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Lichen sclerosus (LS) is a chronic inflammatory dermatosis primarily affecting the genitalia, commonly characterized by pearly-white papules and plaques. Although predominantly affecting females, LS can manifest across all age groups, with a bimodal distribution observed in prepubescent girls and postmenopausal women. This case report presents an unusual instance of exclusive extragenital LS in a 10-year-old girl, showcasing hyperpigmented patches and wrinkled plaques resembling lichen planus on her forearms and lower legs. Histopathological analysis confirmed LS, revealing distinctive epidermal changes and lymphocytic infiltrates. The absence of mucosal involvement and unique clinical presentation differentiated this case from typical LS manifestations. Treatment with topical clobetasol propionate demonstrated significant improvement in pruritus. Extragenital LS is infrequent, particularly among children, and its diagnosis necessitates a comprehensive clinicopathological correlation. The reported case contributes valuable insights into this uncommon variant, emphasizing the importance of accurate diagnosis and tailored treatment strategies. Additionally, it highlights the efficacy of highpotency topical corticosteroids in managing this condition. [ABSTRACT FROM AUTHOR]

Acne vulgaris is a common dermatological diagnosis observed in pediatric patients with skin of color, often resulting in scarring, keloid formation, and post-inflammatory hyperpigmentation, significantly impacting their quality of life. This exploratory retrospective chart review included 77 black pediatric patients seen at a tertiary care center for acne vulgaris between 2018 and 2023. We analyzed demographics, acne descriptors, and treatment modalities. The most common acne morphology was comedonal acne (83.6%), with 71% of the patients being female. Significant age differences were observed particularly for acne at the chin and overall face. Treatment regimens commonly prescribed included combinations of adapalene and benzoyl peroxide (22%), topical antibiotics, tretinoin, and benzoyl peroxide (34%). Given the higher risk of sequelae for patients with darker skin, it is crucial to address their unique treatment needs. This study highlights the distinctive characteristics of acne in black pediatric patients and calls for further research to enhance our understanding and treatment of this population. Limitations include the lack of direct patient interactions and reliance on chart data. Further studies are needed to compare acne presentation in skin of color of other populations, refining our knowledge of acne clinical presentation, complications, and treatment modalities for diverse patient populations. [ABSTRACT FROM AUTHOR]

Background: Bilateral breast hypertrophy, ranging from mild to severe, can lead to various complications, including pain, ulceration, infection, and psychological distress. Swift surgical intervention is often necessary to address the mechanical and psychological challenges associated with excessive breast weight. While treatment approaches for this condition are debated, recent advancements favor surgical strategies like mastectomies with reconstruction to improve clinical and psychological outcomes. We present a unique case of bilateral breast hypertrophy successfully managed through breast amputation and NAC (nipple-areolar complex) graft using wise patterns incision mammoplasty. Case Presentation: This report details the case of a 30-year-old female with hypothyroidism and lupus who experienced significant bilateral breast enlargement during her second pregnancy. The patient faced pain, hyperpigmentation, and limited mobility, along with abnormal laboratory findings. Bilateral reduction mammoplasty (breast amputation) was performed, leading to successful outcomes and improved quality of life for both the patient and her newborn. Follow-up assessments showed no recurrence or complications postoperatively. Conclusion: This case highlights the challenges of managing breast hypertrophy in pregnant patients with autoimmune conditions. Early recognition and multidisciplinary management are crucial in such cases. The positive results of the interventions underscore the importance of timely and comprehensive care for patients facing similar conditions. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to develop ANcam, a novel method for identifying acanthosis nigricans (AN) using a smartphone camera and computer-aided color analysis for noninvasive screening of people with impaired glucose tolerance (IGT). Research Design and Methods: Adult and juvenile participants with or without diagnosed type 2 diabetes were recruited in Trinidad and Tobago. After obtaining informed consent, participants' history, demographics, anthropometrics, and A1C were collected and recorded. Three subject matter experts independently graded pictures of the posterior neck and upper back using the ANcam smartphone application and Burke methods. A correlation matrix investigated 25 color channels for association with hyperpigmentation, and the diagnostic thresholds were determined with a receiver operating characteristic curve analysis. Results: For the 227 participants with captured images and A1C values, the cyan/magenta/yellow/black (CMYK) model color channel CMYK_K was best correlated with IGT at an A1C cutoff of 5.7% (39 mmol/mol) (R = 0.45, P <0.001). With high predictive accuracy (area under the curve = 0.854), the cutoff of 7.67 CMYK_K units was chosen, with a sensitivity of 81.1% and a specificity of 70.3%. ANcam had low interrater variance (F = 1.99, P = 0.137) compared with Burke grading (F = 105.71, P <0.001). ANcam detected hyperpigmentation on the neck at double the self-reported frequency. Elevated BMI was 2.9 (95% CI 1.9–4.3) times more likely, elevated blood pressure was 1.7 (95% CI 1.2–2.4) times more likely, and greater waist-to-hip ratio was 2.3 (95% CI 1.4–3.6) times more likely with AN present. Conclusion: ANcam offers a sensitive, reproducible, and user-friendly IGT screening tool to any smartphone user that performs well with most skin tones and lighting conditions. [ABSTRACT FROM AUTHOR]

