Effect of a Cosmetic Use with 2% Isostearyl-L-Ascorbic Acid Gel for Postinflammatory Hyperpigmentation and Postinflammatory Erythema in Acne Vulgaris

Postinflammatory hyperpigmentation (PIH) and postinflammatory erythema (PIE) in acne vulgaris are important and refractory complications for patients with acne vulgaris. To clarify the effects of 2% isostearyl-L-ascorbic acid (ISAA) against PIH and PIE in acne vulgaris, a clinical pilot study with topical 2% ISAA gel was performed in 25 acne patients with PIH and PIE. Topical ISAA gel was applied on the whole face with PIH and PIE in acne vulgaris twice a day for 3 months. Regarding PIH and PIE, investigator’s global improvement rating (IGIR) was evaluated in 7-point scales according to the reduced area of PIH and PIE before and after the study. Remarkable improvement in PIH was observed in 7 patients (28.0%) and in PIE in 12 (48%) of the 25 patients. No adverse reactions were observed during the treatment. Topical ISAA application can be an alternative, non-invasive available treatment for PIH and PIE in acne vulgaris.

Case Report: Improvement of Long Lasting Hyperpigmentation by Aqueous Human Placenta Extract (Reju Growth Factor, RGF&#174) Treatment

Hyperpigmentation is a common skin problem in a woman. Prolonging topical use of skin whitening may cause hyperpigmentation such as ochronosis whose condition is a challenge for treatment. An aqueous human placenta extract (RGF&#174) contains bioactive therapeutic molecules. There is evidence of human placenta extract showing that melanin synthesis is inhibited by placenta extract in melanocytes. We first reported the case of the hyperpigmentation improvement following face skin mesotherapy human placenta extract treatment.

Dramatic Improvement of Long Lasting Post-Inflammatory Hyperpigmentation by Oral and Topical Tranexamic Acid

Post-inflammatory hyperpigmentation is common problem, but its treatment still remains challenging. Tranexamic acid has been used to treat or prevent excessive bleeding loss in various medical conditions. There have been some reports of the effect of oral and topical tranexamic acid for treatment of pigmented disorder. Herein we report on a case of female patient who showed improvement of PIH after oral and topical tranexamic acid administration.

Paclitaxel-associated reticulate hyperpigmentation:Report and review of chemotherapy-induced reticulate hyperpigmentation

Drug-induced reticulate hyperpigmentation is uncommon. Including the patient described in this report, chemotherapy-associated reticulate hyperpigmentation has only been described in ten individuals. This paper describes the features of a woman with recurrent and metastatic breast cancer who developed paclitaxelinduced reticulate hyperpigmentation and reviews the characteristics of other oncology patients who developed reticulate hyperpigmentation from their antineoplastic treatment. A 55-year-old Taiwan Residents woman who developed reticulate hyperpigmentation on her abdomen, back and extremities after receiving her initial treatment for metastatic breast cancer with paclitaxel is described. The hyperpigmentation became darker with each subsequent administration of paclitaxel. The drug was discontinued after five courses and the pigment faded within two months. Pub Med was searched with the key words: Breast, cancer, chemotherapy, hyperpigmentation, neoplasm, reticulate, tumor, paclitaxel, taxol. The papers generated by the search, and their references, were reviewed. Chemotherapy-induced reticulate hyperpigmentation has been described in four men and six women. Bleomycin, cytoxan, 5-fluorouracil, idarubacin, and paclitaxel caused the hyperpigmentation. The hyperpigmentation faded in 83% of the patients between two to six months after the associated antineoplastic agent was discontinued. In conclusion, chemotherapy-induced reticulate hyperpigmentation is a rare reaction that may occur during treatment with various antineoplastic agents. The hyperpigmentation fades in most individuals once thetreatment is discontinued. Therefore, cancer treatment with the associated drug can be continued in patients who experience this cutaneous adverse event.

