Hyperpigmentation disorder

AL-MURIESH MAHER , MBBS, MSc, M.D

Dep. Of Dermatology and Venereology, 21 September
University of Science & Technology
 Learning objectives

Understand the classify of hyperpigmentation as

epidermal, dermal, or mixed hyperpigmentation;

Common pigmented lesions.

Identify and describe the major cause of

melasma

Common treatment methods for

hyperpigmentation
 Skin color
• Determined by : melanin ( major determinant )
hemoglobin
carotenoids
• Melanin is synthesized by melanocytes.
• Skin color – genetically determined
Melanin synthesis

Miroslawa Cichorek et al. Open Life Sciences 8(4):315-330

Influence on melanin synthesis :

Skin color

UV radiation

Hormonal ( melanocyte stimulating

hormone by pituitary glands)
Abnormal skin
pigments
Hyperpigmentation
Hyperpigmentation:
Hyperpigmentation:

Epidermal Dermal

Mixed hyperpigmentation

• Epidermal hyperpigmentation :light-dark brown,

• Dermal hyperpigmentation: blue-gray coloration due to the Tyndall effect
 ▪ melanin deposition
Epidermis
hyperpigmentation: ▪ increased number of
melanocytes

• presence of melanin
Dermis
hyperpigmentation • melanophages
• hemosiderin

Certain drugs and heavy metals can also cause

hyperpigmentation via the direct deposition of the
substance in the skin.
 Approach to a patient

History
• onset : birth, infancy or later
• Cause : sun exposure, drug, occupation
• Systemic complaints
• Family history: neurofibromatosis, tuberous
sclerosis, vitiligo
 Examination

• Type of lesion: brown, blue, hypopigmented

• ( check sensation), depigmented
• Shape : ash leaf macules ( tuberous sclerosis)
Koebner phenomenon (vitiligo)
• Distribution pattern : linear/segmental,
symmetric (vitiligo), specific sites (melasma,
Addison’s disease)
 Examination aids:

•Hand lens
•Dermatoscopy
•Wood’s lamp 360nm
•Histology
J AM ACAD DERMATOL
VOLUME 88, NUMBER 2
EPIDERMAL
HYPERPIGMENTATION
Ephelis:
• Ephelis (singular) or ephelides (plural), also
known as freckles
▪ light-brown macules occurring on sun-
exposed areas of the face, forearms, and
dorsal hands associated with light skin and
blonde or red hair
• appear until 2 to 3 years of age and can be
induced by sun exposure
Lentigo:
• Lentigo (singular) or lentigines (plural) are
brown macules, of which several clinical
variants have been described, including:
 early age of onset
no predilection for sun-
exposed areas

lentigo
simplex
 solar lentigo: also known as
senile lentigines or liver spots
acquired later in adulthood
arise from accumulated
photodamage of
the skin

solar
simplex
Multiple lentigines
can also be seen in many syndromes with
associated systemic anomalies, including
Noonan syndrome with multiple lentigines,
Carney complex, and Peutz-Jeghers syndrome
Café au lait macule
• characterized by
uniform, light-brown,
well-demarcated
macules or patches.
• solitary lesions and
are typically larger in
size than ephelides or
lentigines.
• maybe present at
birth or first year of
life
DERMAL HYPERPIGMENTATION
 Hori’s nevus, Sun’s Nevus:
congenital dermal
melanocytosis (CDMs):
Mongolian spot, is a congenital
blue-gray patch that is usually
present at birth.
The majority of CDMs
spontaneously regress during
childhood and rarely persist
beyond the age of 6 years.
 Nevus of Ota

• blue-black or slate-gray macules coalescing into

irregular patches
• favors the distribution of the ophthalmic or maxillary
division of the trigeminal nerve usually unilateral,
rarely bilateral
• commonly seen in Asian or Black individuals The age of
onset is bimodal: infancy and puberty. Dose not
spontaneously regress Ocular involvement may be
present
https://healthjade.net/nevus-of-ota/
 •Features similar to
nevus of Ota
Nevus •The deltoid and
of Ito acromioclavicular
regions.
Mukhopadhyay AK. Indian J Dermatol 2013;58:286-9
 • Hori’s nevus, also known
as acquired bilateral
nevus of Ota-like macules.
Hori’s • occurs bilaterally on the
face, most commonly on
nevus, the malar regions
• A unilateral variant,
Sun’s known as Sun’ nevus
Nevus: • has also been described.
In contrast to nevus of
Ota, Hori’s nevus does not
involve ocular or mucosal
surfaces.
Park JM, Tsao H, Tsao S. JAAD. 2009 Jul 1;61(1):88-93.
Xinjun Yang et al. March 2023Skin Research and Technology 29(3)
MIXED EPIDERMAL DERMAL
HYPERPIGMENTATION
 Post inflammatory
hyperpigmentation (PIH)
common
condition that more commonly
occurs because varying shades in dark skin
presents as
of excess of brown, if individual
hyperpigmented
melanin epidermal, to exacerbated by
macules and
following blue gray, if exposure to UV
patches.
inflammation or dermal. radiation or
injury to the visible light
skin.
Drug-induced hyperpigmentation

occur due to several pharmacologic agents,

resulting in cutaneous, mucosal, and/or nail
hyperpigmentation or discoloration.
Jain, Avina, Sathish Pai, and Shrutakirthi
Shenoi. "Exogenous ochronosis." Indian
Journal of Dermatology, Venereology, and
Leprology 79.4 (2013): 522-522.
Melasma

Light-to-dark-brown macules and patches in sun

exposed areas.Most commonly seen in young-to-
middle-aged women with skin phototypes III to
VI
Three classic patterns have been described,
which are as follows: (1) Centro-facial: the most
common pattern, involving the forehead, cheeks,
nose, upper lip, and chin,
(2) malar :involving the cheeks and nose, and
(3) mandibular :involving the jawline.
Etiology:

hormonal
influences, including
UV radiation
pregnancy and
oral contraceptives.

phototoxic drugs or
Less commonly,
antiepileptics, have
other medications,
also been
such as
associated.
Melasma
Physical modalities

Use Q
chemical switched
laser:
peel and pico
second Alex laser IPL laser
Nd:YAG
laser
Thanks