both sides of face along all the 3 divisions of trigeminal nerve with overlying hypertrophy of skin and on left forearm. Nevus fuscocaeruleus was present on upper trunk. All skin lesions were present since birth and were stationary in nature. CT scan of head revealed left-sided cerebral atrophy. Intraocular pressure was controlled after treatment with topical antiglaucoma medications. Pulsed Dye Laser has been advised by dermatologist for skin lesions. Patient has been advised for regular follow-up. Conclusion. The two overlapping dermatological disorders and their association with glaucoma are a rare entity. Management should be targeted both for dermatological and eye conditions.

Exogenous Ochronosis.

Exogenous ochronosis (EO) is a cutaneous disorder characterized by blue-black pigmentation resulting as a complication of long-term application of skin-lightening creams containing hydroquinone but may also occur due to topical contact with phenol or resorcinol in dark-skinned individuals. It can also occur following the use of systemic antimalarials such as quinine. EO is clinically and histologically similar to its endogenous counterpart viz., alkaptonuria, which, however, exhibits systemic effects and is an inherited disorder. Dermoscopy and in vivo skin reflectance confocal microscopy are noninvasive in vivo diagnostic tools. It is very difficult to treat EO, a cosmetically disfiguring and troubling disorder with disappointing treatment options.

Management of Vyanga (facial melanosis) with Arjuna Twak Lepa and Panchanimba Churna.

Background:Vyanga is one of the Kshudraroga, characterized by the presence of Niruja (painless) and Shavavarna Mandalas (bluish-black patches) on face. It is one of the most common diseases as regards the face is concerned. On the basis of clinical features, it can be compared with facial melanosis, one of the hyper pigmented disorders. Drugs with Rakta Prasadaka, Twak Prasadaka and Varnyakara properties are helpful in the management of Vyanga, that pacifies aggregated Doshas and help in Raktashodhana (blood purification).Aim:To evaluate the efficacy of Arjunatwak Lepa and Panchanimba Churna in Vyanga.Materials and Methods:In this study, the trial drugs used were Arjunatwak Churna for Lepa (tropical application) and Panchanimba Churna for oral administration. A total 30 patients of Vyanga were selected from outpatient department and inpatient department of Shalakya Tantra Department and allotted randomly in two groups. In group-A, the patients were treated with external application of Arjunatwak Churna and Madhu for 21 days, while in group-B, patients received Panchanimba Churna orally for 21 days in addition to Arjunatwak Churna for Lepa. Effect of therapy on chief complaint i.e., bluish-black pigmentation in Group A was 60% relief, while in Group B 80% relief was found.Conclusion:The clinical study has shown that combined therapy gives better results than topical treatment.

Alkaptonuria with review of literature

Alkaptonuria, a metabolic disorder characterized by a triad of homogentisic aciduria, arthritis, and ochronosis is one of the first conditions in the group of inborn errors of metabolism proposed to have Mendelian recessive inheritance. It is due to the deficiency of the enzyme homogentisic acid (HGA) oxidase which catalyzes the conversion of HGA to maleylacetoacetic acid in the catabolism of tyrosine. HGA thus accumulates in cells and body fluids and its oxidized polymers bind to collagen, leading to progressive deposition of grey to bluish black pigment resulting in degenerative changes in cartilage, intervertebral disc, and other connective tissues, leading to arthritis which is the only disabling effect in an affected older individual. However, the diagnosis can be made in neonates when blackish stain is noticed in an unwashed diaper. In this report we describe a 46-year-old male patient who presented with typical features of alkaptonuria.

μ‐Raman spectroscopy of prehistoric paintings from the Abrigo Remacha rock shelter (Villaseca, Segovia, Spain)

AbstractThe composition of the materials present in prehistoric paintings discovered on the walls of the Abrigo Remacha rock shelter (Villaseca, Segovia, Spain) has been characterised by micro‐Raman spectroscopy. In addition, scanning electron microscopy and energy dispersive X‐ray microanalysis have been used as auxiliary techniques. The results show that haematite (α‐Fe2O3) is the main component of the red pigment. Amorphous carbon and paracoquimbite (Fe2(SO4)3.9H2O) have been detected in the bluish black pigment used in a significant bi‐colour pictograph. This is the first time that this mineral has been discovered in a prehistoric painting. Accretions of whewellite and weddellite form crusts covering most of the painting panel. Different carbonates are the main components of the rocky substrate. The detection of gypsum on the surface of the panel is associated to the flaking process that is affecting the painting panel. Copyright © 2013 John Wiley & Sons, Ltd.

