Acquired dermal macular hyperpigmentation: an overview of the recent updates

Abstract

Acquired dermal macular hyperpigmentation (ADMH), previously known as macular pigmentation of uncertain etiology (MPUE), is an umbrella concept that unifies the distinct but overlapping acquired dermal pigmentary disorders like lichen planus pigmentosus, ashy dermatosis, erythema dyschromicum perstans, Riehl’s melanosis and pigmented contact dermatitis. All of these disorders usually lack a clinically apparent inflammatory phase, are characterised by dermal pigmentation clinically and histologically, and have a variable protracted disease course. Recently, a proposal has been made to classify these disorders into those with and without contact sensitisation. Dermoscopy is essentially similar across the spectrum of these disorders, and is useful for diagnosis and therapeutic response monitoring. Scoring system has been validated for the same. The treatment of ADMH remains challenging, with multiple topicals, oral therapies including mycophenolate mofetil, and lasers tried. Need of the hour is randomised controlled trials to enhance the therapeutic armamentarium.

Advancements in Laser Therapies for Dermal Hyperpigmentation in Skin of Color: A Comprehensive Literature Review and Experience of Sequential Laser Treatments in a Cohort of 122 Indian Patients

“…A population-based survey in France revealed that tattooing was associated with lower quality of life scores, particularly among individuals with multiple tattoos [11]. Psychological disturbances, including anxiety and depression, may ensue, thus emphasizing the need for future research for more effective therapy [12].…”

“…Incorporating extended follow-up durations would help draw meaningful conclusions since the reduction in dermal pigmentation is slow, with a potential for relapse. For conditions like ADMH that have a variable and unpredictable course with a potential for spontaneous resolution, it would be helpful to include a control group to evaluate whether the observed improvement may be ascribed to the treatment method [12]. The use of the 1064 nm ps-laser in ADMH is yet to be explored; additional research is needed to characterize this condition and establish consistently effective treatments [32].…”