Background: Psoriasis is a chronic, recurring, and immune-mediated inflammatory skin disease. Throughout the period of the last few decades, phototherapy has become widely used in treating stable psoriatic lesions. For the treatment of psoriasis, several light/laser therapies with distinct modes of action have been developed. Cold laser therapy might be an effective therapeutic choice for localized plaque psoriasis. Objective: To assess the safety and efficacy of cold laser therapy clinically and microscopically in localized plaque psoriasis treatment. Patients and methods: 40 patients with localized mild plaque psoriasis were selected from the Dermatology and Venereology outpatient clinic-Tanta University Hospitals and enrolled in the clinical trial. They were treated by cold laser 808nm wavelength (Endolaser 422, Enraf-nonious B.V. Rotterdam, Netherlands) one session for 10 min on each plaque twice weekly separated by 2 days until clinical cure or for a maximum of 8 weeks. Evaluation was done immediately after the last session by taking the average of three blinded dermatologists of the photos, the modified Psoriasis Area and Severity Index [mPASI], dermoscopic examination, patients' satisfaction scale and histopathological and electron microscopic examination of punch biopsy specimens taken before and after the end of treatment from psoriatic lesions in four patients only. Results: There was a statistically significant clinical improvement after the end of treatment compared with before treatment as 16 patients (40%) showed excellent improvement, 8 patients (20%) showed good improvement, 9 patients (22.5%) showed mild improvement, and 7 patients (17.5%) showed poor improvement. As regard mPASI, a statistically significant decrease in mPASI was found after the end of treatment (P<0.001). Regarding dermoscopic examination, a statistically significant reduction in the percentage of patients showing dermoscopic red dots and white scales after the end of treatment (P<0.01). As regard the patients' satisfaction scale, 82.5% of patients were satisfied from the results. Histopathological and ultrastructural evaluation revealed normalization of the psoriatic microscopic changes with cold laser. Conclusion: The use of cold laser therapy for the management of localized mild plaque psoriasis is safe, tolerable, effective, and can be used as an alternative therapy for psoriasis. [ABSTRACT FROM AUTHOR]

Rosa spp., commonly known as rosehips, are wild plants that have traditionally been employed as herbal remedies for the treatment of a wide range of disorders. Rosehip is a storehouse of vitamins, including A, B complex, C, and E. Among phytonutrients, vitamin C is found in the highest amount. As rosehips contain significant levels of vitamin C, they are perfect candidates for the development of skincare formulations that can be effectively used in the treatment of different skin disorders (i.e., scarring, anti-aging, hyperpigmentation, wrinkles, melasma, and atopic dermatitis). This research focuses on the vitamin C content of several Rosa sp. by their botanical and geographic origins, which according to research studies are in the following order: R. rugosa > R. montana > R. canina > R. dumalis, with lower levels in R. villosa and R. arvensis, respectively. Among rosehip species, R. canina is the most extensively studied species which also displays significant amounts of bioactive compounds, but also antioxidant, and antimicrobial activities (e.g., against Propionibacterium acnes, Staphylococcus aureus, S, epidermis, and S. haemolyticus). The investigation also highlights the use of rosehip extracts and oils to minimise the harmful effects of acne, which primarily affects teenagers in terms of their physical appearance (e.g., scarring, hyperpigmentation, imperfections), as well as their moral character (e.g., low self-confidence, bullying). Additionally, for higher vitamin C content from various rosehip species, the traditional (i.e., infusion, maceration, Soxhlet extraction) and contemporary extraction methods (i.e., supercritical fluid extraction, microwaveassisted, ultrasonic-assisted, and enzyme-assisted extractions) are highlighted, finally choosing the best extraction method for increased bioactive compounds, with emphasis on vitamin C content. Consequently, the current research focuses on assessing the potential of rosehip extracts as medicinal agents against various skin conditions, and the use of rosehip concentrations in skincare formulations (such as toner, serum, lotion, and sunscreen). Up-to-date studies have revealed that rosehip extracts are perfect candidates as topical application products in the form of nanoemulsions. Extensive in vivo studies have revealed that rosehip extracts also exhibit specific activities against multiple skin disorders (i.e., wound healing, collagen synthesis, atopic dermatitis, melasma, and anti-aging effects). Overall, with multiple dermatological actions and efficacies, rosehip extracts and oils are promising agents that require a thorough investigation of their functioning processes to enable their safe use in the skincare industry. [ABSTRACT FROM AUTHOR]