Arthropathia ochronotica: eine seltene Ursache frühzeitiger Gelenkdegeneration

A 70-year-old deaf-mute women suffered from progressive chronic pain of the right hip joint caused by destructive osteoarthritis of the hip. In addition to painfully restricted range of motion of the right hip joint the clinical examination showed a bluish-black pigmentation of the ear-cartilage and the sclera. A total endoprosthetic replacement of the right hip joint was performed. During surgery, blackening of the hip joint capsule and cartilage was found. Histological, the diagnosis of an ochronosis was confirmed. Discoloration after exposure of urine to air supported the diagnosis. Based on extensive internal medical examination relevant cardiac changes were excluded. Ochronosis (arthropathia ochronotica) is a rare entity which can be identified by a visual diagnosis. Early diagnosis can provide crucial information for the prognosis. Additionally, an interdisciplinary treatment concept should be established because of the early onset of degenerative changes at the skeletal system and pathological changes at internal organs. With suspicion on an ochronosis extended internal examinations are recommended in order to avoid complications.

Posttreatment lesional hyperpigmentation

A 63-year-old man presented to the dermatology clinic with a 1-year history of numerous erythematous, asymptomatic, annular plaques on his abdomen, arms, and legs (Fig 5). His social history included a long career as a trapper in the south Louisiana marshland; none of his close contacts had a similar outbreak. He reported no sensory loss; however, on physical examination, he had a stocking pattern of numbness that extended from his feet to his ankles. Laboratory studies, including an antinuclear antibody panel, a rapid plasma reagin test, rheumatoid factor, and erythrocyte sedimentation rate, were within normal limits. Biopsy specimens with special stains are shown below (Fig 6). Three months after initiating treatment with minocycline and rifampin, he presented with patches of blue-black pigmentation limited to lesional areas (Fig 7), in both sun-exposed and covered sites. Biopsy specimens were obtained from the pigmented areas. Fontana-Masson and Perls stains are shown in Fig 8 and 9. 6.What is the most likely diagnosis? a.Arcuate dermal erythema b.Morphea c.Hansen disease d.Lupus vulgaris e.Tinea corporis 7.What is the most likely causative agent of the patient’s subsequent hyperpigmentation? a.Dapsone b.Bactrim c.Rifampin d.Minocycline e.Amiodarone 8.What is the type of hyperpigmentation associated with the causative agent that is deposited at locations of inflammation and scarring? a.Type I b.Type II c.Type III d.Type A e.Type C 9.In what manner does type II hyperpigmentation generally stain? a.Positive Perls stain, negative Fontana-Masson stain b.Positive Prussian blue stain, negative Fontana-Masson stain c.Positive Perls stain, positive Fontana-Masson stain d.Negative Prussian blue stain, negative Fontana-Masson stain e.Negative Perls stain, negative Fontana-Masson stain Fig 6 View Large Image Figure Viewer Download Hi-res image Fig 7 View Large Image Figure Viewer Download Hi-res image Fig 8 View Large Image Figure Viewer Download Hi-res image Fig 9 View Large Image Figure Viewer Download Hi-res image

Minocycline-Induced Hyperpigmentation in Multibacillary Leprosy

Minocycline has been used in the treatment of leprosy since the demonstration of its efficacy in inhibiting Mycobacterium leprae growth in 1987. Hyperpigmentation, a well-documented adverse effect, classically shows 3 clinical and histological patterns: type I consists of blue-black pigmentation in areas of current or previous inflammation, type II consists of blue-gray pigmentation of normal skin, often seen on the legs, and type III consists of diffuse muddy-brown pigmentation accentuated on sun-exposed sites. Whereas type I hyperpigmentation stains positively for hemosiderin and type III hyperpigmentation stains positively for melanin, type II hyperpigmentation stains positively for both. We describe 2 patients with leprosy on minocycline therapy who developed multiple patches of blue-gray pigmentation within preexisting leprosy lesions. Biopsies from both patients demonstrated deposition of brownish-black pigment granules within the cytoplasm of foamy histiocytes that was highlighted by both Perls and Fontana-Masson stains. Given the clinical and histological findings in our patients, it is as yet unclear whether this coexistent type I clinical pattern and type II histopathologic pattern of pigmentation is unique to multibacillary leprosy. These findings provide support for the existence of additional subtypes of minocycline-induced hyperpigmentation that do not adhere to the classic 3-type model described.

