Postinflammatory hypopigmentation

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Postinflammatory hypopigmentation
Specialty Dermatology

Postinflammatory hypopigmentation is a cutaneous condition characterized by decreased pigment in the skin following inflammation of the skin. [1]

Contents

Signs and symptoms

Hypopigmented lesions can range in color from hypopigmentation to depigmentation, and their size, form, and primary inflammatory dermatosis frequently correspond with each other. Complete depigmentation is more noticeable in people with darker skin and is frequently observed in cases of discoid lupus erythematosus and severe atopic dermatitis. When pigmentary alterations occur with the initial inflammatory lesions, the diagnosis is often easy to make. Hypopigmentation, however, may be the only characteristic in certain situations, in which the inflammatory phase is not always evident. Little white macules that resemble the size and form of the laser spot are indicative of pigmentary changes brought on by pigment-specific lasers. [2]

Causes

Postinflammatory hypopigmentation is a common consequence of cutaneous inflammatory disorders. Certain conditions, like lichen striatus (LS) and pityriasis lichenoides chronica (PLC), typically cause postinflammatory hypopigmentation as opposed to hyperpigmentation. Postinflammatory hypopigmentation can also result after cutaneous injuries caused by burns, irritants, and dermatological operations (such as chemical peels, dermabrasion, cryotherapy, and laser therapy). [2]

Atopic dermatitis (AD) patients may exhibit postinflammatory hypopigmentation. Strong topical corticosteroids cause more frequent and severe pigmentary alterations. Severe atopic dermatitis has been linked to depigmentation resembling vitiligo. [3]

With a prevalence of up to 59%, lichen striatus is another frequent cause of postinflammatory hypopigmentation. [4] Within two years, the dermatosis spontaneously heals, leaving temporary hypopigmentation, particularly in those with darker skin tones. Furthermore, the inflammatory phase can not be noticeable, leaving hypopigmentation as the only characteristic. [2]

Pityriasis lichenoides chronica frequently manifests as diffuse hypopigmentation with a small number of scaly papular lesions in patients with dark skin. [5]

Changes in pigmentation frequently occur following thermal burns and freezing. Postinflammatory hyperpigmentation is prevalent in minor burns, but postinflammatory hypopigmentation can occur in severe burns. [6]

In addition, postinflammatory hypopigmentation is another potential side effect of chemical peels. In the past, porcelain-white (alabaster) skin was thought to benefit from the use of Baker phenol peel. [2]

Hypopigmentation following laser resurfacing is frequently observed, and it may result in permanent changes that are proportional to the depth of resurfacing. It normally happens three to ten months following the surgery. [2]

Diagnosis

Examining a lesion under a wood lamp highlights it and makes it easier to distinguish between lesions that are hypopigmented and those that are depigmented. It could also be beneficial to rule out certain conditions. Different hypomelanotic conditions can be distinguished using confocal laser scanning microscopy based on patterns of distribution and melanin content. Melanophages are not seen in vitiligo or naevus depigmentosus, but they have been detected in postinflammatory hypopigmentation. [2] However, the degree of inflammation affects both the melanin and dermal papillary ring contents. [7]

The histopathology of postinflammatory hypopigmentation reveals generic features such as the presence of melanophages in the upper dermis, varying degrees of superficial lymphohistiocytic infiltration, and decreased epidermal melanin. [2]

Treatment

The identification of the problem is the most crucial step in management. Usually, if the underlying reason is successfully addressed, the hypopigmentation gradually becomes better. Cosmetic and dermatological operations should be properly executed to prevent iatrogenic hypopigmentation, particularly in high-risk patients. [2]

Postinflammatory hypopigmentation has been treated by twice-daily administration of a medium-potency topical steroid combined with a tar-based preparation, albeit the mechanisms underlying this are still poorly understood. [2]

An open-label pilot study found that topical pimecrolimus cream helped dark-skinned patients with postinflammatory hypopigmentation related to seborrheic dermatitis. [8]

