Hyperpigmented Patches Research Articles

Post-chikungunya hyperpigmentation

A 43-year-old woman presented with facial hyperpigmentation for the past 1 week. She had been hospitalised a month back with high-grade fever, headache, severe arthralgia and generalised morbiliform rash; IgM...

Hyperpigmented Patch With Linear Extension

ABSTRACT This is the case of a 29-year-old man with a well-demarcated, irregularly shaped, hyperpigmented patch located on the dorsal left hand with linear extension spreading across the distal medial surface. The patch initially presented as an erythematous lesion accompanied by burning, which subsided. A multiple-choice clinical question addressing the underlying diagnosis is offered. An answer is provided with a follow-up discussion focusing on underlying pathology, typical clinical presentation, and suggested management guidelines.

Unusual case of chylothorax with unilateral limb swelling

Here, we present an unusual case of 26-month male toddler who presented with swelling of right lower limb with painless hyperpigmented patch over right groin of 18 months duration associated...

The variability of clinical manifestation in Riehl’s melanosis: a two-case report

Riehl’s melanosis is a rare case of pigmented contact dermatitis on the face that is characterized by hyperpigmented patches secondary to dermal melanin deposits. The clinical manifestations may vary in pattern and color of hyperpigmentation. The most common pattern is reticulate but, in few cases, may present with diffuse pattern. The color may vary from grayish-brown to bluish-brown. We reported two cases of Riehl’s melanosis that consisted of grayish-brown reticulate patches and bluish-brown diffuse patches. Both cases had a history of using cosmetics for a long time before the appearance of the hyperpigmented patches without preceding inflammation. The histopathological examination results of both cases showed vacuolar degeneration of the basal layer, pigmentary incontinence, and infiltration of melanophages and lymphocytes in the dermis that supported the diagnosis of Riehl’s melanosis. The patch test results revealed a positive reaction to 25% balsam peru, 5% nickel sulfate, and suspected cosmetics in the first case and 20% neomycin sulfate and 5% nickel sulfate in the other one. The patients were instructed to avoid the cause and were treated with skin-lightening agent with minor clinical improvement. Riehl’s melanosis has a diagnostic challenge because of the variability of clinical manifestations.

One person, two bilateral symmetrical giant Becker nevi

Becker nevus, first described by Samuel William Becker in 1949, is a focal epidermal hypermelanotic disorder. It commonly presents as a unilateral hyperpigmented patch that is predominantly distributed on the upper trunk and proximal extremities and frequently associated with hypertrichosis. There have been few reports in the literature of Becker nevus with bilateral involvement; multiple Becker nevi is also unusual. Herein, we report a young man with two bilateral symmetrical giant Becker nevi, one on the trunk with extension to both arms and the second on the abdomen.

Bilateral Deri Tutulumu ve İskelet Malformasyonlarının Eşlik Ettiği Becker Nevüs Sendromu: Nadir Bir Olgu

Becker nevus (BN) is a hamartomatous lesion characterized by a hyperpigmented patch generally located in the shoulder or upper trunk. Although BN is reported to be congenital, it is frequently seen in the first or second decade. A diagnosis of BN can be made based on clinical findings and, ideally, a skin biopsy of the lesion. Becker nevus syndrome (BNS), which belongs to the epidermal nevus syndrome group, is a rare disorder characterized by BN associated with skin, muscle, or skeletal anomalies. Ipsilateral breast hypoplasia is the most comman skin finding in BNS. Bilateral skin involvement is rarely seen in the syndrome. Herein, we present a female patient with BNS associated bilateral BN and musculoskeletal findings.

Cefixime and ornidazole combination induced fixed drug eruption: a case report

Cefixime, a third generation cephalosporin and ornidazole, a nitroimidazole is used for a wide variety of conditions like urinary tract infections, otitis media, pharyngitis, uncomplicated gonorrhea and anaerobic infections. Fixed drug eruption (FDE) is commonly associated with anticonvulsants, antimicrobials and NSAIDs. Here we report a case of a rare cefixime and ornidazole combination induced fixed drug eruption. A 39 year old male developed hyper-pigmented patches over both forearms and left thigh after consuming fixed dose combination of cefixime and ornidazole tablet for the treatment of urinary tract infection.

Violaceous Papules on the Plantar Feet: An Unusual Presentation of a Nodular Amyloidosis

Primary cutaneous amyloidosis refers to the deposition of amyloid within normal skin without evidence of internal organ involvement. Typically, it is characterized by hyperpigmented, asymptomatic, or pruritic patches (macular variant) or firm, skin-colored, or hyperpigmented papules and plaques (lichenoid variant). A third variant, nodular amyloidosis, is rare.

