Facial Pigmented Lesions Research Articles

Post Laser-Amelanotic Pattern of Lentigo Maligna: Pitfalls in Diagnosis and Treatment of Pigmented Facial Lesions of Unknown Nature

Post Laser-Amelanotic Pattern of Lentigo Maligna: Pitfalls in Diagnosis and Treatment of Pigmented Facial Lesions of Unknown Nature

Objective and non‐invasive evaluation of photorejuvenation effect with intense pulsed light treatment in Asian skin

Intense pulsed light (IPL) has been widely used for photorejuvenation. Although previous literature has shown clinical effectiveness of IPL treatments on cutaneous photoaging, the associated changes in the biophysical properties of the skin following IPL treatments have not been fully elucidated. The aim of this study was to evaluate changes in skin biophysical properties in patients with photoaging after IPL treatments, using non-invasive, objective skin measuring devices. A total of 26 Korean women with facial dyschromias underwent three sessions of IPL treatment at 4-week intervals. Outcome assessments included standardized photography, global evaluation by blinded investigators, patients' self-assessment and objective measurements of colour (Mexameter MX18, Chromatometer), elasticity (Cutometer), roughness (Visiometer), sebum (Sebumeter) and skin hydration (Corneometer). Results Intense pulsed light treatments produced a 15% decrease in the size of representative pigmented lesions (P < 0.05). Patients' self-assessment revealed that 84% and 58% of subjects considered their pigmented lesions and wrinkles were improved respectively. Objective colorimetric measurement demonstrated significant improvements following IPL treatments that were most remarkable after one session of IPL. Moreover, skin elasticity showed significant improvements at the end of the study. Skin wrinkles as measured using Visiometer showed a mild improvement without statistical significance. Sebum secretion and water content of skin remained unchanged. Intense pulsed light provided significant improvement in the appearance of facial pigmented lesions in Korean patients. These effects appeared to be more remarkable in improving pigmentation, skin tone and elasticity.

Dermatoscopy of flat pigmented facial lesions: diagnostic challenge between pigmented actinic keratosis and lentigo maligna

The similarity between clinical pictures of pigmented actinic keratosis (PAK) and lentigo maligna (LM) is well known. To investigate the frequency of dermatoscopic findings suggestive of LM/lentigo maligna melanoma (LMM) in the other facial pigmented skin lesions (FPSL) and to assess the distinguishing dermoscopic criteria of PAK and LM. Eighty-nine FPSL were evaluated with conventional dermatoscopy. The lesions showing one or more dermatoscopic features considered as specific patterns for the diagnosis of LM/LMM, mainly slate-grey to black dots and globules, slate-grey areas, annular-granular pattern, asymmetrical pigmented follicular openings, black blotches, rhomboidal structures, hyperpigmented rim of follicular openings, slate-grey streaks and dark streaks, were included in the study selectively. PAK was diagnosed in 67, LM or LMM in 20 and lichen planus-like keratosis in two lesions, histopathologically. Eleven essential dermatoscopic features were observed in facial PAK: slate-grey dots (70%); annular-granular pattern (39%); rhomboidal structures (36%); pseudonetwork (36%); black globules (34%); slate-grey globules (33%); black dots (30%); asymmetrical pigmented follicular openings (25%); hyperpigmented rim of follicular openings (21%); slate-grey areas (18%); and streaks (3%). PAK has a striking similarity to LM/LMM in clinical and dermatoscopic features, thus representing a diagnostic challange. All dermatoscopic findings except black blotches were observed in PAK. As dermatoscopic diagnosis of a pigmented skin lesion cannot be based on the presence of a single criterion, we may conclude that histopathology still remains the gold standard for correct diagnosis.

Partial unilateral lentiginosis associated with nevus of Ota

To the Editor: A 25-year-old otherwise healthy female was referred to our department for the evaluation of pigmented facial lesions. Localized hyperpigmentation over the right eye had been present since birth. In the last 4 years, she noticed development of ipsilateral multiple brown lentigines extending onto the right forehead, temple, and eyelids, as well as a progressive blue-gray pigmentation on the right eyelid and tip of the nose.

Carcinomes basocellulaires multiples après radiothérapie pour cancer du cavum

Basal cell carcinoma (BCC) is a cutaneous, generally primary malignancy, most common among the elderly. We report the case of a patient presenting numerous BCCs several years after radiation therapy for nasopharyngeal cancer and discuss the risk factors for this tumor and the role played by radiation in its genesis.A 30-year-old woman presented with pigmented facial lesions that had been developing over the past year. Eleven years earlier, she had had an undifferentiated nasopharyngeal carcinoma (T3N2M0), which was treated by neoadjuvant chemotherapy and then external radiation therapy. Initial cutaneous examination noted two lesions that were identified as BCC after biopsy. The tumors were excised surgically. Neither clinical nor radiological check up showed signs of basal cell nevus syndrome.BCC is the most frequent malignant tumor. It is observed mainly among those aged 45-60 years. Disorders that might promote or complicate BCC should be systematically sought in young patients, especially basal cell nevus syndrome. While our patient may have had this syndrome, we found none of the other clinical or radiographic elements often observed with it. The occurrence of BCC within the irradiation area, the multiplicity of lesions, and the sufficient latency period are consistent with radiation-induced tumors. We found no reports in the literature of BCC following radiation treatment for nasopharyngeal cancer, but the occurrence of these tumors in our patient suggests the need for close supervision in such cases.