When functional melanocytes are present in the damaged area, sun or ultraviolet (UV) exposure may aid in repigmentation; however, excessive exposure may intensify the color contrast by tanning the surrounding skin. [2] The restoration of pigment may be aided by topical application of 0.1% 8-methoxypsoralen, 0.5–1% coal tar, or anthralin, followed by sun exposure. [9] With good outcomes, different topical photochemotherapy regimens (topical psoralen UVA; PUVA) have been utilized to treat postinflammatory hypopigmentation brought on by a variety of illnesses. [2]

With nine biweekly treatments, the 308-nm excimer laser showed a response rate of 60–70% for pigmentation stimulation in hypopigmented scars. To preserve the effects, though, a follow-up treatment is required every 1-4 months. [10]

Melanocyte or epidermal grafting may be considered in cases of depigmented lesions exhibiting complete loss of melanocytes. [11] [12]

Outlook

While mild hypopigmentation normally goes away in a few weeks, severe hypopigmentation and depigmentation brought on by scleroderma, burns, or lupus erythematosus can take years to repigment and may even be permanent. [2]

Epidemiology

Postinflammatory hypopigmentation is a highly prevalent pigmentary disease. It can happen to any type of skin. Nonetheless, individuals with darker skin seem to have it more frequently and visibly, perhaps due to the color contrast with their natural skin. The incidence of postinflammatory hypopigmentation is the same for both sexes. [2]

See also

Related Research Articles

<span class="mw-page-title-main">Vitiligo</span> Skin condition where patches lose pigment

Vitiligo is a chronic autoimmune disorder that causes patches of skin to lose pigment or color. The cause of vitiligo is unknown, but it may be related to immune system changes, genetic factors, stress, or sun exposure. Treatment options include topical medications, light therapy, surgery and cosmetics.

<span class="mw-page-title-main">Pityriasis lichenoides et varioliformis acuta</span> Medical condition

Pityriasis lichenoides et varioliformis acuta is a disease of the immune system. It is the more severe version of pityriasis lichenoides chronica. The disease is characterized by rashes and small lesions on the skin. The disease is more common in males and usually occurs in young adulthood, although it has been seen in every age group and every race. It is possible for the disease to go into remission for short periods of time or forever.

<span class="mw-page-title-main">Tinea versicolor</span> Skin disease

Tinea versicolor is a condition characterized by a skin eruption on the trunk and proximal extremities. The majority of tinea versicolor is caused by the fungus Malassezia globosa, although Malassezia furfur is responsible for a small number of cases. These yeasts are normally found on the human skin and become troublesome only under certain conditions, such as a warm and humid environment, although the exact conditions that cause initiation of the disease process are poorly understood.

<span class="mw-page-title-main">Hyperpigmentation</span> Skin condition

Hyperpigmentation is the darkening of an area of skin or nails caused by increased melanin.

<span class="mw-page-title-main">Hypopigmentation</span> Area of skin becoming lighter than the baseline skin color

Hypopigmentation is characterized specifically as an area of skin becoming lighter than the baseline skin color, but not completely devoid of pigment. This is not to be confused with depigmentation, which is characterized as the absence of all pigment. It is caused by melanocyte or melanin depletion, or a decrease in the amino acid tyrosine, which is used by melanocytes to make melanin. Some common genetic causes include mutations in the tyrosinase gene or OCA2 gene. As melanin pigments tend to be in the skin, eye, and hair, these are the commonly affected areas in those with hypopigmentation.

<span class="mw-page-title-main">Melasma</span> Medical condition

Melasma is a tan or dark skin discoloration. Melasma is thought to be caused by sun exposure, genetic predisposition, hormone changes, and skin irritation. Although it can affect anyone, it is particularly common in women, especially pregnant women and those who are taking oral or patch contraceptives or hormone replacement therapy medications.

Parapsoriasis refers to one of a group of skin disorders that are characterized primarily by their resemblance to psoriasis, rather than by their underlying cause.