Hyperpigmented Patch in a 10-Year-Old Boy

Hyperpigmented Patch in a 10-Year-Old Boy

Bleomycin-induced flagellate pigmentation: a case report from North-East India

<p class="abstract">Bleomycin is an antitumour antibiotic commonly used in the management of Hodgkin’s lymphoma and germ cell tumours. Flagellate pigmentation is a very specific and rare cutaneous adverse effect of bleomycin. It is characterised by linear, painless, pruritic, hyperpigmented lesions simulating marks of whiplashes over trunk and extremities. With the advent of targeted therapies resulting in the infrequent use of bleomycin, this unique side effect is also uncommonly encountered nowadays. Here, we report a case of bleomycin-induced flagellate pigmentation in a 35-year-old Indian female with ovarian teratoma. The characteristic patterned hyperpigmented patches developed following 2nd cycle of chemotherapy with bleomycin, etoposide and cisplatin.</p><p class="abstract"> </p>

In vivo reflectance confocal microscopy for evaluating common facial hyperpigmentation.

In clinical settings, atypical facial hyperpigmentation such as nevus of Ota, acquired bilateral nevus of Ota-like macules (ABNOM), melasma, and café-au-lait spots are often missed and misdiagnosed. Summarizing in vivo reflectance confocal microscopy (RCM) features of the hyperpigmentation is helpful in the diagnosis of ambiguous lesions. We recruited 196 patients referred for unequivocal facial hyperpigmentation, including 55 patients with nevus of Ota, 45 patients with ABNOM, 62 patients with melasma, and 34 patients with café-au-lait spots. The RCM images were evaluated at the epidermis, the dermis-epidermis junction (DEJ), and the upper papillary dermis from both hyperpigmented patches and normal skin. In the superficial and middle dermis, 41 of 55 patients (74.5%) with nevus of Ota were characterized by a cord-like or lumpy structure between the collagen fibers. And there was no melanin deposition detected in the dermis in 14 of 55 (25.5%) patients. In ABNOM, 37 of 45 (82.2%) patients were characterized by a cord-like or lumpy structure in the superficial dermis and 8 of 45 patients (17.8%) was no melanin deposition detected in the dermis. The epidermis was no difference between nevus of Ota, ABNOM, and the normal skin. Melasma was detected increased cobblestone pattern in the epidermis of all patients, branching architecture in 21 of 62 patients (33.9%), and focally aggregated round to triangular cells in the upper dermis of 18 of 62 patients (29.0%). In all patients with afé-au-lait spots, increased cobblestone pattern in the epidermis and regular and increased density of ringed pattern in the DEJ were visualized. Our findings indicate that RCM may be useful in the auxiliary diagnosis of nevus of Ota, ABNOM, melasma, and café-au-lait spots.

Systemic lupus erythematosus presenting as toxic epidermal necrolysis

A 27-year-old woman presented with 6 weeks’ history of painful, raised purpuric lesions followed by blisters and sheet-like desquamation on the face, extremities and trunk involving approximately 30% of body...

Terra Firma-Forme Dermatosis, Keratotic Form

Terra firma-forme dermatosis (TFFD) is a condition that presents as hyperpigmented patches or plaques that have a dirt-like resemblance. A keratotic form of TFFD that has not been previously reported is described in this case. The diagnosis and treatment for this condition, the alcohol swab test, did not lead to resolution of the patch in our patient. The keratotic papules had to be removed by using the edge of a microscope slide. This case report serves to provide awareness of this unique, keratotic variant that cannot be removed by wiping with isopropyl alcohol.

Dermoscopic pattern of pityriasis versicolor.

Background: Pityriasis versicolor (PV) is essentially a clinical diagnosis characterized by hypopigmented or hyperpigmented patches on the skin. Dermoscopy is gaining popularity as a noninvasive procedure for the diagnosis of different pigmentary and inflammatory disorders. However, scarce evidence exists on the dermoscopic pattern of PV.Objective: To describe the dermoscopic features of hypopigmented and hyperpigmented lesions of PV.Methods: Dermoscopic images of PV lesions located on different body sites were retrospectively evaluated for the presence of predefined criteria.Results: A total of 178 lesions from 125 patients were included in the study among which 164 lesions were hypopigmented and 14 lesions were hyperpigmented. Nonuniform pigmentation was the most common dermoscopic feature seen in both hypopigmented lesions (n=152, 92.68%) and hyperpigmented lesions (n=14, 100%). Scales were seen in 142 hypopigmented lesions (86.56%) and 13 hyperpigmented lesions (92.86%). Patchy scaling was more common in hypopigmented lesions (n=95, 57.92%) while scaling in the furrows was more common in the dermoscopy of hyperpigmented lesions (n=5, 35.71%). Inconspicuous ridges and furrows and perilesional hyperpigmentation were other significant features seen in dermoscopy of the lesions.Conclusion: To our knowledge, this is the first study describing the dermoscopic features of PV in such a large number of patients. Description of these new features adds valuable information and may help to establish dermoscopy as an important auxiliary tool for the diagnosis of PV.

