Brown Hyperpigmentation Research Articles

Diffuse hyperpigmentation with guttate hypopigmentation: a new pigmentary disorder.

Diffuse hyperpigmentation with guttate hypopigmentation (DHGH) is a new acquired pigmentary disorder. Only a few cases have previously been reported in the Chinese population, in Chinese. To summarise the clinical, dermoscopic, and histopathological findings of DHGH in the English literature, to improve the recognition and management of this condition. This was a retrospective study to summarise the clinical, dermoscopic, and pathological findings of nine cases of DHGH. All nine patients with DHGH were female. The age at onset varied from 6 to 24 years (median 17 years). Patients were generally in good health without systemic disease. The lesions were often generalised to the trunk and extremities without any discomfort. Typical lesions were characterised by multiple uniform hypopigmented spots, 2-5mm in diameter, irregularly distributed over diffuse hyperpigmentation. Dermoscopy revealed multiple blurred patchy areas of brownish pigmentation, sparse linear and dotted vessels, and perifollicular pigmentation on a white to bright white background, surrounded by brown hyperpigmentation. Histopathological findings included mild abnormal pigment of the epidermis, focal vacuolar degeneration of the basal cells, mild pigment incontinence and perivascular lymphocytic infiltration in the dermis. DHGH is a new entity with distinctive clinical manifestations that differ from those of other known pigmentary disorders. So far, DHGH has only been reported in the Chinese population. It may not be uncommon and has not received much attention due to the few reports. The aetiology and pathogenesis of DHGH are still unknown and require further investigation.

Delayed onset Nevus of Ota: A rare presentation in a 60-year-old woman

Nevus of Ota is usually characterized by unilateral, mottled, slate blue or dark brown hyperpigmentation on the forehead, face and around eye area. Otas nevus is usually congenital but may appear in early childhood or in puberty. We report a late onset Nevus of Ota in a 60-year-old Asian woman

The Correlation between Melasma and ABO Blood Type

Aim: Melasma is an irregular brown hyperpigmentation mostly observed in the middle face. Although genetic predisposition, ultraviolet radiation and female sex hormones have been reported as the main causes, inflammatory processes were also considered to play a role in melasma. It has been determined that blood groups play a role in many genetic and inflammatory diseases. Since the genes that encode blood types were associated with inflammation, blood type could play a role in the etiology of melasma, an inflammatory and genetically inherited disease. The present study aimed to investigate the correlation between melasma and ABO/Rh blood types, which has never been investigated before.
 Material and Methods: The study was conducted 100 patients with melasma and 1000 healthy controls. The patient and healthy control blood types and Rh factor data were collected from the hospital automation system retrospectively.
 Results: Female gender ratio was significantly higher in the patient group compared to the control group (p

Evaluation of Efficacy and Safety of Combined Therapy of Melasma by using Azelic, Glycolic and Kojic Acid (Unitone and Neotone)

Background: Melasma is one of the most common disorders of brown hyperpigmentation, which affect primarily the face and later on some other sites of the body , seen most commonly in women during the reproductive period and may seen in men . Many options are used in the treatment of melasma, most commonly: hydroquinone, tretenoin, corticosteroid, azelic acid, glycolic acid, kojic acid, triaximinic acid, ascorbic acid, intralesional glutathione, and lastly medical procedures, like: microdermabrasion, chemical peel, laser and light therapy.
 Objective: To evaluate the efficacy and safety of combined therapy (azelic, glycolic and kojic acids) in the treatment of melasma (UNITONE and NEOTONE) .
 Patients and Methods: A cross-sectional study in which (585) patients complaining of melasma (577 females and 8 males), their age ranged from (17-50) years, with a mean age of 46.15± years. Treated by application of azelic acid (20% cream) for two hours at night, then washed and followed by topical application of combined cream consisted of (5%) glycolic acid and (1%) kojic acid throughout the night and washed in the morning, with application of sun block of ≥50 SPF, and oral ascorbic acid (500mg) tablet twice in the morning and evening .
 Results: Out of 585, 98% was females with a mean age of (46.15±8) years. Eight percent of the patients of MAIS score-1, (22.05%) of score-2, (51.28%) of score-3 and (18.8%) of score-4. Regarding the response to therapy: (44.78%) of patients showed complete clearance of the disease, (48.85%) with good response, (1.7%) of poor response and (5.47%) showed relapse of the melasma after discontinuation of the therapy, and they were retreated by the same combined formula, (93.75%) of them cleared completely and (6.25%) showed good response. Ninety percent of patients developed a variable degree of irritation, erythema and burning sensation, at the beginning of the treatment and after (10-15) days, most of them tolerated the therapy.
 Conclusion: Combined therapy of azelic, glycolic and kojic acids was effective and safe in the treatment of melasma and this combination was superior and alternative to the ordinary and corner therapy of hydroquinone and corticosteroid.