Progressive Cribriform and Zosteriform Hyperpigmentation along with Vitiligo

Background: Progressive cribriform and zosteriform hyperpigmentation (PCZH) is a disorder of pigmentation. Although several cases of PCZH have been reported, cases that associated with vitiligo have not been published in the past. Aim: We report the case to reveal the interesting mosaicism reflecting on the skin. Case Presentation: This case presents a phenomenon of the coexistence of hyperpigmentation and depigmentation arranged in unilateral and symmetric distribution in one patient. Conclusion: The aetiology of the pigmental disorders is still unknown. The linear nature of the pigmented bands probably reflects the clonal migration and proliferation of embryonic melanoblasts, so somatic mosaicism that develops during embryogenesis appears to be the underlying aetiology, which is leading to proliferation and migration of two mixed populations of melanocytes with different potential for pigment production.

Camouflage Therapy for Post-Inflammatory Hyperpigmentation on the Face Caused by Fixed Drug Eruption

Camouflage therapy has been used for permanent contour and pigmentary defects including telangiectasias, vitiligo, lentigines, nevi, atrophic scars and burn scars. The goal of the therapy is to provide new and innovative ways to normalize the appearance of patients with abnormalities. A variety of cosmetic techniques are used to assist these patients in making their irregularities as inconspicuous as possible. Post-inflammatory hyperpigmentation is a frustrating problem afflicting many dermatology patients, particularly on the face. Here we report a case of successful cosmetic camouflage using the theory of complementary colors of light in a patient with post-inflammatory hyperpigmentation of the face caused by fixed drug eruption. Our case report supports the idea that camouflage for patients with post-inflammatory hyperpigmentation on the face caused by fixed drug eruption improves their quality of life and also supports the idea that camouflage should be part of the after care for patients who have received patch testing.

Periorbital Post-Inflammatory Hyperpigmentation after Fractionated CO₂Laser Resurfacing in Asians

Background: Most data on laser resurfacing have come from studies of people with Fitzpatrick skin types 1 - 3;however, the world’s population is comprised mostly of Fitzpatrick skin types 4 - 6, which are more susceptible to post-inflammatory hyperpigmentation (PIH). Objective: For the purpose of expanding the expertise of plastic surgeons treating patients with darker skin types, this study examined the incidence of PIH in Asians who underwent laser resurfacing, including a histologic arm on fractional ablative resurfacing. Methods & Materials: The clinical study included six subjects of Vietnamese origin who underwent single-depth fractionated CO2 laser resurfacing. The histologic study involved a seventh subject. The MiXto SX®laser with a new scanning handpiece was used, along with magnifying loupes to assess ablative depth after each of three laser passes performed. Photographs were taken at various postoperative intervals. Results: All six clinical subjects showed cosmetic improvement in skin texture and tone with no post-inflammatory hyperpigmentation. In the histologic study, H&E stained sections revealed uniform diathermy. Conclusion: It is possible to significantly reduce PIH in darker skinned subjects through use of a new scanning handpiece and a technique using loupes to assess the depth of ablative resurfacing. The histologic study confirms these findings.

Comprehensive Sequential Successful Therapy Comprising Chemical Peeling, Iontophoresis and Topical Vitamin C for Postinflammatory Hyperpigmentation in Acne Vulgaris

A 20-year-old man presented with for 6-month history of facial acne. He had erythema and red papules on the face secondary to BPO-induced contact dermatitis. He was administered topical corticosteroid. Contact dermatitis improved with this treatment, and he had red papules, comedones, prominent postinflammatory hyperpigmentation (PIH), postinflammatory erythema (PIE), erosions and erythema associated with acne vulgaris. He was subsequently treated with oral minocycline 100 mg/d and topical adapalene and ozenoxacin lotion once daily for 3 months. The inflammatory lesions and comedo subsided;however, PIH, PIE, atrophic scar and erosion persisted. During 3 months, the patient underwent chemical peeling using 20% glycolic acid (GA) and subsequent vitamin C iontophoresis twice at 1-month intervals. He showed almost disappearance of red papules and comedones but persistent PIH, PIE and erosion after 3 months of treatment. He was thereafter prescribed topical glyceryl-octyl-ascorbic acid/ascorbyl 2-phosphate 6-palmitate/DL-a-tocopherol phosphate complex for local application twice daily for 3 months. After 7 months of treatment, PIH, PIE, erosion and atrophic scar faded significantly with only trace residual erosions, atrophic scar and PIH. Subsequently, he was prescribed local application of 2% isostearyl-L-ascorbic acid gel vitamin C gel twice daily for 3 months. After 15 months, PIH, PIE, erosion and atrophic scar disappeared completely with significant improvement. Comprehensive sequential therapy resulted in significant improvement. It is suggested that medical treatment using systemic and topical antimicrobials and topical adapalene reduces inflammatory lesions and comedones initially. Subsequent chemical peeling using GA and vitamin C iontophoresis could improve PIH. These synergistic effects might have contributed to the significant improvement observed in this case. Comprehensive sequential treatment using chemical peeling, vitamin C iontophoresis and topical vitamin C can be a useful treatment strategy for PIH in acne vulgaris.