<span class="mw-page-title-main">Lentigo</span> Small pigment spots on skin

A lentigo is a small pigmented spot on the skin with a clearly defined edge, surrounded by normal-appearing skin. It is a harmless (benign) hyperplasia of melanocytes which is linear in its spread. This means the hyperplasia of melanocytes is restricted to the cell layer directly above the basement membrane of the epidermis where melanocytes normally reside. This is in contrast to the "nests" of multi-layer melanocytes found in moles. Because of this characteristic feature, the adjective "lentiginous" is used to describe other skin lesions that similarly proliferate linearly within the basal cell layer.

<span class="mw-page-title-main">Tattoo removal</span> Dermatologic procedure to remove tattoo pigments

Tattoo removal is the process of removing an unwanted tattoo. The process of tattooing generally creates permanent markings in the skin, but people have attempted many methods to try to hide or destroy tattoos.

<span class="mw-page-title-main">Pityriasis lichenoides</span> Medical condition

Pityriasis lichenoides represents a distinct subset of inflammatory skin disorders that includes pityriasis lichenoides chronica, febrile ulceronecrotic Mucha-Habermann disease, and pityriasis lichenoides et varioliformis acuta (PLEVA).

Pityriasis alba is a skin condition, a type of dermatitis, commonly seen in children and young adults as dry, fine-scaled, pale patches on the face. It is self-limiting and usually only requires use of moisturizer creams.

Pigmentation disorders are disturbances of human skin color. There may be a loss or reduction, which may be related to loss of melanocytes or the inability of melanocytes to produce melanin or transport melanosomes correctly.

<span class="mw-page-title-main">Halo nevus</span> Medical condition

Halo nevus is a mole that is surrounded by a depigmented ring or 'halo'.

Interstitial granulomatous dermatitis with arthritis (IGDA) or Ackerman dermatitis syndrome is a skin condition that most commonly presents with symmetrical round-to-oval red or violet plaques on the flanks, armpits, inner thighs, and lower abdomen.

<span class="mw-page-title-main">Airbag dermatitis</span> Skin irritation caused by airbag deployment

Airbag dermatitis is skin irritation secondary to the deployment of airbags. The diagnosis of "air bag dermatitis" is relatively recent; the first case was reported in 1994.

<span class="mw-page-title-main">Nevus depigmentosus</span> Medical condition

Nevus depigmentosus is a loss of pigment in the skin which can be easily differentiated from vitiligo. Although age factor has not much involvement in the nevus depigmentosus but in about 19% of the cases these are noted at birth. Their size may however grow in proportion to growth of the body. The distribution is also fairly stable and are nonprogressive hypopigmented patches. The exact cause of nevus depigmentosus is still not clearly understood. A sporadic defect in the embryonic development has been suggested to be a causative factor. It has been described as "localised albinism", though this is incorrect.

Rheumatoid neutrophilic dermatitis, also known as rheumatoid neutrophilic dermatosis, is a cutaneous condition associated with rheumatoid arthritis.

Histopathology of dermatitis can be performed in uncertain cases of inflammatory skin condition that remain uncertain after history and physical examination.

Postinflammatory hyperpigmentation (PIH) is a skin condition characterized by the darkening of the skin (hyperpigmentation) following an inflammatory injury, such as acne, dermatitis, infectious disease, or trauma. Less frequently, it may occur as a complication of a medical procedure performed on the skin. It is a common cause of skin discoloration and can affect individuals of all skin types.