Evaluation of Efficacy and Safety of Combined Therapy of Melasma by using Azelic, Glycolic and Kojic Acid (Unitone and Neotone)

Background: Melasma is one of the most common disorders of brown hyperpigmentation, which affect primarily the face and later on some other sites of the body , seen most commonly in women during the reproductive period and may seen in men . Many options are used in the treatment of melasma, most commonly: hydroquinone, tretenoin, corticosteroid, azelic acid, glycolic acid, kojic acid, triaximinic acid, ascorbic acid, intralesional glutathione, and lastly medical procedures, like: microdermabrasion, chemical peel, laser and light therapy. Objective: To evaluate the efficacy and safety of combined therapy (azelic, glycolic and kojic acids) in the treatment of melasma (UNITONE and NEOTONE) . Patients and Methods: A cross-sectional study in which (585) patients complaining of melasma (577 females and 8 males), their age ranged from (17-50) years, with a mean age of 46.15± years. Treated by application of azelic acid (20% cream) for two hours at night, then washed and followed by topical application of combined cream consisted of (5%) glycolic acid and (1%) kojic acid throughout the night and washed in the morning, with application of sun block of ≥50 SPF, and oral ascorbic acid (500mg) tablet twice in the morning and evening . Results: Out of 585, 98% was females with a mean age of (46.15±8) years. Eight percent of the patients of MAIS score-1, (22.05%) of score-2, (51.28%) of score-3 and (18.8%) of score-4. Regarding the response to therapy: (44.78%) of patients showed complete clearance of the disease, (48.85%) with good response, (1.7%) of poor response and (5.47%) showed relapse of the melasma after discontinuation of the therapy, and they were retreated by the same combined formula, (93.75%) of them cleared completely and (6.25%) showed good response. Ninety percent of patients developed a variable degree of irritation, erythema and burning sensation, at the beginning of the treatment and after (10-15) days, most of them tolerated the therapy. Conclusion: Combined therapy of azelic, glycolic and kojic acids was effective and safe in the treatment of melasma and this combination was superior and alternative to the ordinary and corner therapy of hydroquinone and corticosteroid.