Inverted duplication including Endothelin 3 closely related to dermal hyperpigmentation in Silkie chickens

The dermal hyperpigmentation phenotype in chickens is controlled by the dominant fibromelanosis allele.One of the ten unique characteristics of Silkie chickens is the fibromelanosis phenotype,which is pigmentation in the dermal layer of the skin and connective tissue.In this study,we found a mutation of fibromelanosis,a genomic rearrangement that included an inverted duplication of endothelin3(EDN3),is responsible.We show that,as a stimulator of melanoblast proliferation,EDN3 expression was increased in silkie embryos and in both skin and muscle throughout adulthood.EDN3 expression led to an increase in expression of the downstream genes EDNRB2 and TYRP2,and was closely relate with the hyperpigmentation phenotype.We examined eight different Chinese chicken breeds showing hyperpigmentation and conclude that this structural genetic variant exists in all fibromelanosis chicken breeds.

Effective Skin Care Guidance for Patients with Acne Vulgaris after Standard Treatment

With the introduction of new drugs, the treatment of acne vulgaris has improved dramatically;however, there remains a considerable gap between treatment outcomes and patients’ treatment goals. This study aimed to determine whether dermatologists’ guidance on appropriate skincare for skin symptoms such as post-inflammatory erythema and post-inflammatory hyperpigmentation (PIH), which are not covered by acne treatment, leads to an improvement in patients’ skin condition and patient satisfaction. Japanese women who had completed standard treatment for acne vulgaris and those with mild symptoms not requiring treatment were included in the study. The participants received instructions about skin care at the beginning of the study, which they continued to apply for 6 weeks. At the start and end of the study, participants were examined by a dermatologist;afterward, skin measurements, including skin color, skin surface lipid content, and image analysis by VISIA® Evolution, analysis of stratum corneum obtained from the skin surface, and Skindex-16 questionnaire for assessing quality of life (QOL), were performed. The following showed significant improvements: PIH score, number of inflammatory acne lesions, and number of non-inflammatory acne lesions observed via skin examination;skin surface lipid content and values of L* and a* obtained via instrumental measurement;n number of pore, texture, red spot, and pigmented spot obtained via by image analysis;and degree of multilayer exfoliation and interleukin-1α determined by analysis of epidermal stratum corneum. QOL measurement using Skindex-16 also improved significantly. Appropriate skin care guidance following standard acne vulgaris treatment is helpful in achieving patients’ treatment goals. .

Familial gastrointestinal stromal tumors with KIT germline mutation in a Chinese family:A case report

BACKGROUND Familial gastrointestinal stromal tumors(GISTs)is a rare autosomal dominant disorder characterized by an array of clinical manifestations.Only 35 kindreds with germline KIT mutations and six with germline PDGFRA mutations have been reported so far.It is often characterized by a series of manifestations,such as multiple lesions and hyperpigmentation.However,the effect of imatinib treatment in these patients is still uncertain.CASE SUMMARY Here,we report two patients(father and daughter)in a Chinese family(for the first time)with germline KIT mutation,and described their pathology,genetics and clinical manifestations.A 25-year-old Chinese woman went to hospital because of abdominal pain,and computed tomography showed multiple tumors in the small intestine.Small pigmented spots appeared on the skin within a few months after birth.Her father also had multiple pigmented spots and a history of multifocal GISTs.Multiple GISTs associated with diffuse interstitial Cajal cells(ICCs)hyperplasia were positive for CD117 and DOG-1.Gene sequencing revealed a germline mutation at codon 560 of exon 11(p.V560G)of KIT gene in these two patients.Imatinib therapy showed the long-lasting disease stability after resection.Remarkably,the hypopigmentation of the skin could also be observed.Luckily germline KIT mutation has not been identified yet in the 3-year-old daughter of the female patient.CONCLUSION Diagnosis of familial GISTs depends on combination of diffuse ICCs hyperplasia,germline KIT/PDGFRA mutation,hyperpigmentation and family history.

