ABSTRACT
Background: Melasma is the commonest cause of facial hypermelanosis in skin type IV-VI. First-line treatment includes a triple combination containing topical corticosteroid and hydroquinone which have side effects on prolonged use. Chemical peels are a second-line management option with the laser being used in refractory cases, but the worsening of hyperpigmentation in darker skin types can occur following laser therapy. Sunscreen is a must to prevent relapses. Aims and Objectives: (i) To compare the effects of treatment with a proprietary combination (phenyl ethyl resorcinol, nonapeptide-1, aminoethyl phosphinic acid, antioxidants and sunscreen) versus sunscreen alone in limiting or reducing, melasma and preventing recurrence as a maintenance regimen after the initial use of triple combination,(ii) to evaluate the safety of the formulation studied, and (iii) to study the improvement of the quality of life of the patients after using the study formulation versus placebo. Methods: It was a prospective double-blinded parallel-group randomized controlled pilot study. A total of 46 subjects were recruited by consecutive sampling methods and randomized to 23 each in case and control groups. The study period was eight months with three phases. Phase 1 constituted the application of triple combination for eight weeks by both groups followed by phase 2 with the case group applying proprietary medicine and the control group applying sunscreen. Phase 3 was a follow-up period to see the sustenance of results in both groups as well as any evidence of relapses. Sunscreen was applied in all three phases. Results: Case group in the study showed improvement in the melasma severity score and mean melanin index as measured by mexameter but it did not attain statistical significance as compared to the control group. The melasma area and severity index score showed a consistent reduction in the case group, whereas it increased in the control group from baseline. Limitations: Small sample size and a short follow-up period of our study were major limitations. Conclusion: The proprietary combination, which has sunscreen as one of its constituents, is more effective in maintaining remission after triple combination without any added inconvenience of application of two separate preparations as compared to sunscreen alone
ABSTRACT
La hipermelanosis nevoide lineal o espiralada es un trastorno esporádico poco frecuente que es caracterizado por máculas hiperpigmentadas, reticuladas o lineales que siguen las líneas de Blaschko.En este artículo se presenta el caso de una infante de 1 año 6 meses con hipermelanosis nevoide. No hubo antecedentes familiares.Esta entidad no ha sido reportada en Ecuador. Se expone un caso clásico en relación a la literatura y sustentado en el examen histopatológico.
Linear or spiral nevus hypermelanosis is a rare sporadic disorder that is characterized by hyperpigmented, reticulated or linear macules that follow the Blaschko lines.This article presents the case of a 1 year old infant 6 months with nevoid hypermelanosis. There was no family history. This entity has not been reported in Ecuador. A classic case is presented in relation to the literature and supported by histopathological examination.
Subject(s)
Humans , Female , Infant , Basal Cell Nevus Syndrome , Hyperpigmentation , Ecuador , Pigmentation Disorders , Skin PigmentationABSTRACT
El eritema discromicum perstans (EDP) o Dermatosis cenicienta es una entidad clínica poco común, de curso crónico e irreversible. Se presenta como máculas hiperpigmentadas color gris-ceniza, de tamaño y forma variable, distribuidas en cara, tronco, y extremidades. En Chile existen pocos casos reportados. La etiología es actualmente desconocida. Los hallazgos histopatológicos no son específicos de EDP, por lo que el diagnóstico es clínico e histopatológico. Aunque se han reportado múltiples opciones de tratamiento, ninguno ha demostrado ser efectivo de manera consistente. Presentamos dos casos de EDP y una revisión de los principales aspectos clínicos, epidemiológicos e histopatológicos de esta entidad.
Erythema dyschromicum perstans (EDP) or cinderella Dermatosis is an uncommon clinical entity, of chronic and irreversible course. Clinically it appears as hyper pigmented gray-ashy macules, of variable size and shape, distributed on face, trunk, and extremities. There are few cases reported on Chile. Etiology is currently unknown. The histopathological features are not characteristic of EDP, so the diagnosis is based upon clinical findings plus histopathology. Although there are several treatment options, none of them have been demonstrated to be consistently effective. We present two cases of EDP and a review of the clinical, epidemiological, and histopathological features of this entity.
Subject(s)
Female , Humans , Middle Aged , Erythema/diagnosis , Erythema/therapy , Pigmentation Disorders/diagnosis , Pigmentation Disorders/therapy , Erythema/pathology , Pigmentation Disorders/pathology , Diagnosis, DifferentialABSTRACT
La dermatosis cenicienta o eritema discrómico perstans, fue descrita en El Salvador en 1957 por el Dr. Oswaldo Ramírez; desde entonces, se ha considerado como una hipermelanosis idiopática, adquirida, crónica y de evolución lenta, caracterizada por lesiones maculares de color azul grisáceo, similares a la ceniza. Afecta principalmente cara, cuello, tronco y extremidades. La mayoría de los casos han sido reportados en América latina y Asia, afectando a personas de piel oscura, ambos sexos y desde el año de edad hasta los 80 años. El diagnóstico es por correlación clínico-patológica, debido a la similitud con patologías como el liquen plano pigmentado y la pigmentación macular eruptiva idiopática. Desde su descubrimiento se han probado esquemas terapéuticos siendo el uso de dapsona y clofazimina las opciones que han alcanzado mayor eficacia. El caso clínico es el de una mujer de 41 años con lesiones grisáceas en cara, cuello y brazos, quien fue diagnosticada por dermatología como xerosis y liquen plano simple, durante tres años recibió manejo con cremas hidratantes, corticodes y antihistamínicos hasta que realizan biopsia de piel identificándose dermatosis cenicienta e iniciando tratamiento con clofazimida con mejoría notable.