OA16 A great imitator of scleroderma

Introduction/BackgroundEosinophilic fasciitis is a rare disease of idiopathic aetiology, which can often mimic scleroderma in presentation and has been associated with haematological diseases. We present a case of eosinophilic fasciitis where the diagnosis was delayed due to the attribution of skin manifestations to scleroderma. This case highlights the importance of careful history and examination to recognize these differential diagnoses, prevent delay and improve outcome.Description/MethodA 69-year-old gentleman was referred to the Rheumatology clinic with suspected diffuse cutaneous systemic sclerosis. He presented with a 9-month history of skin tightening, pain and swelling affecting his legs, finding it difficult to fully extend at the knees, to drive or walk. His symptoms progressed overtime with skin changes spreading to all four extremities, abdomen and back. He reported weight loss of 12Kg associated with early satiety. He also experienced intermittent numbness of his hands. There were no respiratory symptoms, dysphagia or Raynaud’s phenomenon reported. His medical history includes atrial fibrillation and asbestos exposure. Currently on Apixaban 5mg/daily and Bisoprolol 2.5mg/daily.Physical examination revealed diffuse brown hyperpigmentation, erythema and thickened skin on his upper and lower limbs, abdomen and back, it was difficult to crease the skin and there was ‘peau d’orange’ appearance in his forearms. His face and hands were spared. Phalen's and Tinel’s tests were negative.Prior to clinical review he was investigated for paraneoplastic disease: a CT chest, abdomen and pelvis showed an incidental cyst in the thymus and emphysema with no underlying malignancy. Laboratory tests showed normocytic normochromic anaemia with haemoglobin 112 g/L and eosinophilia 1.5 x 109/L, elevated erythrocyte sedimentation rate 62mm/h, CRP 57mg/L, polyclonal hypergammaglobulinaemia IgA 4.3g/L and IgG 24.85g/L. The myeloma screen were negative.The absence of Raynaud’s, and the distribution of skin changes sparing his face, hands and feet, eosinophilia and raised inflammatory markers, made the diagnosis of eosinophilic fasciitis. Histological analysis of a full thickness skin biopsy confirmed patchy lymphoplasmacytic inflammatory cell infiltrate within the fascia and spilling into subcutis, with eosinophils.Subsequently, he was commenced on prednisolone 40mg/daily reducing regimen and Methotrexate 20mg/weekly, with a good response and regression of the swelling and pain. He is now able to walk without difficulty.Discussion/ResultsEosinophilic fasciitis is rare. Symptoms can be similar to those of scleroderma, sometimes considered a variant. The exact aetiology is unknown; however, the literature mentions a potential paraneoplastic, inflammatory, infectious or physical trigger, leading to an abnormal response with accumulation of eosinophils in different tissues. Consequently, this may release transforming growth factor beta to activate fibroblasts, increasing expression of other factors in the connective tissue, resulting in fibrosis.This case highlights that eosinophilic fasciitis present with hardening and thickening of the skin and surrounding tissue similar to that of scleroderma, however, lacks Raynaud’s phenomenon, sclerodactyly. Another striking features from his examination which helped us distinguishing from scleroderma was that his skin changes spare his face, hands and feet.Carpal tunnel syndrome is described in the literature which can progress if untreated.Typical blood tests findings documented in the literature include eosinophilia in 80% of the cases, elevated ESR and C-reactive protein (CRP), polyclonal hypergammaglobulinaemia, are usually present, however, eosinophilia may be transient, therefore normal eosinophil count does not exclude the disease. ANA and Rheumatoid factor can be positive in up to 10 % of the cases.MRI of the extremities to look for thickening of the fascia has been used in other cases, however, it was not required in our case because our Orthopaedics colleagues helped us with performing an urgent full thickness biopsy.Recommended treatment includes high dose steroids and immunosuppressive medication such Methotrexate is most often used for severe or resistant cases.The prognosis is good, however if treatment is delayed patients can develop joint contractures in 85% of patients and skin hardness may persist.In conclusion, careful history and examination is essential in differentiating scleroderma from the scleroderma-mimics especially when there is an atypical distribution, no sclerodactyly and no autoantibodies.Key learning points/Conclusion1. This case suggest that clinicians should be aware that eosinophilic fasciitis typically spare the hands, feet and face.2. Eosinophilia may be transient, therefore normal count does not exclude the disease.3. Recognizing this rare but great imitator of scleroderma set the stage for prompt therapy in either condition and reduce morbidity.

Cutaneous hemosiderosis in chronic venous insufficiency: A review

Hemosiderosis is the deposition of hemosiderin, a storage form of iron derived from the breakdown of erythrocytes. This process commonly occurs in patients with chronic venous insufficiency (CVI) due to venous hypertension and vascular ectasia. Cutaneous accumulation of hemosiderin in CVI causes brown hyperpigmentation and contributes to lipodermatosclerosis and ulceration, further highlighting the pathogenic role of iron metabolism in these disorders. In this review, we examine the pathophysiology and clinical presentation of hemosiderosis in CVI, summarize its management and prevention strategies, and explore its impact on quality of life.

