PIGMENTARY

DISORDERS

Dr. Wiwin Mulianingsih SpKK Mkes

Pigmentary disoders:
- Hypomelanoses
- Hypermelanoses
Hypomelanoses:
- Piebaldism - Idiopathic guttate
- Vitiligo hypomelanoses
- Pinta - drugs:
- Albinism - arsenical
- Leprosy - chloroquine
- Pityriasis alba - hydroquinone
- Pityriasis versicolor - retinoid
Hypermelanoses:
- Lentigines - Nevus melanositic
- Berloque dermatitis - melasma
- Pityriasis versicolor -Berloque dermatis
- Drugs
- 5 Fluoro Uracil
- Cyclophosphamide
- Topical Bleomycine
VITILIGO
 Definition
It is an acquired, often
disfiguring, anomaly of the
skin manifested by
depigmented white patches
surrounded by anormal or a
hiperpigmented.
 Etiology

Complex :

Genetic predisposition.

Precipitating factors.
Clinical Manifestation
Macula has a chalk or
milk-white color.
Several variation :
Trichrome vitiligo.
Quadrichrome vitiligo.
Pentachrome vitiligo.
Inflammatory vitiligo.
Hypopigmentation maculas on the face, neck and
Chest
Hipopigmentation on the glans penis
Hypopigmentation macula on the finger
Morbus Hansens tuberculoid type
Hypopigmentation maculas of Tinea versicolor
Hypopigmentation maculas of Tinea
Hypopigmentation maculas of Idiopathic guttate
hypomelanosis
 Types of Vitiligo
1. Focal vitiligo.

2. Segmental vitiligo

3. Generalized vitiligo.

4. Other cutaneus abnormalities.

 Incidence

1 - 2% of the population

(0.14 - 8.8%).
 Prevalence
All races are affected.

Sex : male = female.

Developed at any age.

Peak age of onset : 10 - 30

years.
 Histopathology
Absence of dopa-positive

melanocytes.

Langerhans cell no

increased.
 Pathogenesis

Autoimmunity.

Neurohumoral.

Exogenous chemical exposures.

 Diagnosis

Anamnesis.

Clinical manifestation.

Histopathology.
 Treatment
Spontaneus repigmentation (15 - 25%).
Psoralen ultra violet A (PUVA):
repigmentation (50 70%).
Systemic steroid.
Surgical therapy.
 INTRODUCTION
Definition
Also known as chloasma
Melasma a common aquired
symetrical hypermelanosis characterized
by irregular light-brown to grey brown
macules and patches on sun-exposed
areas of the skin.
 EPIDEMIOLOGY

Age of onset young adults

Sex Female >> male
(10% men )
Race more frequent in person with
brown or black constitutive skin
colour
 ETIOLOGY
The precise cause is as yet unknown, but
the contributing factors include :
Genetic Endocrine disfunction
Pregnancy Drugs
Cosmetics UltraViolet light
exposure
 PATHOGENESIS
Unknown.
Estrogen preparation alone post
menopauseal women melasma,
despite sun exposure
pregnancy melasma, (combination of
estrogen and progestational agent) as used
for contraception frequent melasma.
 HISTOPATOLOGY
Epidermal melanin
Basal and suprabasal higher than
normal level of melanin
Dermalblue-gray, melanin laden
macrophages occur in perivascular
superficial & mid-dermal
 HISTOPATOLOGY
Ultrastructure shows :
melanocytes
melanogenesis
Transfer of melanosomes
Size & percentage of melanosomes in
keratinocyte
PHYSICAL EXAMINATION
Large patches of epidermal or
dermal commonly involve :
Cheeks
Forehead
Nose
Mustache area
Eyebrows
Chin
 PHYSICAL EXAMINATION

Three typical patern of distribution :

Centrofacial : cheeks, forehead,
upperlip, nose and chin
Malar : nose and cheeks
Mandibular : less common
 Clinical manifestation
Macular lesions:
- serrated
- irreguler
- geographic border
- usually symetry
Hyperpighmentation on the
Hyperpigmentation maculas on both of
cheeks
Clinical manifestation:

Type of hypermelanosis:
- brown (epidermal)
- blue-grey (dermal)
- brown-grey (mixed)
 Woods lamp examination
Epidermal type: lesions of contrast with
around normal skin
Dermal type : lesions of no contrast with
around normal skin
Mixed type : there are lesions contrast
or no with around normal
 TREATMENT
The principles of therapy :
Protection from sunlight
Inhibition of the activity of melanocytes
Inhibition of the synthesis of melanin
Removal of melanin
Disruption of melanin granules
 TREATMENT

Protection from sunlight

Sunscreen : Sun protection factor (SPF)
Cosmetics : acylglutamate (cleanser)
Systemic drug: chloroquin, Vit.C & E,
 TREATMENT
Inhibition of the activity of melanocytes
Avoiding :
Exposure to sunlight
Pregnancy
Birth control pills
Scented cosmetics
Phototoxic drugs
 TREATMENT

Inhibition of the syntesis of

melanin
Topical hydroquinone 2% - 4%
Kojic acid 2 4 %
Azeleic acid 20 %.
 TREATMENT
Removal of melanin
Trichloroacetic acid (TCA)
Jesners Solution
Glycolic acid 70 %
Disruption of melanin granules
Pigmented laser
DIFFERENTIAL DIAGNOSE
Post inflamatory hypermelanosit
Tinea Versicolor
Acquired brachial Cutaneus dyschromatos
Tar Melanosis
Pellagra
Photocontact dermatitis
Thank You