Clinical Applications of the 532-nm Diode Laser for the Treatment of Facial Telangiectasia and Pigmented Lesions: Literature Review, History, and Discussion of Clinical Experience

Introduction: Facial telangiectasias are common lesions resulting from multiple factors. Multiple therapies and devices have been used for the treatment of facial telangiectasia with varied success and complication rates. The 532-nm diode (diode-pumped, frequency-doubled Nd:YAG) laser is compared with other laser and nonlaser modalities for the office-based cosmetic surgery practice. Materials and Methods: This article provides a literature review and examines the history of laser treatment of facial telangiectasia and the evolution of modern laser therapy. Clinical experience is also detailed in the treatment of facial telangiectasia and pigmented lesions. Results: 532-nm diode lasers are lightweight, extremely portable systems that are effective in the treatment of facial telangiectasia and various pigmented lesions. When compared to other popular modalities and laser wavelengths, the 532-nm diode laser can successfully treat facial telangiectasia and some pigmented facial lesions with less chance of collateral tissue damage and resultant complications. Discussion: The 532-nm diode laser is representative of technological innovations that enable small, lightweight, and affordable lasers to be used by the office-based cosmetic surgeon. Distinct advantages are evident when it is compared with other wavelength lasers. Because of the smaller spot size and depth of penetration, this laser also has treatment limitations; however, it provides a welcomed addition to the armamentarium for the surgeon treating facial ectatic and pigmented lesions. Conclusion: Because of its demonstrated clinical effectiveness, ease of use, and lack of resultant purpura, as well as affordability and portability, this laser is well suited for the office-based cosmetic practice.

Melasma and acquired immunodeficiency syndrome (AIDS)

AbstractBackground Hyperpigmentation of skin, mucous membranes and nails has been described in patients with acquired immune deficiency syndrome (AIDS).Patients and methods 7 AIDS patients affected with melasma‐like facial hyperpigmentation were studied. The patients had human immunodeficiency virus infection associated with recurrent mucocutaneous and systemic opportunistic infections. All had a low T4‐CD4 helper cell count and four of them died of severe infections, caused by cytomegalovirus (CMV), mycobacteria (Mycobacterium tuberculosis or Avium) and Pneumocystis carinii pneumonia. In these patients the autopsy showed intense infiltration of the adrenal glands. One of them died of Waterhouse‐Friderichsen syndrome; her autopsy showed a massive presence of cytomegalovirus in the adrenal glands.Results In 4 patients dosages of testosterone, cortisol, T3, T4, TSH gave normal results. The level of DHEA‐S was below normal revealing an adrenal insufficiency. The α‐MSH test in 12 patients (4 patients with AIDS and facial hyperpigmentation and 8 volunteers with AIDS, but without pigmented facial lesions) revealed blood levels of α‐MSH above the norm (60.33 pg/ml standard deviation 13.21). The α‐MSH test in 20 healthy subjects revealed a mean value of 44.40 pg/ml (standard deviation 10.47). The biopsy of melasma revealed that melanocytes were present in normal numbers and size with a localized increase of melanin pigment in the basal cell layer.Conclusion An increased production of ACTH and its derivatives such as α‐MSH pituitary may be the cause of hyperpigmentation in AIDS patients.

Melasma and acquired immunodeficiency syndrome (AIDS)

Background Hyperpigmentation of skin, mucous membranes and nails has been described in patients with acquired immune deficiency syndrome (AIDS).Patients and methods 7 AIDS patients affected with melasma-like facial hyperpigmentation were studied. The patients had human immunodeficiency virus infection associated with recurrent mucocutaneous and systemic opportunistic infections. All had a low T4-CD4 helper cell count and four of them died of severe infections, caused by cytomegalovirus (CMV), mycobacteria (Mycobacterium tuberculosis or Avium) and Pneumocystis carinii pneumonia. In these patients the autopsy showed intense infiltration of the adrenal glands. One of them died of Waterhouse-Friderichsen syndrome; her autopsy showed a massive presence of cytomegalovirus in the adrenal glands.Results In 4 patients dosages of testosterone, cortisol, T3, T4, TSH gave normal results. The level of DHEA-S was below normal revealing an adrenal insufficiency. The α-MSH test in 12 patients (4 patients with AIDS and facial hyperpigmentation and 8 volunteers with AIDS, but without pigmented facial lesions) revealed blood levels of α-MSH above the norm (60.33 pg/ml standard deviation 13.21). The α-MSH test in 20 healthy subjects revealed a mean value of 44.40 pg/ml (standard deviation 10.47). The biopsy of melasma revealed that melanocytes were present in normal numbers and size with a localized increase of melanin pigment in the basal cell layer.Conclusion An increased production of ACTH and its derivatives such as α-MSH pituitary may be the cause of hyperpigmentation in AIDS patients.

Unusual facial granulomas occurring in a child. Report of a case.

This report describes the occurrence of distinctly unusual skin lesions in a young patient. Although the histopathologic appearance resembled tuberculosis and other granulomatous entities, the manifestations could not be ascribed to any of the known diagnostic possibilities. The disparity between the benign, limited clinical course and the serious systemic implications of the pathological findings was of considerable interest. Report of a Case The patient, a white female born in August, 1957, was seen first in August, 1959, because of 3 pigmented facial lesions of 4 months' duration. In April, 1959, at the angle of the left jaw, a soft nontender swelling was noted. This was thought to be mumps, was not treated, and abated within 2 weeks, spontaneously. However, at this time 3 slightly raised, 2 cm. flesh-colored lesions developed in the same area and during the next few months became more deeply pigmented. The size of the lesions remained