Cross Skin Reactivity to Tyrosine Kinase Inhibitors in a Patient with Chronic Myelogenous Leukemia

Tyrosine kinase inhibitors (TKI) targeting the bcr-abl protein, c-kit and the platelet-derived growth factor receptors, are significant part of the pathogenic therapy of chronic myelogenous leukemia. A broad spectrum of cutaneous side effects has been described with the clinical use of imatinib mesylate, ranging from various acute rashes to toxic epidermal necrolysis. Herein, a case of cross skin toxicity to TKI in a patient with chronic myelogenous leukemia is presented. In the course of imatinib mesylate therapy the patient developed a grade 4 diffuse lichenoid drug eruption. Six months after switching to nilotinib, hyperpigmented macules and patches spread over his trunk and extremities. To date, few cases of cross skin reactivity to imatinib and nilotinib have been described, none of which showing different clinical phenotypes. Further understanding of the underlying mechanisms and leading to the development of skin rashes from different class of TKI is important to highlight new drug targets and modify the current therapies to a level of maximal efficacy.

Oral Manifestations of Chloroquine and Hydroxychloroquine: Differential Diagnoses

Chloroquine phosphate and hydroxychloroquine sulfate are organic compounds, known as aminoquinolines for containing an amino group attached to a quinoline ring. They have been used since World War II as antimalarial agents. The article search that made up this review was carried out in the PubMed database, using the keywords “Chloroquine”, “Hydroxychloroquine”, and “Oral Manifestations”, in the period including 2005 to 2020. The sample size was 7 female patients aged 40 to 66 years, with an age predominance of between 50 and 60 years old. The predominant lesion site was the hard palate with 6 cases. To reach the diagnosis of pigmented lesions in the oral cavity, meticulous anamnesis prior to physical examination is extremely important. In this pandemic and post-pandemic period, a more detailed investigation of the medications used by the patient in recent periods, such as chloroquine and hydroxychloroquine are essential to detect if the lesion was possibly caused by these drugs.

Progressive Symmetrical Erythrokeratoderma-Like Psoriasis: A New Case Report

Background: Psoriasis, a chronic, systemic, inflammatory disease with prominent skin involvement, affects approximately 2% - 4% of the world population. Common variants of psoriasis are plaque psoriasis, inverse psoriasis, guttate psoriasis, erythrodermic psoriasis, pustular form either palmoplantar pustular psoriasis or generalized pustular psoriasis, nail psoriasis, and psoriatic arthritis. Progressive Symmetrical Erythrokeratoderma (PSEK) is a rare genetic disorder, characterized by fixed, well-defined erythematous and hyperkeratotic plaques distributed predominantly on the elbows, knees, trunk, and dorsal surfaces of hands and feet. Clinically has the same presentation to psoriasis especially at early onset and could be confused with psoriasis but histopathological findings and progression of the psoriatic disease can differentiate between both conditions. Aim: To document a new variant of a severe, recalcitrant type of psoriasis with a history of recurrent attacks of exacerbations and partial remissions especially in lesions involving lower extremities that are clinically PSEK-like in presentation, but histopathologically consistent with psoriasis. Case report: A 12-year-old childhood male, known case of Down’s syndrome, presented to our clinic with a history of severely pruritic skin rashes involving the perioral area, corners of the mouth, bilateral elbows, dorsal hands, scrotum, and both lower extremities for 6 years duration. The rashes gradually progressed with time to form fixed lesions in the last 2 years. He was received multiple treatment modalities, including topical steroids, topical vitamin D derivatives, and narrowband UVB phototherapy without significant improvement and the lesions became more worsened over time. Conclusion: psoriasis can be presenting with a new variant of a severe, recalcitrant, and difficult to treat type in Down syndrome cases with a history of recurrent attacks of exacerbations and partial remissions especially in lesions involving lower extremities which are clinically PSEK-like in presentation, but histopathologically consistent with psoriasis. However, early diagnosis and strict management are important in controlling the severity of the condition.