Hydroxychloroquine (HCQ) is used as a traditional disease-modifying antirheumatic drugs (DMARDs), for the treatment of autoimmune diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). However, it can cause serious adverse reactions, including hyperpigmentation of the skin and bull's-eye macular lesions. Here, we present a case of HCQ-induced hyperpigmentation of the skin and bull's-eye macular lesions in a patient who received HCQ for RA. A 65-year-old female patient developed blurred vision and hyperpigmentation of multiple areas of skin over the body for one month after 3 years of HCQ treatment for RA. Based on clinical presentation, ophthalmological examination and dermatopathological biopsy, a diagnosis of drug-induced cutaneous hyperpigmentation and bullous maculopathy of the right eye was made. After discontinuation of HCQ and treatment with iguratimod tablets, the hyperpigmentation of the patient 's skin was gradually reduced, and the symptoms of blurred vision were not significantly improved. We also reviewed the available literature on HCQ-induced cutaneous hyperpigmentation and bull's-eye macular lesions and described the clinical features of HCQ-induced cutaneous hyperpigmentation and bull's-eye macular lesions. In conclusion, clinicians should be aware of early cutaneous symptoms and HCQ-associated ophthalmotoxicity in patients with rheumatic diseases on HCQ sulphate and should actively monitor patients, have them undergo regular ophthalmological examinations and give appropriate treatment to prevent exacerbation of symptoms. [ABSTRACT FROM AUTHOR]

Melasma is a chronic hyperpigmentation skin disorder that is more common in the female gender. Although melasma is a multifactorial skin disorder, however, sun-exposure and genetic predisposition are considered as the main etiologic factors in melasma occurrence. Although numerous topical and systemic therapeutic agents and also non-pharmacologic procedural treatments have been considered in melasma management, however, the commonly available therapeutic options have several limitations including the lack of sufficient clinical effectiveness, risk of relapse, and high rate of unwanted adverse drug reactions. Recruitment of nanotechnology for topical drug delivery in melasma management can lead to enhanced skin penetration, targeted drug delivery to the site of action, longer deposition at the targeted area, and limit systemic absorption and therefore systemic availability and adverse drug reactions. In the current review, first of all, the etiology, pathophysiology, and severity classification of melasma have been considered. Then, various pharmacologic and procedural therapeutic options in melasma treatment have been discussed. Afterward, the usage of various types of nanoparticles for the purpose of topical drug delivery for melasma management was considered. In the end, numerous clinical studies and controlled clinical trials on the assessment of the effectiveness of these novel topical formulations in melasma management are summarized. [ABSTRACT FROM AUTHOR]

Background and Objective: The most frequently seen intra-oral soft tissue is the gingiva. Most often, it is seen as coral-pink tissue that surrounds the neck of the teeth. Gingiva that encircles the tooth necks and covers the alveolar processes of the jaws is an intra-oral tissue that exhibits biomimetic features. The wide range of colors of the gingiva depends on the configuration of gingival vascularity, the degree of epithelial cornification, level of melanogenesis, and the depth of epithelialization. However, the color of the gingiva varies depending on the degree of melanin pigmentation. The current study aimed to identify the different distribution patterns of gingival color and determine the correlation between skin color, gender, and geographical area of origin. Materials and methods: A total of 839 subjects were involved in the study where the gingival color and skin tone were measured using the Dummett-Gupta Oral pigmentation Index (DOPI) combined with VITA VMK MASTER and skin shade method developed by Revlon (USA) and L'Oreal (France) for makeup foundation shades. One investigator was calibrated for the examination of the colors after being tested for normal color vision and color aptitude using the line test. Results: A significant association was found between skin color and gingival pigmentation (χ2 value (6) = 114.48; P = 0.001). It was also found that females (67.1%) significantly had darker gingiva than males (58.3%). The study statistics display that location of the individual was also statistically associated with melanin pigmentation of the gingiva (χ2 value (57) = 559.33; P = 0.001). Conclusion: The study concluded that gender, skin color, and individual location are significantly associated with gingival melanin pigmentation. [ABSTRACT FROM AUTHOR]

