Manual Dermatology and Dermatological Therapy of Pigmented Skins

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Many dermatologists have long believed that there may be a hormonal component to melasma, and a recently published study found that there were an increased number of estrogen receptors in areas where patients developed melasma. For this reason, Dr. Breadon advises patients with melasma to consider stopping oral contraceptives and hormone replacement therapy due to the large amount of estrogens in these medications. Regular sunscreen use is vital to protect the skin from further hyperpigmentation. With melasma, the skin can be affected in three different ways: Dermatologists use a light device known as the Woods lamp, which shows skin diseases as specific colors, to determine how deep melasma has penetrated the skin.

For superficial melasma, the triple cream combination of hydroquinone, retinoic acid and mild hydrocortisone with regular sunscreen use can be effective, with clearance occurring in about three months for most patients. Breadon noted that cases where melasma has penetrated the dermis are very difficult to treat and the combination triple cream medication will not be effective in these patients. However, some patients may experience improvement with microdermabrasion, dermabrasion, chemical peels or lasers.

In cases where both the epidermis and the dermis are involved, the triple cream medication may offer some improvement for some patients. Dermatologists can help patients decide the best course of treatment, depending on the severity of the condition. While lichen planus can affect people of all races and genders, it is more pronounced in people with darker skin since, as the lesions heal, the affected skin can develop very dark, leopard-looking spots. When caught early, steroid injections are used to reduce the inflammation thereby minimizing hyperpigmentation.

Chemical Peels and Microdermabrasion. Dermatitis in Pigmented Skin. Dermatophyte Infections in Ethnic Populations: Tinea Ca Hypopigmented Mycosis Fungoides. Tinea Polymorphous Light Eruption.


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McMichael and Valerie D. Lupus Erythematosus and Dermatomyositis. Inflammatory Disorders with Pustules or Cysts. Central Centrifugal Cicatricial Alopecia. Heat, Chemicals, and Other Drying Agents. Nandedkar and Kenneth W. Neal-- Disorders of Hypopigmentation. Melasma Familial Racial Periorbital Hyperpigmentation. Drugs Used in the Management of Pigmentary Disorders. Infectious Diseases of Pigmented Skins: Sanchez -- Superficial Fungal Infections.

Cutaneous Balamuthia mandrillaris Infection. Chronic Infective Lymphocytic Psoriaform Dermatitis. Saripalli and Sharon Bridgeman-Sha -- Sarcoidosis. Endocrine Disease - Diabetes Mellitus. Hepatic Disea Lichen Planus. Pruritus in Hepatic Disease.

Cryoglobulinemia and Hepatitis C. Pruritus in Renal Disease. Halder and Collette J. Intrinsic Skin Aging in Pigmented Races. Harris -- General Considerations. Anthropologic Considerations and Facial Characteristics. Ethnic Considerations - Facial Aging.

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Upper Mid Fac Lower Face. Photoaging in Pigmented Skins; Rebat M. Halder and Georgianna M. Richards -- Photoaging in East and Southeast Asians. Therapy of Photoaging of Pigmented Skins. Grimes and Brooke A. Jackson -- Botulinum Toxin. Chemical Peel Peeling Agents. Medium and Deep Peels. Rejuvenation in Ethnic Skin.

The most common pigmented lesions in sun-exposed skin include ephelides, actinic lentigo, pigmented solar keratoses and seborrhoeic keratoses, and lentigo maligna. The white spots in aged skin are usually stellate pseudoscars or idiopathic guttate hypomelanosis. Greying of the hair is due to progressive loss of melanocytes from the hair follicles. In vivo and in vitro studies are necessary to increase overall understanding of the processes involved and to improve treatment of the pigmentary changes in ageing skin.

The cheilitis is a ' inflammation of the skin to the lip that manifests as cuts, swelling and even ulceration that depart from the corners or edge and extend on the lips. Gangrene is a type of necrosis caused by a critically insufficient blood supply. This potentially life-threatening condition may occur after an injury or infection, or in people suffering from any chronic health problem affecting blood circulation.

The primary cause of gangrene is reduced blood supply to the affected tissues, which results in cell death. Diabetes and long-term smoking increase the risk of gangrene. Gangrene is not a communicable disease; it does not spread from person to person, though the infection associated to some forms can. The types of gangrene differ in symptoms, and include dry gangrene, wet gangrene, gas gangrene, internal gangrene, and necrotizing fasciitis. Surgical removal of gangrenous tissue and antibiotics are the mainstays of treatment for gangrene.

After the gangrene is treated, the underlying cause is addressed.