The ashy dermatosis or erythema dyschromicum perstans was described by Oswaldo Ramírez from El Salvador in 1957. It is an acquired, chronic, idiopathic hypermelanosis of long-standing evolution that is characterized by blue-gray color macules that look like ash. It usually affects the face, neck, trunk, and extremities. Most of the cases have been reported in Latin America and Asia. It usually affects dark skin people of both sexes and from ages ranging from one to eighty years. The diagnosis is achieved by clinic-pathological correlation because of the similarities with other disease such as lichen planus pigmentosus and idiopathic eruptive macular pigmentation. Since its discovery, many therapeutic regimes have been tried, but dapsone and clofazimine are the most effective choices. The clinical case is about a 41 year old woman with gray lesions on the face, neck and arms, who was diagnosed by dermatologist like xerosis and lichen planus, handled for 3 years with moisturizers creams, corticosteroids and antihistamines until a biopsy specimen was taken, the ashy dermatosis was identified and the treatment with clofazimine was started, producing great improvement.
Subject(s)
Dapsone , Erythema , MelanosisABSTRACT
Linear and whorled nevoid hypermelanosis(LWNH) is a congenital disorder characterized by hyperpigmented macules in a linear and whorled pattern along Blaschko's lines, and develops a few weeks after birth. Skin manifestations closely resemble hypomelanosis of Ito with inverse pigmentation. There is no preceding inflammatory event and no pigmentary incontinence histologically. It may be associated with various congenital abnormalities. We report a case of linear and whorled nevoid hypermelanosis associated with congenital hemihypertrophy of left extremities in a 10-year old boy.
Subject(s)
Child , Humans , Male , Congenital Abnormalities , Congenital, Hereditary, and Neonatal Diseases and Abnormalities , Extremities , Hyperpigmentation , Hypopigmentation , Parturition , Pigmentation , Skin ManifestationsABSTRACT
Linear and whorled nevoid hypermelanosis(LWNH) is characterized by macules in streaks and whorls along Blaschko's lines, that are not preceded by inflammation. LWNH can present with various findings such as neurologic, musculoskeletal, ophthalmologic, facial and cardiac abnormalities. Intracranial lipoma is very rare condition, with an incidence of less than 1% of all intracranial tumors. We recently experienced a case of LWNH with intracranial lipoma of corpus callosum. We report this case with a brief review of the related literature.
Subject(s)
Corpus Callosum , Hyperpigmentation , Incidence , Inflammation , LipomaABSTRACT
Linear and whorled nevoid hypermelanosis(LWNH) is a congenital disorder which was first described by Kalter in 1988 and is characterized by asymmetrically distributed linear and whorled hyperpigmentation following Blaschko's lines. It usually appears at birth or during the first weeks of life and is rarely associated with various congenital defects. Its pathogenesis is not well known, but developmental somatic mosaicism appears the most likely cause. It is probably not a rare disease, but not well recognized or is confused with other entities. Herein, we report a typical case of LWNH in 9 month-old boy.
Subject(s)
Humans , Infant , Male , Congenital Abnormalities , Congenital, Hereditary, and Neonatal Diseases and Abnormalities , Hyperpigmentation , Mosaicism , Parturition , Rare DiseasesABSTRACT
We report a case of a 25-month-old girl presented to us for the evaluation of a severe delayed psychomotor development who also has pigmentary abnormalities. Linear and whorled hyperpigmentations following Blaschko's lines were noticed on her entire body except on her face, palms, soles, eyes and mucous membranes, which closely resembled those found in hypomelanosis of Ito, but inversely pigmented. Histologic examination revealed basal layer hyperpigmentation without incontinence of pigment or dermal melanophages. Chromosomal analysis of cultured peripheral leukocytes and fibroblasts from the hyperpigmented and the hypopigmented skin revealed normal female karyotype with no evidence of mosaicism or chimerism. This entity represents a kind of neurocutaneous syndrome-referred to by some authors as linear and whorled nevoid hypermelanosis.
Subject(s)
Child, Preschool , Female , Humans , Child Development , Melanosis/pathology , Nevus/pathology , Psychomotor Performance , SyndromeABSTRACT
In adrenal insufficiency, recognition of the disease in its earlier phases may present a real challenge. The disease, if unrecognized and untreated, carries an almost uniformly poor and frequently fatal prognosis. We report a rare case of congenital adrenal aplasia accompanied by hyperpigmentation on the whole body surface. The diagnosis was confirmed by ACTH stimulation test and autopsy findings.