Dowling-Degos disease (DDD) is an uncommon genodermatosis. The most closely associated disorder is Galli-Galli disease (GGD). Both conditions are considered on the same disease spectrum, with the differentiating factor being the presence of acantholysis in GGD. A 51-year-old female with a 21-year history of pruritic eruption in flexural areas progressing to the trunk and limbs presented to our dermatology consult. Physical examination revealed reddish-to-dark brown hyperkeratotic papules and reticulated confluent macules. Dermoscopy showed irregular star-shaped brown mottled areas and yellow-brown polygonal structures. Histopathology confirmed features consistent with GGD. Genetic screening identified a mutation in the POGLUT1 gene. Treatment with topical clobetasol propionate 0.05% and oral antihistamines decreased pruritus, but the skin eruption persisted. We present a rare case of GGD describing clinical, genetic, dermoscopy, and histopathological features. Clinicopathological correlation and good cooperation between dermatologists and histopathologists are essential to make the correct diagnosis of GGD. [ABSTRACT FROM AUTHOR]

The heightened awareness of ethnic dermatology aligns with the growing prevalence of skin of color communities globally, where hyperpigmentation disorders pose a common dermatological challenge. Effectively addressing dermal pigmentation is challenging due to its resistance to conventional therapies and its association with impaired quality of life. This underscores the need for effective treatments and a thorough grasp of laser advancements. A relevant literature search spanning the last 7 years across the PubMed database reveals core studies, challenges, and the evolution of laser technologies tailored for various forms of congenital and acquired dermal hyperpigmentation in skin of color. This comprehensive review explores the mechanisms, applications, and recommendations for pigmentary laser technologies, highlighting the key role of Q-switched lasers in their established millisecond/ nanosecond forms and emerging picosecond lasers, fractional non-ablative and ablative lasers, Intense Pulsed Light, etc. The summary of evidence includes studies on dermal melanocytosis (nevus of Ota and Hori's nevus), tattoos, acquired dermal macular hyperpigmentation, etc., and also entities with mixed epidermal–dermal components, such as melasma and post-inflammatory hyperpigmentation. The review offers valuable insights for clinicians to make informed decisions based on diagnosis, skin type, and the latest technologies to optimize results and minimize complications, especially in darker Fitzpatrick skin types. In their five-year study with 122 Indian patients, the authors applied specific laser combinations for diverse dermal melanoses, including tattoos, dermal/mixed melasma, acquired dermal macular hyperpigmentation, and dermal nevi. Substantial pigmentation reduction, subjectively assessed by both physicians and patients, was observed across all groups. A one-way ANOVA indicated a significant difference in mean improvement scores across various pigmentary conditions (F = 3.39, p = 0.02), with melasma patients exhibiting a significantly higher improvement score than tattoos (p = 0.03). The results affirmed the safety and efficacy of sequential laser therapy for dermal pigmentation in skin of color, advocating for flexibility in approach while maintaining the rationale behind the laser sequences. Despite advancements, challenges persist, and gaps in the current literature are identified. In conclusion, this summary highlights the ongoing pursuit of optimal protocols in dermatological laser treatments for dermal melanoses, offering valuable insights for future research and clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Facial pigmentation is a common presentation of patients attending dermatology out patient department (OPD) and is of great concern to patients. Facial pigmentation may be multifactorial and is only rarely diagnosed accurately by a detailed history and clinical examination. Pigmentary disorders cause psychological distress and negatively impact the quality of life of an individual. Aims and Objectives: (1) To study different dermoscopic patterns in facial melanosis. (2) To estimate the frequency of different dermoscopic patterns. Materials and Methods: Patients with facial hyperpigmentation attending the dermatology OPD were recruited after taking their written consent. A detailed history was taken to collect demographic data. Clinical examination and dermoscopy were done in all patients. Biopsy was done as and when required. Descriptive statistics has been used to describe the quantitative data. Qualitative data were presented as frequency and percentage for clinical and dermoscopic patterns. Results: The study included 100 patients with 15 different facial melanoses. The most common age group affected was 21-40 years in 53 (53%) cases. The female-to-male ratio was 1.63:1. Melasma was reported as the most common cause of facial melanosis constituting 49 (49%) of the total cases. Out of the total melasma cases, epidermal melasma constituted 22 (45%) cases, dermal melasma constituted four (4%) cases and mixed melasma constituted 23 (47%) cases. Other cases included were lichen planus pigmentosus (14; 14%), facial acanthosis nigricans (14; 14%), periorbital hyperpigmentation (7; 7%), post-inflammatory hyperpigmentation (4; 4%), exogenous ochronosis (2; 2%), lentigines (2; 2%), frictional melanosis (2;2%), and one case each of Becker's nevus, nevus of Ota, olanzapine-induced hyperpigmentation, Riehl's melanosis, macular amyloidosis, and tanning. Conclusions: Melasma was reported as the most common cause of facial melanosis. The most common dermoscopic feature was accentuated pseudopigment network. The study is beneficial in understanding the different clinical and dermoscopic patterns of facial melanosis, thus helping the physician to effectively manage the conditions and reduce the need of biopsy. Limitations: (1) A small sample size. (2) Histopathological correlation was not done in all cases. [ABSTRACT FROM AUTHOR]

