“Melanosis” in the small and large intestine

Deposition of pigment in the intestinal mucosa is commonly observed by the endoscopist, especially within the colon, and particularly during investigations for constipation. Pigment may also be detected in the small intestine. Although labeled as melanosis, electron microscopy and X-ray analytical methods have provided evidence that this pigment is not melanin at all, but lipofuscin. Often, herbal remedies or anthracene containing laxatives are often historically implicated, and experimental studies in both humans and animal models have also confirmed the intimate relationship with these pharmacological or pseudo-pharmacological remedies. The appearance of melanosis coli during colonoscopy is largely due to pigment granule deposition in macrophages located in the colonic mucosa. The pigment intensity is not uniform, being more intense in the cecum and proximal colon compared to the distal colon. Possibly, this reflects higher luminal concentrations of an offending agent in the proximal compared to distal colon, differential absorption along the length of the colon, or finally, differences in macrophage distribution within the colon. Mucosal lymphoid aggregates normally display a distinct absence of pigment producing a "starry sky" appearance, especially in the rectosigmoid region. Interestingly, some focal, usually sessile, colonic mucosal neoplastic lesions, rather than submucosal lesions, may be better appreciated as pigment deposition may be absent or limited. If detected, removal and further histopathologic analysis of the polyp may be facilitated.

Comparison of two types of colectomy in treating slow transit constipation with or without melanosis coli

AIM: To compare the follow-up outcomes of ileosigmoidal anastomosis(ISA) and caecorectal anastomosis(CRA) in patients with slow transit constipation(STC) with or without melanosis coli(MC).METHODS: We collected the clinical data of 48 STC patients with or without MC from May 2002 to May 2007.Twenty-six patients underwent CRA(14 with MC) and 22 cases received ISA(14 with MC).A 3-year postoperative follow-up was conducted.RESULTS: CRA improved the quality of life [evaluated by the gastrointestinal quality of life index(GIQLI)] in patients without MC,but was inferior to ISA in stool frequency and Wexner and GIQLI scores for MC patients.In the CRA group,patients with MC suffered worse outcomes than those without MC.CONCLUSION: CRA is more suitable for STC patients without MC; however,for STC patients with MC,ISA is a better choice.

Neurocutaneous melanosis with an intracranial cystic-solid meningeal melanoma in an adult:A case report and review of literature

BACKGROUND Neurocutaneous melanosis(NCM)is a rare congenital,nonhereditary neurocutaneous syndrome that mainly occurs in children;adult NCM is very rare.Due to its rarity,the clinical features and treatment strategies for NCM remain unclear.The purpose of this study was to explore the clinical features,diagnosis,treatment and prognosis of NCM in adults.Most intracranial meningeal melanomas are solid masses,and cystic-solid malignant melanomas are very rare.Due to the lack of data,the cause of cystic changes and the effect on prognosis are unknown.CASE SUMMARY A 41-year-old woman was admitted to the hospital with intermittent headache for 1 mo.Magnetic resonance imaging(MRI)showed a 4.7 cm×3.6 cm cystic-solid mass in the left temporal lobe with peritumoral edema.The entire mass was removed,and postoperative pathology indicated malignant melanoma.CONCLUSION MRI is the first-choice imaging approach for diagnosing central nervous system diseases in NCM patients,although cerebrospinal fluid may also be used.At present,there is no optimal treatment plan;gross total resection combined with BRAF inhibitors and MEK inhibitors might be the most beneficial treatment.

