Acquired Bilateral Dyspigmentation on Face and Neck: Clinically Appropriate Approaches

Abstract

Facial dyspigmentation in Asian women often poses diagnostic and therapeutic challenges. Recently, a distinctive bilateral hyperpigmentation of face and neck has occasionally been observed. This study was performed to investigate the clinico-pathological features of this dyspigmentation as well as proper treatment approaches. We retrospectively investigated the medical records including photographs, routine laboratory tests, histopathologic studies of both lesional and peri-lesional normal skin and patch test of thirty-one patients presented acquired bizarre hyperpigmentation on face and neck. The mean age of patients was 52.3 years and the mean duration of dyspigmentation was 24.2 months. In histologic evaluations of lesional skin, a significantly increased liquefactive degeneration of basal layer, pigmentary incontinence and lymphocytic infiltration were noted, whereas epidermal melanin or solar elastosis showed no statistical differences. Among 19 patients managed with a step-by-step approach, seven improved with using only topical anti-inflammatory agents and moisturizer, and 12 patients gained clinical benefit after laser therapy without clinical aggravation. Both clinical and histopathologic findings of the cases suggest a distinctive acquired hyperpigmentary disorder related with subclinical inflammation. Proper step-by-step evaluation and management of underlying subclinical inflammation would provide clinical benefit.

Therapeutic Effects of New Pulsed-Type Microneedling Radiofrequency for Refractory Facial Pigmentary Disorders

“…They are related to multiple endogenous and exogenous factors such as exposure to sun light, use of cosmetics and drugs, and chronic subclinical irritation. 1 Although various treatments including lasers and topical agents have been used, some patients with melasma fail to respond. More recently, abrupt bilateral hyperpigmentation of the face and neck, so-called Riehl melanosis or pigmented contact dermatitis, has increased in frequency and become chronic despite conventional treatments.…”

Carvedilol, an Adrenergic Blocker, Suppresses Melanin Synthesis by Inhibiting the cAMP/CREB Signaling Pathway in Human Melanocytes and Ex Vivo Human Skin Culture

“…MITF performs the most essential role in the regulation of melanin synthesis and the resultant transcription of melanogenic enzymes [ 26 , 40 , 41 ]. During this intracellular signaling process, melanogenesis is regulated by a key enzyme, tyrosinase, and additional enzymatic proteins, such as TRP-1 and DCT [ 1 , 2 , 3 , 4 ]. In the present study, carvedilol effectively reduced the phosphorylation of CREB, which indicates that it reduced MITF and tyrosinase proteins by inhibiting MITF transcription ( Figure 4 ).…”

“…A wide range of pigmentary skin disorders have a significant psychological and social impact on patients. Various treatment modalities, including systemic and topical agents as well as laser therapy, have been developed [ 1 , 2 , 3 ]. However, the results are often unsatisfactory and adverse reactions, such as post-inflammatory hyperpigmentation (PIH) and hypopigmentation, from treatment are common.…”

Treatment of burn scars in Fitzpatrick phototype III patients with a combination of pulsed dye laser and non-ablative fractional resurfacing 1550 nm erbium:glass/1927 nm thulium laser devices

“…Another study found that acquired facial hyperpigmentation can be managed using a combination of topical anti-inflammatory agents and the thulium laser. 24 Additionally, several reports have studied the laser's efficacy in treating photo-damage induced pigmentation and found that the thulium fractional laser can dramatically improve the appearance of dyspigmentation, ephelides, lentigines and keratosis. [25][26][27][28] In all of these applications, most of the data are only pertinent to patients with a FP of less than V. To our knowledge, our case series is the first report using the 1927 nm thulium laser to as part of a multimodal approach to specifically address burn scar hyperpigmentation.…”