Objectives: Cutaneous hyperpigmentation is one of the main adverse effects encountered in patients undergoing leprosy treatment with multidrug therapy (WHO‐MDT). This adverse effect has been described as intolerable and capable of contributing to social stigma. The objectives of this study were to quantify the variation in skin colour induced by clofazimine during and after treatment and to assess the related stigma. Methods: This observational cross‐sectional study objectively measured skin colour in 51 patients by reading the individual typology angle (ITA°) with a spectrophotometer, followed by the application of the Stigma Scale of the Explanatory Model Interview Catalogue (EMIC). Results: Skin hyperpigmentation was observed in 100% of the individuals. They showed more negative ITA° values in lesion areas than non‐lesion areas, particularly in sun‐exposed regions. Clofazimine‐induced cutaneous hyperpigmentation was not homogeneous and seemed to follow the lesion locations. The mean EMIC score was 18.8 points. Conclusion: All patients presented skin hyperpigmentation caused by clofazimine, detectable through spectrophotometry. Hyperpigmentation strongly impacted the social domain, indicating the intersectionality of disease and skin colour stigma, contributing to the social isolation of these patients. Health authorities should consider the negative impact of clofazimine on treatment adherence. [ABSTRACT FROM AUTHOR]

Melanins are biopolymeric pigments formed by a multi-step oxidation process of tyrosine in highly specialized cells called melanocytes. Melanin pigments are mainly found in the skin, iris, hair follicles, and inner ear. The photoprotective properties of melanin biopolymers have been linked to their perinuclear localization to protect DNA, but their ability to scavenge metal ions and antioxidant properties has also been noted. Interactions between drugs and melanins are of clinical relevance. The formation of drug–melanin complexes can affect both the efficacy of pharmacotherapy and the occurrence of adverse effects such as phototoxic reactions and discoloration. Because the amount and type of melanin synthesized in the body is subject to multifactorial regulation—determined by both internal factors such as genetic predisposition, inflammation, and hormonal balance and external factors such as contact with allergens or exposure to UV radiation—different effects on the melanogenesis process can be observed. These factors can directly influence skin pigmentation disorders, resulting in hypopigmentation or hyperpigmentation of a genetic or acquired nature. In this review, we will present information on melanocyte biology, melanogenesis, and the multifactorial influence of melanin on pharmacological parameters during pharmacotherapy. In addition, the types of skin color disorders, with special emphasis on the process of their development, symptoms, and methods of treatment, are presented in this article. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Postinffammatory hyperpigmentation (PIH) is a common sequela of acne vulgaris. Topical treatment with hydroquinone is the standard treatment, but may be associated with complications. Cysteamine is a relatively safe depigmenting agent with an observed depigmenting effect. We designed this study to assess the efficacy of a cysteamine 5% cream in treating acne-induced PIH. METHODS: Twenty-eight out of 32 participants finalized this investigator-blind, randomized, and controlled trial (registered in Iranian Registry of Clinical Trials [IRCTID: IRCT20140212016557N5]). We randomized the patients to apply either cysteamine 5% or hydroquinone 4%/ascorbic acid 3% (HC) cream. Postacne hyperpigmentation index (PAHPI) and melanin index were the assessment measures after four months of treatment. We evaluated the quality of life by the Dermatology Life Quality Index (DLQI) questionnaire. RESULTS: Both cysteamine and HC cream significantly decreased the PAHPI score and melanin index of acne-induced PIH patients (p<0.05). The decrease in PAHPI score and melanin index were not significantly different in treatment groups after four months (p>0.05). Quality of life ameliorated significantly only with cysteamine treatment. However, no significant change in quality of life was observed between groups. LIMITATIONS: Limitations of our study include the relatively small sample size and absence of follow-up. CONCLUSION: Cysteamine cream is an effective treatment of post-acne PIH, with similar efficacy to the accepted treatment of PIH, i.e., hydroquinone cream. [ABSTRACT FROM AUTHOR]