Retrospective Studies on Clinical Features of Melanosis of the Colon and Its Correlation with the Polypus and Carcinoma of Large Intestine

OBJECTIVE To investigate the clinical characteristics of melanosis of the colon （MC） and its correlation with polypus and carcinoma of the large intestine. METHODS Clinical feature and colonoscopic findings of 156 MC patients were retrospectively analyzed. Final diagnosis of MC case was made after colonoscopic and pathological examination, and data of the case history was recorded. RESULTS The overall detection rate of MC was 1.12%, with 0.46% in males, 0.66% in females. An 82.69% of the patients suffered various constipations and had a history of taking cathartics. The clinical manifestation of total-colon melanosis occurred in 83.97% of the patients. There was no significant difference between the rate of concomitant polypus （27.56%） in the MC patients and the detection rate of polypus in the patients who underwent a synchronous colonoscopy （χ^2 = 1.205, P = 0.298）. Also there was no significant difference between the detection rate of carcinoma of the large intestine （8.97%） in MC patients and the detection rate of the same disease in the patients who underwent synchronous colonoscopy （χ^2 = 0.268, P = 0.604）. A logistic regression analysis has shown that the older the age of MC patients is, the more opportunities of MC and the concomitant polypus would occur. CONCLUSION MC may be related to constipations and a long-term administration of cathartics, among which total-colon melanosis ranks first in the cases. There is an earlier age of onset in the females, with a higher detection rate. The older the age of the patients is, the higher the detection rate of MC is, and the more possibility the onset of the concomitant polypus.

Lifa Disease: Frictional Dermal Melanosis over Bony Prominences (Clinicopathological Study)

Background: Lifa disease (Frictional dermal melanosis over bony prominences) has been described in Iraq for the first time in 1993, as a new distinctive pigmentary skin condition that followed chronic friction with a body washing agent (lifa) during bathing. Objective: To assess this increasingly common problem where still many doctors unaware about its presence especially in other Middle East countries. Patients and Methods: A case series descriptive study done in Departments of Dermatology-Najaf and Baghdad Teaching Hospitals, between March 2007- Oct.2008. Full history and clinical examination were done for all patients including Wood's light examination. Biopsies were taken from 21 patients and sent for hematoxylin-eosin and Congo red stains. Results: Fifty two (49 female and 3 male) patients with typical clinical features of lifa disease were studied. The mean age of presentation was 27.92 ± 7.58 years. All patients were slim with prominent bones and low body mass index, used lifa vigorously during bathing.Pigmentation was distributed bilaterally and symmetrically over bony prominences. The most common affected sites were: clavicular areas (67.3%) and upper back (42%). Wood's light and histopathological examinations revealed dermal melanosis. No amyloid deposit was detected by using Congo red stain in any patient. Conclusions: Lifa disease is a common distinctive pigmentary disfiguring problem especially among females. The histopathology showed dermal melanosis, and might be confused with other pigmentary problems like macular amyloidosis.

Frictional Melanosis of Rubbing Thighs in Iraqi Patients

Background: Frictional melanosis of rubbing inner thighs is a common problem among Iraqi females causing great psychological and cosmetic impact. It might simulate lifa disease but it is a different entity. It is unfortunately not reported in the medical literatures although commonly encountered in daily clinical practice. Objective: To evaluate the hyperpigmentation of inner aspects of thighs in Iraqi females as an isolated pigmentary problem. Patient and Methods: Sixty patients with frictional melanosis of rubbing thighs were seen in Department of Dermatology, Baghdad Teaching Hospital in this case descriptive, clinical and histopathological study, during the period from April 2011 to March 2012. Any associated skin problems were also noticed like folliculitis and boils at area of friction. Forty individuals were enrolled in the present work as the healthy control group. The pigmentation was assessed by clinical, Wood’s light and histopathological examinations (H&E and Fontana stains). Body mass index was obtained for all patients and obesity was graded according to WHO recommendations. Results: The ages of patients ranged between 19 - 52 (32.86 ± 7.65) years, with 59 (98.3%) females and 1 (1.6%) male. By Wood’s light examination, accentuation in pigmentation was observed in 39 (58%) patients, while 21 (42%) of lesions showed no change. Body mass index was ranged from 23.3 - 43.6 (34.04 ± 4.13), history of vigorous rubbing of pigmented area with washing tool (lifa) was positive in 46 (76.6%) patients. Skin biopsies in 10 patients showed pure dermal melanophages in 3 of biopsies with slight melanosis of basal layer of epidermis, while the other 7 biopsies showed mainly increase in basal melanin. There was a statistically significant association between obesity and the severity of pigmentation of the inner thighs. Forty control individuals (2 males and 38 females) were assessed, their ages ranged from 19 - 50 (31.72 ± 6.40) years. All females were within normal weight while males were overweight and BMI was ranged from 19.7 - 28.2 (22.49 ± 1.84). All control individuals showed no pigmentation of inner aspects of thighs. Conclusion: Frictional melanosis of rubbing thighs is considered a new entity which had been not reported before in the medical literatures. This is a disease of mostly young obese females and the effective therapy is weight reduction and possibly liposuction.