MULTIPLE ORAL MUCOSA PIGMENTATION: IMPORTANCE OF CLINICAL ASPECTS AND MEDICAL INVESTIGATION

MULTIPLE ORAL MUCOSA PIGMENTATION: IMPORTANCE OF CLINICAL ASPECTS AND MEDICAL INVESTIGATION

557 A case of acquired dermal melanocytosis associated with Imatinib mesylate treatment

557 A case of acquired dermal melanocytosis associated with Imatinib mesylate treatment

Becker's Nevus Syndrome

The simultaneous occurrence of a patch of light or dark brown hyperpigmentation with hypertrichosis (Becker's nevus) together with (usually ipsilateral) soft tissues hypoplasia (especially breast, in women) and underlying skeletal anomalies (i.e., vertebral hypoplasia, scoliosis, pectus carinatum or excavatum) represents the Becker's nevus syndrome (BNS) phenotype. It was first described (as a single cutaneous lesion) by Becker in 1949 and then associated with the surrounding musculoskeletal disorders. The syndrome has also been reported as pigmentary hairy epidermal nevus syndrome. Less than 100 cases have been reported in the literature, with a slightly higher incidence in females and only few familiar cases: paradominant postzygotic mutations and/or an androgen-dependent hyperactivation have been reported as the causes of the diseases.The extracutaneous lesions are congenital and nonprogressive, and the natural history of the Becker's nevus is the same as that of isolated nevi: in prepubertal boys, the pigmentation may be less intense and the hairiness may be absent or mild, as occurs in women, whereas in men, there is an increase of hairiness after puberty. The treatment is essentially cosmetic, and potential therapeutic options include electrolysis, waxing, makeup, or laser.

Pigmented Oral Lichen Planus: A Case Report

<p><strong>Background:</strong> Lichen planus is a chronic muccocutaneous inflammatory disorder. Oral lichen planus (OLP) has certain specific characteristics in its clinical presentation, but can also be presented in forms resembling other diseases. This may introduce difficulty in the diagnostic process. It has been reported that OLP affects between 0.1 to 4% individuals, predominantly women and people over 40 years old. <strong>Case Report:</strong> A 46-year-old woman complained of a non-healing ulcer present for 1.5 months. Intraorally, multiple white striae with prominent central areas of brownish hyperpigmentation were apparent on the right and left buccal mucosa, right and left buccal sulcus, and lateral and dorsum of the tongue. A biopsy was completed and the histopathology features confirmed the diagnosis of OLP. For the initial treatment, a topical corticosteroid was prescribed, followed by steroid mouthwash. Response to this treatment was positive. OLP has been frequently reported to affect women over the age of 40, with psychological stress as a primary predisposing factor. The clinical presentation is characteristic of Wickham’s striae with erosive areas. However, a biopsy and histopathological examination is mandatory to confirm the diagnosis. The clinical feature of pigmented OLP has been reported and confirmed by microscopic finding of band-like lymphocytic appearance which is the pathognomonic features of OLP, along with basal cell liquefaction degeneration, and melanin in continence at the lamina propria. <strong>Conclusion:</strong> Pigmented OLP is a variant of erosive OLP. Anamnesis, clinical presentation, and histopathological examination confirm diagnosis.</p>

Acral melanoma

Acral melanoma

Pigmented oral lichen planus: A case report

Background: Lichen planus is a chronic muccocutaneous inflammatory disorder. Oral lichen planus (OLP) has certain specific characteristics in its clinical presentation, but can also be presented in forms resembling other diseases. This may introduce difficulty in the diagnostic process. It has been reported that OLP affects between 0.1 to 4% individuals, predominantly women and people over 40 years old. Case Report: A 46-year-old woman complained of a non-healing ulcer present for 1.5 months. Intraorally, multiple white striae with prominent central areas of brownish hyperpigmentation were apparent on the right and left buccal mucosa, right and left buccal sulcus, and lateral and dorsum of the tongue. A biopsy was completed and the histopathology features confirmed the diagnosis of OLP. For the initial treatment, a topical corticosteroid was prescribed, followed by steroid mouthwash. Response to this treatment was positive. OLP has been frequently reported to affect women over the age of 40, with psychological stress as a primary predisposing factor. The clinical presentation is characteristic of Wickham’s striae with erosive areas. However, a biopsy and histopathological examination is mandatory to confirm the diagnosis. The clinical feature of pigmented OLP has been reported and confirmed by microscopic finding of band-like lymphocytic appearance which is the pathognomonic features of OLP, along with basal cell liquefaction degeneration, and melanin in continence at the lamina propria. Conclusion: Pigmented OLP is a variant of erosive OLP. Anamnesis, clinical presentation, and histopathological examination confirm diagnosis.