Hyperpigmented patch of the left hemithorax

Hyperpigmented patch of the left hemithorax

Treatment of the nevus of Ota with the 1064-nm Q-switched Nd:YAG laser

Nevus of Ota is a benign hamartoma which presenting as blue-gray hyperpigmented patches on the face and mucous membranes usually within the distribution of first and second branches of the trigeminal nerve. It may occur at birth or during adolescence and the nevus of Ota is very common seen in Japan and east countries. The pigmentation varies and can be dark brown to blue to black-blue. We report a 31-year-old female patient with the nevus of Ota. The Q-switched Nd:YAG laser, had a spot size of 3 mm, an 8 Hz repetition rate, 720 mj/cm2 fluence. The patient's lesion improved in a rate of 60% with a single session. The Q-switched Nd:YAG laser has a significant effect in treating the nevus of Ota.

Hyperpigmented patches following blaschko lines: Two probable cases of linear atrophoderma of moulin with subtle atrophy and a critical review of the subject

Linear atrophoderma of Moulin (LAM) is a rare clinical entity characterized by hyperpigmented, depressed band-like skin lesions following blaschko lines (BL). Since its first description by Moulin et al., several authors have presented cases with variable clinical and histopathological features and have diagnosed them as LAM. Whether all those cases represented classical LAM as described by Moulin et al. or they represented a related dermatosis; depends on whether we confine the diagnosis of LAM as presented by Moulin et al. or consider it to be a spectrum where lesions may have overlapping clinical and histopathological findings. Some dermatoses that follow BL and have overlapping clinical and histopathological findings include LAM, idiopathic atrophoderma of Pasini and Pierini and Blaschkolinear morphea. Thus, it becomes difficult for a physician to diagnose these conditions when their typical clinical and histopathological findings are not present, especially when they present in early stages of evolution. Here in, we present two cases of LAM where the visible clinical atrophy is mild in one and not appreciable in the other. Whether our cases are the genuine cases of LAM or represent a stage of LAM or fall in the spectrum of LAM depends on how we expand the definition of LAM. We believe that whenever there is an encounter with hyperpigmented lesions in a blaschkoid pattern, a long-term follow-up is needed with serial biopsies to make a final definitive diagnosis.

In vivo multiphoton microscopy of melasma.

Melasma is a skin disorder characterized by hyperpigmented patches due to increased melanin production and deposition. In this pilot study, we evaluate the potential of multiphoton microscopy (MPM) to characterize non-invasively the melanin content, location, and distribution in melasma and assess the elastosis severity. We employed a clinical MPM tomograph to image in vivo morphological features in melasma lesions and adjacent normal skin in 12 patients. We imaged dermal melanophages in most dermal melasma lesions and occasionally in epidermal melasma. The melanin volume fraction values measured in epidermal melasma (14%±4%) were significantly higher (p<0.05) than the values measured in perilesional skin (11%±3%). The basal keratinocytes of melasma and perilesions showed different melanin distribution. Elastosis was predominantly more severe in lesions than in perilesions and was associated with changes in melanin distribution of the basal keratinocytes. These results demonstrate that MPM may be a non-invasive imaging tool for characterizing melasma.

A case of ochronosis successfully treated with the picosecond laser.

Exogenous ochronosis is a cutaneous condition characterized by blue-black pigmentation resulting as a complication of long-term application of skin-lightening creams containing hydroquinone and other substances such as quinine, phenol and mercury derivatives. We report a case of a 55-year-old woman who developed exogenous ochronosis as a result of prolonged use of topical hydroquinone for 5years, characterized by greyish hyperpigmented patches on the nose and cheeks. The diagnosis was confirmed histologically. Treatment with picosecond laser resulted in marked clinical improvement together with improvement in overall texture and quality of the skin.

A teenage girl with bilateral hyperpigmentation of cheeks and sclera and a vascular stain on her cheek: What is your diagnosis?

CLINICAL PRESENTATION A 16 year old girl was referred to dermatology clinic with bilateral blue gray hyperpigmented patches on her cheeks since birth. Upon close physical examination, scleral blue-gray hyperpigmentation was observed in both her eyes (Figure 1). She also had a blanchable red patch with poorly defined borders on her right cheek (Figure 2). Ophthalmology consultation further revealed an increased intraocular pressure with optic nerve damage. She had neither systemic problems nor a history of a similar condition in her family.