Experimental Study on the Molecular Mechanism of Anthraquinone Cathartics in Inducing Melanosis Coli

Objective：To explore the significance of colonic epithelial cell apoptosis and tumor necrosis factorα（TNF-α）changing in pathogenesis of melanosis coli（MC）in guinea pig and the molecular mechanism of rhubarb（Rhu）in inducing the disease,by means of using different dosages of Rhu to induce the disease. Methods：One hundred and forty-four male guinea pigs,clean grade,were randomized according to their body weight into 5 groups,the untreated normal group and the 4 Rhu groups treated,respectively,with different doses of Rhu,3 g/kg·d for low dose（Rhu-I）group,6 g/kg·d for moderate dose（Rhu-m）group,12 g/kg·d for high dose（Rhu-h）group and 24 g/kg·d for super-high dose（Rhu-s）group via gastric infusion.All animals were sacrificed 60 days later,their viscera were taken for observing the pathologic and morphologic changes with HE, melanin and melatonin staining,and the apoptosis of colonic epithelial cells was detected with TUNEL stain and transmission electric microscopy.In addition,the levels of TNF-αin serum and colonic tissue were measured using ELISA and RT-PCR.Results：The pathological changes of MC could be found by naked eye in all Rhu groups,especially apparent at caecum and proximal end of colon,but did not found in gallbladder,jejunum and ileum.In normal guinea pigs,the colonic membrane was pink in color with no apparent pigment deposition. Membranous color deepened in the Rhu groups depending on the dosage of Rhu used.MC scoring showed the highest scores revealed in the Rhu-s group（6.00±0.00）,which was significantly different to those in the Rhu-I （3.86±0.69）,Rhu-m（4.43±0.79）and Rhu-h groups（4.88±0.35,all P0.05）.Levels of cell apoptosis in colon and TNF-αin serum in all Rhu groups were higher than those in the normal group（P0.01）,but showed no significant difference among the Rhu groups（P0.05）.Moreover,a positive correlation was found in the degree of induced MC with apoptosis rate and TNF-αlevel.Conclusions：Rhu（anthraquinone purgatives）had apparent effect on inducing MC;its molecular mechanism is maybe to destroy intestinal mucosal barrier and advance proinflammatory factor TNF-αreleasing,which leads to colonic epithelial cells apoptosis,and finally induce the change of MC due to the deposition of brown pigments,i.e.the macrophage phagocytized apoptotic body,on the colonic membrane.

Expression of aquaporin 8 and its relationship with melanosis coli

Background The relationship between melanosis coli （MC） and aquaporin 8 （AQP8） has not yet been elucidated. The aim of this research was to investigate the relationship between the expression of AQP8 and the pathological mechanism of MC.Methods Expression of AQP8 was detected by immunohistochemistry and reverse transcription-polymerase chain reaction （RT-PCR） in 37 MC colon tissues and 13 control colon tissues. Global gene expression analysis was also used to identify differently expressed genes. Its relationship with MC was analyzed by SPSS 11.5 statistical software.Results The positive rate of AQP8 expression detected by immunohistochemistry in the MC group was 24.3% （9/37）,significantly lower than the 69.2% （9/13） in the control group （P 〈0.05）. The relative expression level of AQP8 in MC group was 0.639±0.160, lower than 0.921±0.148 of controls （P 〈0.05）. Global gene expression analysis showed that AQP8 mRNA expression was downregulated in MC patients.Conclusions The decreased AQP8 expression in MC patients indicates that chronic use of laxatives containing anthraquinone may cause reduced water absorption. The expression of AQP8 may be related to MC.

