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Skin-Melanocytic tumors
Hyperpigmentation
Author: Nat Pernick, M.D., PathologyOutlines.com, Inc.
Revised: 5 July 2009, last major update November 2008
Copyright: (c) 2005-2009, PathologyOutlines.com, Inc.
Clinical
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● Common, usually harmless condition, in which patches of skin become darker than normal surrounding skin
● Due to melanocyte stimulation from sunlight, heat, post-inflammatory (eMedicine), drugs (Merck), hormones, malignancy, metabolic disease, scars, various dermatoses, familial progressive hyperpigmentation (Eur J Dermatol 2006;16:246)
● Patches near axilla may be post-inflammatory due to hair plucking (Int J Cosmet Sci 2006;28:247)
● Amiodarone may deposit in skin and cause hyperpigmentation (Arch Dermatol 2008;144:92)
● Hyperpigmentation can be evaluated with Taylor hyperpigmentation scale (Cutis 2005;76:270)
● Age / liver spots are common, due to sun damage on hands or face
Case reports
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Drugs
● Bleomycin (Arch Dermatol 2003;139:337)
● Diltiazem (Arch Dermatol 2006;142:206)
● Hydroxychloroquine (J Cutan Pathol 2008;35:1134)
● Imatinib (Dermatol Online J 2008;14(7):7)
● Imipramine (Dermatol Online J 2007;13(4):8)
● Minocycline (J Clin Rheumatol 2008;14:17)
Malignancy
● Leukemia cutis (J Cutan Pathol 2008;35:662)
Other
● Periungual hyperpigmentation in newborns (Pediatr Dermatol 2008;25:25)
● Vitamin B12 deficiency (Indian J Dermatol Venereol Leprol 2006;72:389)
Treatment
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● None
● Bleaching products with hydroquinone, retinol and antioxidants (Cutis 2008;81:365)
● Laser therapy (Plast Reconstr Surg 2008;121:282)
● Note: hydroquinone slows production of melanin so darker areas gradually fade to match surrounding skin; tretinoin and cortisone take 3-6 months to produce improvement
Clinical description
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● Skin with darker pigmentation than surrounding healthy skin, due to increased melanin
Clinical images
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Post-drug use:
Bleomycin Diltiazem Imatinib
Imipramine Minocycline
Other:
Pre- and post-treatment for Vitamin B12 deficiency
Post-inflammatory arthritis
Micro description
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● Increased pigmentation of basal keratinocytes, increased transfer of melanin into adjacent keratinocytes
● Variable melanophages, deposits in dermal cells and apoptotic cells
● No atypia
Micro images
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Diltiazem Imipramine: gold brown pigment in upper and mid dermis
Additional references
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End of Skin-Melanocytic Tumors > Hyperpigmentation
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