Cutaneuos findings in patients with predialysis chronic kidney disease.

Several cutaneous findings are seen in dialysis dependent chronic kidney disease (CKD) patients. However, there are only a few small studies on cutaneous findings in predialysis CKD patients. We aimed to determine cutaneous findings in predialysis CKD patients. This was a cross-sectional study. Consecutive predialysis CKD patients from nephrology outpatient clinic in a university affiliated hospital were recruited to this study. Detailed dermatologic examination was performed by a senior dermatologist. Blood urea, creatinine, hepatitis B surface antigen and hepatitis C antibody test were studied for each participant. A total of 365 consecutive predialysis CKD patients (stages 2-5) included in the study. Three hundred and fifty-eight patients (98.1%) had at least one dermatologic finding. The most common cutaneous finding was xerosis (64.9%) followed by hair findings (41.4%), pruritus (19.2%), pigmentary changes (17.5%), nail findings (15.3%) and oral mucosal findings (9.3%). Longitudinal striations was the most common nail finding, diffuse brown hyperpigmentation was the most common pigmentary change, coated tongue was the most common oral mucosal finding and androgenetic alopecia was the most common hair finding. Frequency and diversity of dermatologic findings did not change across CKD stages. This is the largest study investigating dermatologic findings in a well-characterized predialysis CKD patient population. We found that at least one cutaneous finding was present in almost all of the CKD patients. Cutaneous findings are very common and diverse among predialysis CKD patients.

Mitten-Line Hyperpigmentation of an Infant.

Dear Editor: A 9-day-old female infant recovering from respiratory distress syndrome was referred to us for linear skin eruption on her forearm during hospitalization. She was born at gestational age 38 weeks 1 day by normal spontaneous vaginal delivery and weighed 3,260 g at birth. For the 5 days preceding the development of the skin lesion, mittens had been placed on both her hands to prevent acrocyanosis. Physical examination revealed a linear, partially circumferential, erythematous and vesicular patch corresponding to the elastic band of the mitten on the dorsal side of the right forearm (Fig. 1A). Sensory and motor function of the affected area was intact and there were no other skin or systemic abnormalities. After 1 week without mitten use and application of a topical steroid cream, the skin lesion healed and became an area of brown hyperpigmentation (Fig. 1B). During the 1-month follow-up period, the hyperpigmentation line gradually faded. Fig. 1 (A) Linear, circumferential, erythematous and vesicular band on the forearm of a 9-day-old female at her first examination. (B) Brownish hyperpigmentation after one week. Mitten- or sock-line hyperpigmentation, also known as sock-line band or infantile garment band, is a recently described, rare infant skin condition1,2,3,4. In 2005, Zhu et al.5 experienced two infants with linear hyperpigmentation of the calves, and first described this condition as 'congenital curvilinear palpable hyperpigmentation'. However, it is considered to be a misnomer since it was not actually congenital origin. To the best of our knowledge, there are only 20 cases of this distinct condition in the literature1,2,3,4,5. It is characterized by a linear, partially or fully circumferential, hyperpigmented patch along the area compressed by a tight garment such as socks, mittens, pants or diapers1,2,3. This acquired lesion usually presents as a single, unilateral, brown-colored, flat configuration, but multiple, bilateral, raised as well as atrophic lesions have also been described. It occurs predominantly on the posterior aspect of the ankle or calf, and rarely on the wrist, thigh, or heel3,4. Although the pathogenesis is unclear, dermal inflammation or panniculitis related to local pressure may lead to post-inflammatory hyperpigmentation2. Characteristics of infantile skin, including vulnerability to physical trauma and high saturated fatty acid content, as well as the inability to remove the tight garment or effectively communicate discomfort, may be related to the development of this condition2. A diagnosis can be easily reached upon obtaining the history related to garment wear and the characteristic clinical features. Differential diagnosis should include other infant linear skin eruptions with different courses related to child abuse, amniotic band syndrome, acquired raised bands of infancy. In addition, congenital hyperpigmentation syndromes following Blaschko's lines, such as linear epidermal nevi, linear and whorled nevoid hypermelanosis, and incontinentia pigmenti should also be considered2,3. The distinct clinical features of mitten- or sock-line hyperpigmentation for distinguishing from other linear hyperpigmentation is that it typically presents as one or two hyperpigmented patch perpendicular to the limb axis and does not follow the line of Blaschko. Avoiding local pressure from tight garments is the mainstay of preventive therapy. This condition typically resolves within a few months without any sequelae, although a few persistent cases longer than 2~3 years have been described in the literature3. In conclusion, we report the first Korean case of mittenline hyperpigmentation on the right forearm of a 9-day-old female.

Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type Involving Skin Masquerading as Eczema

Dear Editor: Extranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKTL) is an uncommon type of lymphoma that is endemic to East Asia and parts of Central and South America1. Most of the patients clinically present with nasal obstruction, sinusitis, ulcer, and epistaxis due to a destructive mass involving the midline facial tissues and skin is the second most commonly affected organ after nasal area1. Descriptions of cutaneous manifestations of ENKTL are of well-circumscribed lesions such as nodules/tumors, plaques and ulcers. Other atypical, various clinical morphologies have been reported including papules, cysts, ulcers, and cellulitis2. ENKTL presenting in the skin is highly aggressive with a mean survival of less than 12 months3. We report a case of extranodal NK/T-cell lymphoma, nasal type who presented with lesions clinically similar to eczema. A 63-year-old woman visited with pruritic erythematous papules and plaques with areas of postinflammatory hyperpigmentation on right upper back, left breast, and left thigh which persisted for 6 weeks (Fig. 1A~C). Under the clinical impression of eczema and urticarial dermatitis, she was treated with oral antihistamines and topical steroids ointment for 2 weeks. Despite treatment the lesions persisted and therefore skin biopsy was done on erythematous plaque of right upper back. Histopathologic findings revealed mixed atypical lymphoid cells and histiocytic cells along superficial and deep perivascular area (Fig. 2A). Lymphocytic infiltration showed perivascular pattern, with pale cytoplasm and dense chromatin with irregularly shaped nuclei (Fig. 2B). Immunohistochemical study showed CD3 and CD4 positivity in majority of lymphoid cells (Fig. 2C), focal positivity in CD8, CD30, CD56 (Fig. 2D) strong and profuse positivity in in situ hybridization for Epstein-Barr virus (EBV) (Fig. 2E). The patient was informed to visit immediately, however, did not visit within 2 weeks of notification. Five weeks after the initial visit the patient presented with left eye ptosis and swelling of left eyelid and mandibular area. Under the impression of extranodal NK/T-cell lymphoma, nasal type, the patient was transferred to hemato-oncology department. Fig. 1 Erythematous papules and plaques with areas of brownish hyperpigmentation on (A), (B) right upper back and (C) left thigh. Fig. 2 (A) Mixed atypical lymphoid cells and histiocytic cells along superficial and deep perivascular area (H&E, ×40). (B) Lymphocytic infiltration in perivascular pattern, with pale cytoplasm and dense chromatin with irregularly shaped nuclei ... The NK/T-cell lymphomas are classified into 2 subtypes, nasal and non-nasal NK/T-cell lymphomas. The non-nasal group can be further subdivided into primary cutaneous and 4 types of secondary cutaneous lymphomas: nasal-type, aggressive, blastoid, and other specific lymphoma types4,5. Nasal-type NK/T-cell lymphoma is the most common subtype among the secondary cutaneous non-nasal NK/T-cell lymphomas5. The skin is the most common extranodal site of involvement followed by the soft tissues, and could be either primary or secondary feature of the disease3. The new sites of involvement are also mostly extranodal, and are similar to the predilection sites at presentation4. Extracutaneous involvement at the time of presentation is associated with worse prognosis3. In a patient with known ENKTL, a skin biopsy should be obtained from any suspicious clinical lesion to assess for possible cutaneous involvement. Furthermore, a simple erythematous patch may be the initial presenting manifestation of the disease. In conclusion, we report a case which stresses the importance of awareness of malignancy and prompt skin biopsy in patients with erythematous papules and plaques that fail to respond to traditional management.