Storage in ice incorporated antimelanotic agent and its effects on melanosis and quality of giant red shrimp(Aristaeomorpha foliacea)

Since melanosis starts very quickly after catching in shrimps,it is immediately treated with an antimelanotic agent.Shrimps are transported to land with ice.In this study,it was aimed to combine these two applications and to produce antimelanotic added ice and to preserve the shrimps in this ice.In ice production,4-hexylresorcinol and sodium metabisulphite were used at ratios 0.0025%and 0.625%,respectively.Shrimp(Aristaeomorpha foliacea)dipped in 4-hexylresorcinol and sodium metabisulphite solutions at ratios 0.005%and 1.25%,respectively,and shrimp kept in normal ice were considered as controls.The melanosis scores of the shrimp stored in ice containing antimelanotics were found to be lower than those of the shrimp dipped into antimelanotics.This situation showed that storage in ice containing antimelanotic agent delayed the formation of melanosis in shrimps.The highest TVB-N and TMA-N values were determined in the control group that did not contain antimelanotic agents.Shrimp stored in ice containing 4-hexylresorcinol had lower TVB-N and TMA-N values compared to sulphide added ice.The highest pH values were determined in shrimps dipped in 4-hexylresorcinol solution and in the control group.The pH values of shrimps treated with 4-hexylresorcinol were higher than those of shrimps treated with sulphite.The incorporation of antimelanotics to ice prevented the softening of shrimps and preserved the texture.Sodium metabisulphite and 4-hexylresorcinol showed a microbial inhibition effect in shrimp,and this effect was more clearly observed by storage in ice containing antimelanotic agent.

The clinical features and meningeal histochemistry of meningeal malignant melanosis

Meningeal malignant melanosis is a meninges tumor that can produce melanin. Primary intracranial neurocutaneous melanosis is rare. It grows fast with a high degree of malignancy and is associated with earlier intracranial hypertension and meningeal irritation. Most of them can not be diagnosed unless by biopsy or autopsy1. lntracranial malignant melanosis is divided into two kinds： primary and secondary which transfers through the lymph or blood. We report one case of meningeal malignant melanosis that was confirmed by meningeal pathology.

Neurocutaneous melanosis with intraspinal malignant melanoma in adults—an extremely rare clinical entity: A case report with review of literature

Objectives: Neurocutaneous melanosis(NCM) in adult patients was rare, and few cases had been reported. In this report, we summarized the features of NCM in adult patients for providing useful information about this rare clinical entity. Methods: In this report, we present a case of a 41-year-old woman, who was eventually diagnosed with NCM with intraspinal malignant melanoma. The clinical features,treatments, and prognosis of cases of NCM in adults were thoroughly reviewed and discussed. Results: A 41-year-old woman was eventually diagnosed with NCM with intraspinal malignant melanoma. The post-operative course was uneventful and her symptoms significantly improved(VAS: 3 points). However, she developed symptoms of intracranial hypertension and deteriorated rapidly after 11 months of operation, and died 1 month later. To date, only 15 cases of NCM in adults have been reported in the English literature. Analyses showed that the average age was 33.8 years(range19–65 years), and 11 patients(68.8%) were between 20 and 40 years. A slight male predominance(M:F/11:5) was found. For the 12 cases which detailed follow-up information was available, 9 patients(75%) died, with a survival time ranging from 1 day to 29 months post-operation. Death occurred within the first month of operation in 6 cases(46. 2%). The median survival time was 3 months. Conclusions: We presented a rare case of NCM with intraspinal malignant melanoma in an adult patient. Although rare, this clinical entity causes significant mortality and has poor prognosis.

