Differential diagnosis of melasma and hyperpigmentation

Honigman, Anthony; Rodrigues, Michelle

doi:10.1002/der2.144

Cited by 3 publications

(3 citation statements)

References 37 publications

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“…A study treating PIH patients with a fractionated ps-755 nm laser brought 50-75% improvement at 3 years, suggesting that it could serve as a long-term treatment for PIH in Asian skin [51] (Table 5). Strictly compartmentalizing melasma based on pigment levels is challenging, with studies revealing that the majority of cases are, in fact, of the mixed type [53]. Regardless of the treatment modality, the long-term recurrence rates for melasma appear to be high (in contrast to ADMH, nevus of Ota, etc., in which recurrences seldom occur once the lesion has been cleared) [13].…”

Section: Post-inflammatory Hyperpigmentation (Pih)mentioning

confidence: 99%

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

Garg,

Vashisht,

Garg

et al. 2024

JCM

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The heightened awareness of ethnic dermatology aligns with the growing prevalence of skin of color communities globally, where hyperpigmentation disorders pose a common dermatological challenge. Effectively addressing dermal pigmentation is challenging due to its resistance to conventional therapies and its association with impaired quality of life. This underscores the need for effective treatments and a thorough grasp of laser advancements. A relevant literature search spanning the last 7 years across the PubMed database reveals core studies, challenges, and the evolution of laser technologies tailored for various forms of congenital and acquired dermal hyperpigmentation in skin of color. This comprehensive review explores the mechanisms, applications, and recommendations for pigmentary laser technologies, highlighting the key role of Q-switched lasers in their established millisecond/ nanosecond forms and emerging picosecond lasers, fractional non-ablative and ablative lasers, Intense Pulsed Light, etc. The summary of evidence includes studies on dermal melanocytosis (nevus of Ota and Hori’s nevus), tattoos, acquired dermal macular hyperpigmentation, etc., and also entities with mixed epidermal–dermal components, such as melasma and post-inflammatory hyperpigmentation. The review offers valuable insights for clinicians to make informed decisions based on diagnosis, skin type, and the latest technologies to optimize results and minimize complications, especially in darker Fitzpatrick skin types. In their five-year study with 122 Indian patients, the authors applied specific laser combinations for diverse dermal melanoses, including tattoos, dermal/mixed melasma, acquired dermal macular hyperpigmentation, and dermal nevi. Substantial pigmentation reduction, subjectively assessed by both physicians and patients, was observed across all groups. A one-way ANOVA indicated a significant difference in mean improvement scores across various pigmentary conditions (F = 3.39, p = 0.02), with melasma patients exhibiting a significantly higher improvement score than tattoos (p = 0.03). The results affirmed the safety and efficacy of sequential laser therapy for dermal pigmentation in skin of color, advocating for flexibility in approach while maintaining the rationale behind the laser sequences. Despite advancements, challenges persist, and gaps in the current literature are identified. In conclusion, this summary highlights the ongoing pursuit of optimal protocols in dermatological laser treatments for dermal melanoses, offering valuable insights for future research and clinical practice.

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Section: Post-inflammatory Hyperpigmentation (Pih)mentioning

confidence: 99%

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

Garg,

Vashisht,

Garg

et al. 2024

JCM

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“…Dermoscopy has proved to be a noninvasive method for diagnosing Riehl's melanosis. The most common findings are pseudonetwork patterns with brown/gray dots/globules grouped in an arcuate, semiarcuate, or hexagonal way (Honigman & Rodrigues, 2022; Yim et al, 2019). Telangiectatic vessels, tiny scales, perifollicular hypopigmented halos, and follicular keratotic plugs can also be seen (Krueger et al, 2022; Subburaj et al, 2022).…”

Section: Diagnosismentioning

confidence: 99%

Unveiling the mystery of Riehl's melanosis: An update from pathogenesis, diagnosis to treatment

Ding

Xiang

et al. 2023

Pigment Cell Melanoma Res

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Riehl's melanosis is a hyperpigmentation disorder that has a significant psychological and social impact on individuals. In the past 10 years, new categories have been developed, raising questions about how to classify Riehl's melanosis. The mechanism of this disease remains unclear, although the type IV hypersensitivity response caused by allergic sensitization, as well as genetic, ultraviolet radiation, and autoimmune factors, is to blame. Clinical manifestation, dermoscopy, reflectance confocal microscopy, patch/photopatch testing, histopathology, and a novel multimodality skin imaging system have been used for the diagnosis. A variety of therapies including topical skin‐lightening agents, oral tranexamic acid, glycyrrhizin compound, chemical peels, and lasers and light therapies (intense pulsed light, 1064‐nm Q‐Switched Nd: YAG laser, 755‐nm PicoWay laser, nonablative 1927‐nm fractional thulium fiber laser, new pulsed‐type microneedling radiofrequency), with improved effectiveness. The latest findings on possible biomarkers and their relationship to other autoimmune diseases were also summarized.

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“…To correctly identify and treat these lesions, one must first grasp their origins and potential consequences. Unilateral facial hyperpigmented lesions are difficult to diagnose due to the large range of diseases that might show similarly [ 2 ]. Differential diagnoses include congenital melanocytic nevi, Becker's nevus, Ota's nevus, linear epidermal nevi, and others.…”

Section: Introductionmentioning

confidence: 99%

Unilateral Hyperpigmented Facial Lesion Since Birth

Dalave,

Deoghare,

Buccha

2023

Cureus

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Facial hyperpigmented lesions that are unilateral are a rare and challenging dermatological anomaly since birth which can be genetic and non-genetic. This paper seeks to provide an exhaustive overview of the etiology, clinical presentation, differential diagnosis, and management strategies for these congenital lesions. Unilateral facial hyperpigmented lesions can be caused by a number of conditions, such as congenital melanocytic nevi, Becker's nevus, nevus of Ota, linear epidermal nevi, and café-au-lait macules. Accurate diagnosis requires meticulous examination, dermoscopy, and histopathological evaluation. Observation, topical therapies, surgical excision, and laser therapy are among the available treatment options. Treatment decisions should be influenced by factors such as lesion characteristics, aesthetic concerns, and patient preferences. Long-term supervision and psychosocial support are indispensable elements of comprehensive management. We present a case of a 12-year-old patient with a progressively growing hyperpigmented lesion on the right side of the face, present since birth with an intermittent area of normal skin in between. Dermoscopy unveiled an irregular, dark brown pigment network, and histopathological evaluation showed an increased number of melanocytes in the dermis. This case highlights the diagnostic challenges of such lesions and underscores the significance of a multidisciplinary approach for accurate evaluation and management. This paper aims to cover existing knowledge gaps regarding unilateral facial hyperpigmented lesions since birth and direct future research efforts for diagnostic and therapeutic interventions.

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Differential diagnosis of melasma and hyperpigmentation

Cited by 3 publications

References 37 publications

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

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

Unveiling the mystery of Riehl's melanosis: An update from pathogenesis, diagnosis to treatment

Unilateral Hyperpigmented Facial Lesion Since Birth

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