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This includes lifestyle modification such as smoking cessation, better control of diabetes, revascularization or, rarely, medical therapy to stop vascular spasm or the production of cold-induced vascular obstruction by cold-precipitated cryoglobulins. Dark circles also known as dark circles or periorbital hyperpigmentation are dark blemishes around the eyes. There are many causes of this symptom, including heredity and bruising. Any condition that causes the eyes to itch can contribute to darker circles due to rubbing or scratching the skin around them.

Hay fever sufferers in particular will notice under-eye "smudges" during the height of the allergy season. Some food allergies can also cause the area under the eyes to appear darker. Rosacea rose-AY-sha is a common skin disease. It often begins with a tendency to blush or flush more easily than other people. The redness can slowly spread beyond the nose and cheeks to the forehead and chin. Even the ears, chest, and back can be red all the time. Rosacea can cause more than redness. There are so many signs and symptoms that rosacea has four subtypes: Redness, flushing, visible blood vessels.

Redness, swelling, and acne-like breakouts. Skin thickens and has a bumpy texture. Eyes red and irritated, eyelids can be swollen, and person may have what looks like a sty. With time, people who have rosacea often see permanent redness in the center of their face. Dry skin is an uncomfortable condition marked by scaling, itching, and cracking. It can occur for a variety of reasons. You might have naturally dry skin. But even if your skin tends to be oily, you can develop dry skin from time to time.

Dry skin can develop on any part of your body. In many cases, lifestyle changes and over-the-counter moisturizers may be all you need to treat it. Exposure to dry weather conditions, hot water, and certain chemicals can cause your skin to dry out. Dry skin can also result from underlying medical conditions. A rash is a change of the skin which affects its color, appearance, or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell, and may be painful.

The causes, and therefore treatments for rashes, vary widely.

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Diagnosis must take into account such things as the appearance of the rash, other symptoms, what the patient may have been exposed to, occupation, and occurrence in family members. Rash can last 5 to 20 days, the diagnosis may confirm any number of conditions.

Anti Pigmentation Products & Care by Dr. Malvika Kohli

The presence of a rash may aid diagnosis; associated signs and symptoms are diagnostic of certain diseases. For example, the rash in measles is an erythematous, morbilliform, maculopapular rash that begins a few days after the fever starts. It classically starts at the head, and spreads downwards. Genital warts are symptoms of a contagious sexually transmitted disease caused by some types of human papillomavirus HPV. Warts are the most easily recognized symptom of genital HPV infection. HPV types 6 and 11 are most frequently the cause of genital warts.

It is spread through direct skin-to-skin contact, usually during oral, genital, or anal sex with an infected partner. While some types of HPV cause cervical cancer and anal cancers, these are not the same types of HPV that cause genital warts. Dermatosis papulosa nigra DPN is a condition of many small, benign skin lesions on the face, a condition generally presenting on dark-skinned individuals.

From a histological perspective, DPN resembles seborrheic keratoses. The condition may be cosmetically undesirable to some patients. Keloid, also known as keloid disorder and keloidal scar, is the formation of types of scars which, depending on its maturity, is composed mainly of either type III early or types I late collagen. It is a result of an overgrowth of granulation tissue collagen type 3 at the site of a healed skin injury which is then slowly replaced by collagen type 1.

Keloids are firm, rubbery lesions or shiny, fibrous nodules, and can vary from pink to the color of the patient's flesh or red to dark brown in color. A keloid scar is benign and not contagious, but sometimes accompanied by severe itchiness, pain, and changes in texture. In severe cases, it can affect movement of skin. Keloid scars are seen 15 times more frequently in people of African descent than in people of European descent.

Keloids should not be confused with hypertrophic scars, which are raised scars that do not grow beyond the boundaries of the original wound. A milium plural milia , also called a milk spot or an oil seed, is a clog of the eccrine sweat gland. It is a keratin-filled cyst that can appear just under the epidermis or on the roof of the mouth.

Milia are commonly associated with new-born babies but can appear on people of all ages. They are usually found around the nose and eyes, and sometimes on the genitalia, often mistaken by those affected as warts or other sexually transmitted diseases. Milia can also be confused with stubborn whiteheads. In children, milia often disappear within two to four weeks. For adults, they can be removed by a physician a dermatologist will have specialist knowledge in this area. Pemphigus vulgaris is a rare chronic blistering skin disease and the most common form of pemphigus.

It is classified as a type II hypersensitivity reaction, with the formation of antibodies against desmosomes, components of the skin that function to keep certain layers of skin bound to each other. As desmosomes are attacked, the layers of skin separate and the clinical picture resemble a blister.