Effects of green tea-and amla extracts on quality and melanosis of Indian white prawn(Fenneropenaeus indicus,Milne Edwards,1837)during chilled storage

Effect of ethanol extracts of green tea(Camellia sinensis L.)and amla(Phyllanthus emblica Linn)were investigated on quality and melanosis of chilled stored Indian white prawn(Fenneropenaeus indicus)during 28 days.Extracts were subjected to antioxidant assays viz.1,1-diphenyl-2-picryl hydrazyl radical reducing power methods(DPPH),total antioxidant capacity(TAC),total phenolic content(TPC)and ferric reducing antioxidant power(FRAP)to evaluate antioxidant potentiality and fourier-transform infrared spectroscopy(FT-IR)to identify organic constituents.Polyphenol oxidase(PPO)inhibition was assessed to check the efficacy of the extracts as anti-melanogenic agents.Biochemical(total volatile nitrogen,free fatty acid and peroxide values),bacteriological(aerobic counts),melanosis inhibition and sensory quality of chilled stored shrimp were addressed to investigate the efficacy of extracts as preservative and anti-melanogenic remedy.Free reducing power of green tea-and amla extracts were in a range of 28.72-65.67%and 17.38-66.95%,respectively.Phenolic content level was almost same for green tea and amla extract(2.46±0.002 and 2.51±0.036 mg GAE/gram).Total antioxidant capacity of green tea(210.33±4.63 mg EqAsc/g)was slightly higher than that of amla extracts(145.56±1.98 mg EqAsc/g).FRAP value revealed that green tea(477.49±3.25 mgE Fe(II)/g)had more ferric reducing power than amla(324.39±5.85 mgE Fe(II)/g).FT-IR analysis revealed the presence of essential organic bioactive compounds,which play an important role in reducing lipid oxidation and quality loss,and both extracts possess an encouraging PPO inhibition ability.Treatment by green tea-and amla extracts on chilled stored shrimp showed promising effects on biochemical and microbiological parameters followed by melanosis inhibition and enhanced sensory attributes.Treated Indian white prawn with green tea-and amla extract revealed significantly(P<0.05)lower value of biochemical indices and microbial load during chilled storage compared to untreated sample.

Clinical Observation in 30 Cases of Chloasma Treated by Auricular Point Pressing and Pricking

Methods of Treatment1. Auricular point pricking: Ear Apex, Subcortex,Endocrine and Spleen or Stomach were selected as the pricking points.

Clinical and Biochemical Evaluation of Facial Acanthosis Nigricans

Background: Acanthosis nigricans is a well known cause of facial melanosis in Iraqi males and usually it is a part of ordinary acanthosis nigricans. It is commonly associated with many metabolic derangements. Objectives: To evaluate cases of acanthosis nigricans of the face for all metabolic disturbances including fasting blood sugar, fasting serum insulin, total cholesterol, triglyceride, growth hormone and serum leptin. Patients and Methods: Twenty seven cases of acanthosis nigricans of the face were included in this case descriptive, clinical and biochemical study. This was conducted in Department of Dermatology-Baghdad Teaching Hospital and Department of Clinical Biochemistry, College of Medicine, Baghdad, Iraq during the period from November 2012-August 2014. It consisted of 26 males and one female, their ages ranged from 16 - 58 (39 ± 4.9) years. The diagnosis was established by clinical and histopathological evaluation. Sharquie’s ANSI scoring of acanthosis nigricans of face was carried out for all patients, also body mass index was assessed. Biochemical evaluation was carried out for all patients including total cholesterol, triglyceride, fasting blood sugar and insulin, insulin resistance, growth hormone and leptin enzyme immunoassay. Twenty seven healthy control non obese individuals with comparable ages and gender were assessed for all tests. Results: Biochemical results showed that fasting blood glucose, fasting serum insulin, insulin resistance, fasting serum triglyceride, total cholesterol, growth hormone and serum leptin were statistically significantly high in patients with acanthosis nigricans of the face in comparison with control individuals and all were positively correlated with the scoring of acanthosis nigricans of the face apart from high density lipoprotein was negatively correlated. Conclusion: Acanthosis nigricans of the face is a good marker for the associated metabolic diseases and these metabolic changes were statistically significantly correlated with the severity of acanthosis nigricans.