Brown hyperpigmentation of the hands and chest in a patient with lung cancer and muscle weakness

Brown hyperpigmentation of the hands and chest in a patient with lung cancer and muscle weakness

Cutaneous siderosis secondary to intramuscular iron dextran treated with 755 nm Q‐switched alexandrite laser: A case report

Cutaneous siderosis is accumulation of iron in the dermis and the subcutaneous tissue secondary to extravasation of an intramuscular or intravascular iron injection. It presents as varying shades of brown macules with no distinct contours. The hyperpigmentation is permanent without treatment. Q-switched lasers have been used effectively to treat lentigines and tattoos however, there is little data on the treatment of cutaneous siderosis with lasers. Our objective was to effectively treat cutaneous siderosis with a Q-switched alexandrite laser. A 50-year-old female had received nine injections of intramuscular iron dextran, one injection every 2 weeks alternating right buttock and left buttock over the course of 5 months. A couple of weeks after her 9th injection which was on the left, she noted brown hyperpigmentation in the injection area with the left worse than the right. She waited 3 months for the hyperpigmentation to self-resolve before presenting in our clinic. We utilized the Q-switched alexandrite laser to treat the patient with a test spot. One week later, there was nice partial clearance from the test spot so we commenced full treatment of the hyperpigmentation. There was significant improvement after the first treatment and she has been treated 4 times with continued improvement over the past 2 months. The Q-switched alexandrite laser is a useful tool in the treatment of cutaneous siderosis secondary to iron injection.

Hpv-Associated Penile Pigmented Lesion

Summary HPV infection is involved in the etiology of a number of nonmalignant, premalignant and malignant cutaneous lesions. One of them is the so-called giant condyloma of Buschke-Löwenstein type (Buschke-Löwenstein tumor, BLT), which sometimes can imitate clinically other tumors or tumor-like conditions. Clinicians face a particular challenge in cases of BLT where, clinically, the lesions demonstrate a permanent brown hyperpigmentation in parallel with the dermatoscopic lack of the characteristic melanocytic network, globules or regression zones. There are uncommon clinical presentations with solitary, sharply demarcated pigmented lesions. In these cases the histopathological verification of the lesion is obligatory and the most efficient treatment method in the early period of the disease is the complete surgical excision. We report a case of a 74-year-old man who was admitted to the University Hospital “Lozenetz” in connection with profuse variceal bleeding of the esophagus associated with liver cirrhosis of unknown etiology. He underwent a consultative examination at the department of dermatology because of suspected advanced stage melanoma of the prepuce. Computed tomographic analysis indicated diffuse bone metastases located in the small pelvis and femur, as well as metastatic disease in the left inguinal lymph nodes. However, the subsequent histopathologic examination of the lesion, rather than showing melanoma, confirmed the presence of HPV-associated giant condyloma of Buschke and Löwenstein in initial stage, without histopathological evidence for invasive and destructive tumor growth. After his death, the patient’s relatives did not give consent for an autopsy, and therefore the genesis of the metastases, demonstrated by nuclear magnetic resonance imaging (NMR), remained unclear. In some cases, the clinical picture of the malignant and premalignant cutaneous lesions in the genital area could be problematic. The complete surgical excision with a subsequent histopathological verification is the best way to find out the exact diagnosis

Caso para diagnóstico

Erythromelanosis follicularis faciei et colli is a rare disease of unknown etiology characterized by symmetric erythematous brownish hyperpigmentation on the frontal, malar and temporal areas associated with involvement of the pilary follicle. It is common to present pilar keratosis on the shoulders and neck. The three main clinical characteristics are: erythema (with or without telangiectasias), discrete follicular papules and brownish hyperpigmentation.