Over time the condition inevitably progresses without treatment: Leukoplakia generally refers to a firmly attached white patch on a mucous membrane which is associated with an increased risk of cancer. The edges of the lesion are typically abrupt and the lesion changes with time. Advanced forms may develop red patches.

Dermatologists shed light on common pigmentation problems and solutions in skin of color

There are generally no other symptoms. It usually occurs within the mouth, although sometimes mucosa in other parts of the gastrointestinal tract, urinary tract, or genitals may be affected. The cause of leukoplakia is unknown. Risk factors for formation inside the mouth include smoking, chewing tobacco, excessive alcohol, and use of betel nuts. It is a precancerous lesion, a tissue alteration in which cancer is more likely to develop. Actinic keratosis also called solar keratosis and senile keratosis is a pre-cancerous patch of thick, scaly, or crusty skin. These growths are more common in fair-skinned people and those who are frequently in the sun.

They usually form when skin gets damaged by ultraviolet UV radiation from the sun or indoor tanning beds. AKs are considered potentially pre-cancerous; left untreated; they may turn into a type of cancer called squamous cell carcinoma. Development of these growths occurs when skin is constantly exposed to the sun over time.

They usually appear as thick, scaly, or crusty areas that often feel dry or rough. In fact, AKs are often felt before they are seen, and the texture is often compared to sandpaper. They may be dark, light, tan, pink, red, a combination of all these, or have the same color as the surrounding skin. An actinic keratosis lesion commonly ranges between 2 and 6 millimeters in size but can grow to be a few centimeters in diameter. They often appear on sun-exposed areas of the skin, such as the face, ears, neck, scalp, chest, backs of hands, forearms, or lips.

Because they are related to sun-damage on the skin, most people who have an AK have more than one. A melanocytic nevus also known as "nevocytic nevus" or "nevus-cell nevus" is a type of lesion that contains nevus cells a type of melanocyte.


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Some sources equate the term mole with "melanocytic nevus". Other sources reserve the term "mole" for other purposes. The majority of moles appear during the first two decades of a person's life, with about one in every babies being born with moles. Acquired moles are a form of benign neoplasm, while congenital moles, or congenital nevi, are considered a minor malformation or hamartoma and may be at a higher risk for melanoma.

A mole can be either subdermal under the skin or a pigmented growth on the skin, formed mostly of a type of cell known as a melanocyte. The high concentration of the body's pigmenting agent, melanin, is responsible for their dark color. Moles are a member of the family of skin lesions known as nevi. Molluscum contagiosum MC , sometimes called water warts, is a viral infection of the skin and occasionally of the mucous membranes.

MC can affect any area of the skin, but is most common on the trunk of the body, arms, groin, and legs. MCV has no non-human reservoir infecting primarily humans, though equids can rarely be infected. The virus that causes molluscum contagiosum is spread from person to person by touching the affected skin. The virus may also be spread by touching a surface with the virus on it, such as a towel, clothing, or toys. Risk factors include being sexually active, and those who are immunodeficient. Approximately million people were affected worldwide by molluscum contagiosum as of 1.

It is more common in children. Molluscum contagiosum is most common in children aged one to 11 years old. Some evidence indicates molluscum infections have been on the rise globally since , but these infections are not routinely monitored because they are seldom serious and routinely disappear without treatment. Molluscum contagiosum is contagious until the bumps are gone.

Some growths may remain for up to 4 years if not treated. Poikiloderma vasculare atrophicans PVA , sometimes referred to as parapsoriasis variegata or parapsoriasis lichenoides is a cutaneous condition skin disease characterized by hypo- or hyperpigmentation diminished or heightened skin pigmentation, respectively , telangiectasia and skin atrophy.

Other names for the condition include prereticulotic poikiloderma and atrophic parapsoriasis. The condition was first described by pioneer American pediatrician Abraham Jacobi in On the surface of the skin, these areas may range in size from small patches, to plaques larger, raised areas , to neoplasms spreading, tumor-like growths on the skin.

Mycosis fungoides, a type of skin lymphoma, may be a cause of PVA. The condition may also be caused by, associated with or accompany any of the following conditions or disorders: Rare causes include arsenic ingestion, and the condition can also be idiopathic. It was one of the earliest known complications, first documented in Diabetic dermopathy also known as "shin spots" is a type of skin lesion usually seen in people with diabetes mellitus.

It is characterized by dull-red papules that progress to well-circumscribed, small, round, atrophic hypopigmented skin lesions usually on the shins. Black hairy tongue BHT, also termed lingua villosa nigra refers to a condition of the tongue where the filiform papillae elongate with black or brown discoloration, giving a black and hairy appearance. The appearance may be alarming, but it is a harmless condition. Predisposing factors include smoking, xerostomia dry mouth , soft diet, poor oral hygiene and certain medications.