Ochronosis: a case of severe ochronotic arthropathy

Ochronosis involves primarily the large cartilaginous joint surfaces, ribs, intervertebral discs, ear cartilage etc. We report on a 52-year-old woman with typical alkaptonuric ochronosis with dark urine, blue-black pigmentation of the auriculae and hands, spondylarthropathy and severe hip and shoulder joints involvement. The differential diagnosis of this rare condition is discussed with a review of the literature.

An unusual dark pigmentation on the tympanic membrane

To report an extremely rare case of dark pigmentation on the tympanic membrane due to alkaptonuria, and to discuss the probable association between this condition and hearing loss. A 58-year-old man with alkaptonuria was admitted with tinnitus and hearing loss in both ears. Physical examination showed bluish-black pigmentation on the helixes of both ears and both sclerae. Otoscopic examination revealed dark discolouration of both tympanic membranes. Audiological evaluation revealed mixed high frequency hearing loss in both ears. Tympanometric examination revealed type A tympanograms bilaterally, and absence of acoustic reflexes both ipsilaterally and contralaterally. Computed tomography of the temporal bones revealed no abnormality. Clinicians should consider alkaptonuria in the differential diagnosis of patients with abnormal tympanic membrane pigmentation and hearing loss.

Cutaneous melanocytoma in a cynomolgus monkey (Macaca fascicularis): cytologic and histologic characteristics

A 4-year old, male cynomolgus monkey (Macaca fascicularis) imported from China was acquired by Wyeth Research from a commercial source. On physical examination the animal had a 2 cm in diameter pigmented raised mass at the dorsal aspect of the neck. The mass was surgically removed for cytologic and histopathologic evaluations. Touch imprints of the mass stained with Wright–Giemsa revealed pleomorphic neoplastic cells arranged individually and in small clusters, admixed with extracellular pigment granules. The neoplastic cells were mostly round to oval and were filled with green-black to blue-black pigment granules obscuring the nucleus. The pigment granules were about 1 μm, oval to elongate, and consistent with melanin granules. Histologically, this nonencapsulated mass was composed of poorly demarcated, heavily pigmented melanocytes diffusely infiltrating the dermis. In the bleached sections, the neoplasm was composed of fairly uniform round to polygonal cells arranged in packets and supported by a fibrovascular stroma. The cells had discrete cell borders, and the nuclei were mostly round with finely stippled chromatin and lacked nuclear atypia. The cytologic and histologic findings supported a final diagnosis of melanocytoma. To the authors’ knowledge, the present case is the first cytologic description of a cutaneous melanocytoma in a nonhuman primate.

Bluish-Black Pigmentation of the Sclera and the Aortic Valve in a Patient with Alkaptonuric Ochronosis

A 69-year-old male patient was referred for evaluation of cardiac decompensation. He had previously been diagnosed with ochronosis (evident from bluish-black discoloration of the sclera of both eyes, Figure 1) and a degenerative valve defect with aortic, mitral and tricuspid valve insufficiency (evident from Doppler echocardiography). These were diagnostic clues to an ochronosis-associated valvular heart disease, and the patient was treated with an angiotensin-converting enzyme inhibitor to slow down the progression of valvular dysfunction. Further cardiac investigations revealed now that the function of the aortic valve had deteriorated such that replacement of the valve was inevitable. On operation, a bluishblack discoloration of the aortic valve (Figure 2, intraoperative view; at that time of operation the valve was already partially resected) and the aortic intima (Figure 3) was found. The bluish-black discoloration was due to the deposition of homogentisic acid, an intermediate catabolic product of the tyrosine metabolism which accumulates in ochronosis patients due to a lack of the enzyme homogentisic 1,2-dioxygenase. As seen here, the initial diagnosis of cardiovascular ochronosis was later confirmed by the requirement of aortic valve replacement.

Nasal argyria (deposition of silver-selenium) in the photographic film industry: histopathology and microanalysis