References

  1. ↑ Marks, James G; Miller, Jeffery (2006). Lookingbill and Marks' Principles of Dermatology (4th ed.). Elsevier Inc. ISBN   1-4160-3185-5.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 Vachiramon, V.; Thadanipon, K. (2011). "Postinflammatory hypopigmentation: Postinflammatory hypopigmentation". Clinical and Experimental Dermatology. 36 (7): 708–714. doi:10.1111/j.1365-2230.2011.04088.x. PMID   21671990. S2CID   28162346.
  3. ↑ Larrègue, M; Martin, J; Bressieux, J M; Canuel, C; De Giacomoni, P; Ramdenée, P; Babin, P (1985). "Vitiligoid achromias and severe atopic dermatitis. Apropos of 4 cases". Annales de dermatologie et de venereologie (in French). 112 (8): 589–600. PMID   4096464.
  4. ↑ Peramiquel, Laura; Baselga, Eulàlia; Dalmau, Joan; Roé, Esther; del Mar Campos, Maria; Alomar, Agustín (2006-01-13). "Lichen striatus: clinical and epidemiological review of 23 cases". European Journal of Pediatrics. Springer Science and Business Media LLC. 165 (4): 267–269. doi:10.1007/s00431-005-0032-9. ISSN   0340-6199. PMID   16411095. S2CID   36626542.
  5. ↑ Lane, Tanda N; Parker, Sareeta S (March 2010). "Pityriasis lichenoides chronica in black patients" (PDF). Cutis. 85 (3): 125–129. PMID   20408509 . Retrieved 1 March 2024.
  6. ↑ El-Bishry, M. Adly; Nassar, Alia M.; El-Maghraby, Magda Z. (1979). "Tattooing, A New Hope for Secondary Leukoderma". Scandinavian Journal of Plastic and Reconstructive Surgery. Informa UK Limited. 13 (1): 147–153. doi:10.3109/02844317909013044. ISSN   0036-5556. PMID   451462.
  7. ↑ Xiang, Wenzhong; Xu, Aie; Xu, Jin; Bi, Zhigang; Shang, Yingbin; Ren, Qiushi (2010-02-24). "In vivo confocal laser scanning microscopy of hypopigmented macules: a preliminary comparison of confocal images in vitiligo, nevus depigmentosus and postinflammatory hypopigmentation". Lasers in Medical Science. Springer Science and Business Media LLC. 25 (4): 551–558. doi:10.1007/s10103-010-0764-2. ISSN   0268-8921. PMID   20180143. S2CID   9185505.
  8. ↑ High, Whitney A.; Pandya, Amit G. (2006). "Pilot trial of 1% pimecrolimus cream in the treatment of seborrheic dermatitis in African American adults with associated hypopigmentation". Journal of the American Academy of Dermatology. Elsevier BV. 54 (6): 1083–1088. doi:10.1016/j.jaad.2006.01.011. ISSN   0190-9622. PMID   16713477.
  9. ↑ Ruiz-Maldonado, Ramon; de la Luz Orozco-Covarrubias, Maria (1997). "Postinflammatory hypopigmentation and hyperpigmentation". Seminars in Cutaneous Medicine and Surgery. Frontline Medical Communications, Inc. 16 (1): 36–43. doi:10.1016/s1085-5629(97)80034-x. ISSN   1085-5629. PMID   9125764.
  10. ↑ Alexiades-Armenakas, Macrene R.; Bernstein, Leonard J.; Friedman, Paul M.; Geronemus, Roy G. (2004-08-01). "The Safety and Efficacy of the 308-nm Excimer Laser for Pigment Correction of Hypopigmented Scars and Striae Alba". Archives of Dermatology. American Medical Association (AMA). 140 (8): 955–960. doi:10.1001/archderm.140.8.955. ISSN   0003-987X. PMID   15313811.
  11. ↑ Suvanprakorn, Pichit; Dee-Ananlap, Sompong; Pongsomboon, Chalit; Klaus, Sidney N. (1985). "Melanocyte autologous grafting for treatment of leukoderma". Journal of the American Academy of Dermatology. Elsevier BV. 13 (6): 968–974. doi:10.1016/s0190-9622(85)70247-2. ISSN   0190-9622. PMID   3908515.
  12. ↑ FALABELLA, RAFAEL (1987). "Postdermabrasion Leukoderma". The Journal of Dermatologic Surgery and Oncology. Wiley. 13 (1): 44–48. doi:10.1111/j.1524-4725.1987.tb00495.x. ISSN   0148-0812. PMID   3540047.

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