Management is by improving oral hygiene, especially scraping or brushing the tongue. Erythroplakia or erythroplasia is a clinical term to describe any erythematous red area on a mucous membrane that cannot be attributed to any other pathology. The term erythroplasia was coined by Louis Queyrat to describe a precancerous red lesion of the penis.

This gave rise to the term erythoplasia of Queyrat. Depending upon the context, this term may refer specifically to carcinoma in situ of the glans penis or vulva appearing as a red patch, or may be used as a synonym of erythroplasia on other mucous membrane or transitional sites. It mainly affects the glans penis the head of the penis , although uncommonly it may present on the mucous membranes of the larynx and rarely, the mouth or the anus. Neurodermatitis is a skin condition that begins with an itch. The itch can develop anywhere on the surface of the body. Most commonly, though, an itchy patch develops on an arm, leg, or the back of the neck.

It also commonly develops in the anal and genital areas. When it appears in the genital area, it often appears on the scrotum or vulva. The itch can be so intense that a person scratches or rubs the itchy patch frequently. The itch can also come and go. For most people, the area feels itchiest when they are relaxing or sleeping.

The itch causes people to scratch or rub the area while sleeping — and it can awaken someone from a sound sleep. Poikiloderma of Civatte is a cutaneous condition and refers to reticulated red to red-brown patches with telangiectasias. It is identifiable as the reddish brown discoloration on sides of the neck, usually on both sides. It is more common with women than men and more commonly effects middle-aged to elderly women. An epidermoid cyst is a benign cyst usually found on the skin. The cyst develops out of ectodermal tissue.

Histologically, it is made of a thin layer of squamous epithelium. Dermatitis, also known as eczema, is a group of diseases that results in inflammation of the skin. These diseases are characterized by itchiness, red skin, and a rash. In cases of short duration there may be small blisters while in long-term cases the skin may become thickened. The area of skin involved can vary from small to the entire body. Dermatitis is a group of skin conditions that includes atopic dermatitis, allergic contact dermatitis, irritant contact dermatitis, and stasis dermatitis.

The exact cause of dermatitis is often unclear. Cases are believed to often involve a combination of irritation, allergy, and poor venous return. The type of dermatitis is generally determined by the person's history and the location of the rash. For example, irritant dermatitis often occurs on the hands of people who frequently get them wet. Allergic contact dermatitis, however, can occur following brief exposures to substances a person is sensitive too.


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  7. Squamous cell carcinoma SCC or SqCC , also known as squamous cell cancer, is one of the main types of skin cancer that begins from squamous cells in the skin. Cancers that involve the anus, cervix, head and neck, and vagina are also most often squamous cell cancers. The esophagus, urinary bladder, prostate, and lung are other possible sites.

    Frequent exposure to direct, strong sunlight without adequate sunscreen protection is a risk factor for skin cancer. Despite sharing the name squamous cell carcinoma, the SCCs of different body sites can show differences in their presenting symptoms, natural history, prognosis, and response to treatment. SCC typically occurs in people older than 50 years.

    As of an increasing number of people in their 20s and 30s are being affected. It is twice as common in men as in women. People with darker skin and eyes have a lower risk than individuals with lighter colored skin. People with fair skin, light hair and eyes are at highest risk of developing the disease. With aging, the outer skin layer epidermis thins, even though the number of cell layers remains unchanged.

    The number of pigment-containing cells melanocytes decreases. The remaining melanocytes increase in size. Aging skin looks thinner, paler, and clear translucent. Large pigmented spots, including age spots, liver spots, or lentigos, may appear in sun-exposed areas. Changes in the connective tissue reduce the skin's strength and elasticity.

    Skin Pigment Disorders

    This is known as elastosis. It is more noticeable in sun-exposed areas solar elastosis. Elastosis produces the leathery, weather-beaten appearance common to farmers, sailors, and others who spend a large amount of time outdoors. The blood vessels of the dermis become more fragile.

    This leads to bruising, bleeding under the skin often called senile purpura , cherry angiomas, and similar conditions. Sebaceous glands produce less oil as you age. Men experience a minimal decrease, most often after the age of Women gradually produce less oil beginning after menopause. This can make it harder to keep the skin moist, resulting in dryness and itchiness. Melanoma, also known as malignant melanoma, is a type of cancer that develops from the pigment-containing cells known as melanocytes.

    Melanomas typically occur in the skin but may rarely occur in the mouth, intestines, or eye.