Argyria is grayish black discoloration of skin or mucous membrane caused by silver deposition; it may be localized or diffuse. Diffuse argyria occurs as a result of elevated silver levels in blood, whereas localized argyria occurs when there is direct deposition from an external source. Exposure to silver was common in the last century; however, in the present times, argyria is an uncommon entity because of the restrictive use of silver-containing medicines and decreased industrial exposure. Occupational exposure is common among silversmiths [1], mineworkers, photographic film laboratory workers, and individuals involved in the electroplating industry. Cases after prolonged use of silver salts for wound dressing, acupuncture needles, silver earrings [2], eyedrops containing silver, and irrigation of urethral or nasal mucous membranes with silver-containing solutions have been reported. Argyria has also been seen among patients undergoing dental procedures, such as silver amalgam tattooing. 2. Case presentation A 66-year-old man had nasal blockage and intermittent drainage from both nares for many years. The drainage was watery and persistent even after being treated with multiple medications. Nasal examination revealed bilateral bluish black pigmentation of mucosa in the superior-anterior portion of the nasal septum. There was no other area of pigmentation either on the skin or elsewhere. The patient’s history is significant for stroke, myocardial infarction, and hypertension. He worked as a supervisor in the chemical sensitizing paper unit of a photographic film–producing company before retiring in 1992 and was exposed to a large number of chemicals, including silver nitrate. In 2004, a computed tomographic scan of the patient’s paranasal sinuses showed minimal mucosal thickening in the left maxillary sinus. A small biopsy specimen of the pigmented nasal mucosa was taken under local anesthesia and sent for routine histopathologic analysis. Subsequently, analysis using scanning electron microscopy (SEM) and energy dispersive x-ray spectroscopy (EDS) was also performed.

Blue-Black Pigmentation of Legs and Arms in a 68-Year-Old Woman—Quiz

A 69-year-old man presented to the dermatology clinic with chronic swelling of the lower legs accompanied by pruritus and scaling. He had noticed a gradual increase in pigmentation of the lower part of his left leg. His medical history included congestive heart failure, hypertension, and protein C deficiency with deep venous thrombosis of the lower part of the left leg. Physical examination revealed bilateral ( 2) pitting edema of the legs extending proximally to his knees, associated with violaceous erythematous scaling patches and superficial erosions of the right lower extremity. On the left anterior tibial surface were brown hyperpigmented patches with fine scale admixed with speckled black pigment (Figure1). There were no other skin findings. A punch biopsy specimen was obtained from both lower parts of the legs and stained with hematoxylineosin, melanin, and iron stains (Figure 2 and Figure 3). What is your diagnosis?

Ochronosis with cardiovascular involvement: a case report

Ochronosis is a rare autosomal-recessive disease, characterized by increased homogentisic acid (HGA) and substrates due to deficiency of HGA oxidase. The most common clinical presentations are homogentisic aciduria, blue-black pigment accumulation in collagen tissues, large joint arthropathies and degenerative disk diseases. However, the disease may exert very large spectrum with various system involvements. In this article, a patient who was admitted by progressed musculoskeletal system pains and diagnosed as ochronosis, especially with emerging cardiovascular involvement, was presented.

Alkaptonuric ochronosis: Report of a case and brief review

Alkaptonuria, a metabolic disorder characterized by a triad of homogentisic aciduria, arthritis and ochronosis is one of the first conditions in the charter of group of inborn errors of metabolism proposed to have Mendelian recessive inheritance. It is due to the deficiency of the enzyme homogentisic acid oxidase which catalyzes the conversion of homogentisic acid to maleylacetoacetic acid in the catabolism of tyrosine. Homogentisic acid thus accumulates in cells and body fluids and its oxidized polymers bind to collagen, leading to progressive deposition of grey to bluish black pigment resulting in degenerative changes in cartilage, intervertebral disc and other connective tissues, leading to arthritis which is the only disabling effect in an affected older individual. However the diagnosis can be made in neonates when blackish stain is noticed in an unwashed diaper. Alkaptonuria is treated symptomatically, surgical intervention necessitates in advanced stages, treatment with ascorbic acid (Vitamin C) and dietary restrictions of food containing phenylalanine and tyrosine have proved to be successful in alleviating the symptoms.

Drug-related skin and atherosclerotic plaque pigmentation

A 67-year-old woman with long-standing rheumatoid arthritis was admitted for bilateral femoral to anterior tibial artery bypasses for gangrenous toes. She was noted to have chronic skin pigmentation changes affecting her legs, arms and her face, which started after using minocycline (Panels A and B). Blue-black pigmentation is a well-recognized side effect of minocycline therapy.1 The most commonly involved sites include the skin, oral cavity, teeth, bones, and thyroid. Similar pigmentation changes were noted in the common femoral artery and anterior tibial artery walls at the time of endarterectomy and bypass surgery (Panel C). Very few reports of atherosclerotic plaque pigmentation involvement have been published.2,3 Despite the pigmented appearance of the arterial wall, uneventful revascularization was accomplished. She did eventually require amputation of her necrotic digits. Panel A Panel B