Pigmentation disturbances

skin colors are combination of :

chromophore melanine: brown
oxyhaemoglobine : red
de-oxyhaemoglobine : blue
carotane : yellowish orange
melanine: the most important role
- produced by melanocyte on basale layer
- controlled by MSH of hypophise
- stimulated by: UV, irritant substances
- there are two types : eu- melanine: brown
pheo- melanine: red
- the role: to absorb UV- radiation
- skin colour depent on the measure & the
shape of melanosome
 MELASMA / CHLOASMA
- local hyperpigmentation
- deff : symmetric hyperpigmentation of face skin
- risc factors : U V
gravidity
hormonal contraception
epileptic medicine
fragrance of cosmetic
- clinical manifestations:
hyperpigmentation macule,
sharply demarcated,
irregular margin,
gear- like : map- like
- predilection : cheeks, nose, forehead
based on location:
- centrofacial : cheeks, forehead, supralabial,
nose, chin
- molar : cheeks, nose
- mandibular : ramus mandibula

based on melanin location

- epidermal - dermal - mixed
treatment:
- general:
avoid : hormonal, UV, fragrance in cosmetic
use sunscreen with sun protection factor SPF 15

- specific
topical :
hydroquinone cream 2 5 %
night cream: only for several hours (irritant)
side effects: allergic/ irritant contact dermatitis
long time using : ochronosis
(deposite of HQ
oxydation)
- Kligmans formula.
consist of : HQ 5 %
tretinoin 0,1 %
corticosteroid
side effects : relapse fastly if discontinue
irritant contact dermatitis
acne steroid
- Pataks formula :
consist of : HQ 2 %
tretinoin : 0,05 0,1 %
- azelaic acid 20 %
- glikolic acid 8 15 %

- high dose Vitamine C

- chemical peeling : glicolic acid

20-35% regularly 3-4 weeks
- laser
 MELANODERMA POST- INFLAMMATION
- hyperpigmentation postinflammation
- caused by:
- various reactions : allergy
phototoxic
medicamentosa
- various infections: varicella
herpes zoster
- physical injury
- inflammation
- permanent in black skin
- clinical signs :
pattern& distribution follow the previous disease

- histopathology :
the number of melanocyte: persistent
the number of melanine: increase
 ALBINO
- general hypopigmentation
- main deffect : in melanine synthesis
- in epidermis:
the number of melanocyte: normal
without tyrosinase enzyme

- various clinical signs

oculocutaneous: the most frequent
- skin colour: very pale/ pink
- hair: yellowish
- eyes: blue / pink
- the eyes : nystagmus
photophoby
severe refraction disturbance
- protect from uv: sunscreen, occlusive clothing
- skin cancer: high risk
(squamous cell carcinoma, melanoma )
- early detection
complications:
- caused by lack of visual
- caused by hypopigmentation

treatment:
- controlled by the opthalmologist
especially the patient who has myopic, hypermetropic
astigmatisme
- protection from UV: sunscreen
hat
cloth
 VITILIGO
- local hypopigmentation
- was born: had normal skin
- damage of melanocyte
- epidemiology :
- 1 2 % population
- onset 10- 30 years
- have family history
- coinsidence : DM, thyroid probleme, anemia pernisiosa
alopecia areata
SLE, psoriasis
pathogenesis:
damage of melanocyte: unclear
- autotoxic theory
metabolite of melanin destroies the melanocyte
(there are suicide cellulars)

- immunologic theory
there is a relation with other endocrine disturbances
(tyroiditis, DM, anemia perniciosa)

- neural theory
more frequent in one side (unilateral lesion)
- oxydant- antioxydant theory:
accumulation of free radical
toxic to melanocyte

- viral mechanisme theory:

the elements of virus
toxic to melanocyte
-clinical signs :
hypo / depigmentation macule
amelanotic macule
initial: reddish to milky white
well- defined border
symmetric: acral, extremity, face
also in: mucosal, retina, leptomening,
hair, khoroid
segmental vitiligo :
- unrelated with autoimmune diseases
- more frequent in children
- >> 50 % has poliosis
- unilateral/ dermatomal

acro-facial vitiligo:
- distal of digiti
- peri- orificium area
general vitiligo/ vitiligo vulgaris:
- the most prevalence
- extensive, simmetric

universalis vitiligo:
- part of endokrinopathy syndrome
- almost cover the whole body

mucosal vitiligo:
- limited on mucosal area
clinical varian :Vogt Koyanagi Harada
- hearing disturbance
- uveitis
- iritis
- poliosis
treatment: to restore the pigment
- sunscreen
lesion area : to avoid sunburn
non- lesion area: to avoid tanning
- cosmetic:
especially for focal vitiligo
cheaper
minimal side effect
easy application
- topical corticosteroid:
for limited area
especially for children
area: face (attention: surrounding eyes)
neck
extremities (except digities)
evaluation: 3 months

- topical immuno- modulator

tacrolimus
face, neck
safer for children (compare with steroid)
- pUVA: for body, upper extrimities, face
topical psoralen + UVA
for lesion less than 20 %
side effects photo- toxic reaction
pruritus
systemic psoralen + UVA
if topical fail
- UVB
- Laser: excimer Laser
- grafting
 LEUCODERMA POST- INFLAMMATION
- hypopigmentation post- inflammation
- damage of melanocyte caused by:
- infection
- physical trauma
- chemical trauma
- normally:

repigmentation through melanocyte proliferation

of hair follicle

permanent damage if hair follicles melanocyte disturbed

the main cause :
- combustio
- radiation
- deep laceration
- infection with scar :
zoster, varicella
- the other dermatoses:
psoriasis
pityriasis versicolor
syphyllis
pityriasis rosea
atopic dermatitis