A Case of Coexistence of Aplasia Cutis Congenita and Giant Congenital Melanocytic Nevus:Coexistence of Two Rare Skin Diseases

Aplasia cutis congenita(ACC)is a rare disease that is characterized by complete or partial absence of skin at birth,either in a localized or widespread region.Melanocytic nevi refers to tumor-like malformations of the skin or mucous membrane caused by benign proliferation of melanocytes.It is classified as a giant congenital melanocytic nevus(GCMN)when the diameter of the largest nevus exceeds 20 cm.The co-occurrence of ACC and GCMN is extremely rare,to the best of our knowledge.We report a case of coexistence of ACC and GCMN of infancy in a 2-month-old male infant.The lesions consisted of a large hyperpigmented plaque occupying most of the trunk and pelvic region,and smaller hyperpigmented plaques on the trunk,head,and extremities.Additionally,there were large,sharply marginated,triangular,depressed atrophic plaques covered by thin,translucent,glistening epithelial membranes in the center of the GCMN on the back.The presumptive diagnosis was coexistence of GCMN and ACC.This could be a manifestation of SCALP syndrome,a rare neuro-cutaneous condition characterized by the presence of Sebaceous nevus,Central nervous system(CNS)malformations,Aplasia cutis congenita,Limbal dermoid and Pigmented(giant melanocytic)nevus.

Warm Needling at Back-Shu Acupoints for Melasma in Women

Objective:To observe the clinical effect of warm needling at the BackShu acupoints for melasma in women.Methods:A total of 100 cases who met the inclusion criteria were randomly allocated into a treatment group of 52 cases and a control group of 48 cases.Cases in the treatment group were treated with warm needling at the Back-Shu acupoints,whereas cases in the control group were treated with conventional acupuncture therapy.The therapeutic efficacies were then evaluated after three courses of treatment.Results:The total effective rate in the treatment group was 96.2%,versus 85.4%in the control group,showing a statistical difference(P<0.05).Conclusion:Warm needling at the Back-Shu acupoints works well for melasma in women.

Clinical Observation of Auricular Bloodletting Therapy for Chloasma in 30 Cases

Objective： To observe the clinical efficacy of auricular bloodletting therapy in the treatment of chloasma. Methods： Thirty cases of chloasma were treated by auricular bloodletting therapy. Results： Eight cases obtained basic cure, 10 cases marked improvement and 8 cases improvement; the total effective rate was 86.7%. Conclusion： Auricular bloodletting therapy is quite effective for chloasma, with no side effects.

Therapeutic Observation on Acupuncture plus Auricular Point Sticking for Melasma

Objective： To observe the clinical efficacy and safety of acupuncture plus auricular point sticking in treating melasma. Methods： Forty-three eligible subjects with melasma were intervened by acupuncture plus auricular point sticking, 10 times as a treatment course, with an interval of 3-5 d between each two courses. The therapeutic efficacy was analyzed after 1, 2 and 3 treatment courses respectively. Results： With the increase of treatment course, the markedly effective rate and total effective rate were also increasing. Of the 43 subjects after 3 treatment courses, the epidermal type had the highest markedly effective rate and total effective rate, then it＇s the subtype IV of the mixed type and dermal type, and the subtype III of the mixed type had the lowest markedly effective rate and total effective rate. Conclusion： Acupuncture plus auricular point sticking is effective and safe in treating melasma, but different types have different therapeutic efficacies.