BACKGROUND: Acanthosis nigricans is a common hyperpigmentation disorder with a profound aesthetic impact. The primary concern of most patients is the cosmetic improvement, that is way there is a continuous search for the most effective cosmetic therapeutic option. METHODS: 40 acanthosis nigricans patients were included, lesions are split into equal halves; right side treated with TCA 15% peel and left side was treated with microneedling followed by TCA 15% peel, both sides were treated monthly for three months. Response to treatment was assessed by acanthosis nigricans grade improvement along with the percentage of improvement in texture and pigmentation individually. RESULTS: There was statistically signiffcant improvement in acanthosis nigricans grade after treatment in both sides. The combination side showed more improvement in terms of texture and pigmentation. CONCLUSION: Both TCA 15% alone or combined with microneedling were effective in improving acanthosis nigricans with superior results in combination modality. [ABSTRACT FROM AUTHOR]

A case of Cronkhite-Canada syndrome is reported・ A 68-year-old man presented with stomachache and diarrhea for 3 months・ The dermatological examination revealed diffuse hair thinning, especially on the frontal region, symmetrical distribution of brown pigmentation covered with green bean-sized maculopapules on the upper and lower lips, hands, and soles. Two-thirds of distal part of the toenails were missing, w让h rough and uneven dull surface ・ Pitted edema was observed on the upper eyelids and legs・ Laboratory examination showed anemia and hypoproteinemia ・ Electronic colonoscopy revealed multiple polyps in the colon. Diagnosis: Cronkhite-Canada syndrome・ Following high protein nutritional support and symptomatic treatment, anemia and hypoproteinemia were significantly improved・ The patient is still under follow-up. [ABSTRACT FROM AUTHOR]

A charming smile is determined not only by the alignment and the color of the teeth but also by the gingival health and appearance. The pigmentation of the gingiva is considered to be unaesthetic by many patients, and it may have a psychological impact on them. Pigmentation is contributed by-products of the physiological process and/or pathological diseases, and conditions. Melanin pigmentation results from melanin granules which are produced by melanocyte cells. Furthermore, environmental risk factors such as tobacco smoking contribute to the gingival hyperpigmentation in both active and passive form. Ethnicity and age also influence the color of gingiva and has no sexual predilection.Although a wide array of depigmentation methods are available to manage this condition, there is a shortage of literature which guides clinicians to select the most appropriate technique. Hence, the aim of this review is to emphasis on the advantages and disadvantages of the available depigmentation therapeutic modalities. [ABSTRACT FROM AUTHOR]

Topicals and chemical peels are the standard of care for management of facial hyperpigmentation. However, traditional therapies have come under recent scrutiny, such as topical hydroquinone (HQ) has some regulatory restrictions, and high concentration trichloroacetic acid (TCA) peel pose a risk in patients with skin of colour. The objective of our research was to identify, investigate and elucidate the mechanism of action of a novel TCA‐ and HQ‐free professional‐use chemical peel to manage common types of facial hyperpigmentation. Using computational modelling and in vitro assays on tyrosinase, we identified proprietary multi‐acid synergistic technology (MAST). After a single application on human skin explants, MAST peel was found to be more effective than a commercial HQ peel in inhibiting melanin (histochemical imaging and gene expression). All participants completed the case study (N = 9) without any adverse events. After administration of the MAST peel by a dermatologist, the scoring and VISIA photography reported improvements in hyperpigmentation, texture and erythema, which could be linked to underlying pathophysiological changes in skin after peeling, visualized by non‐invasive optical biopsy of face. Using reflectance confocal microscopy (VivaScope®) and multiphoton tomography (MPTflex™), we observed reduction in melanin, increase in metabolic activity of keratinocytes, and no signs of inflammatory cells after peeling. Subsequent swabbing of the cheek skin found no microbiota dysbiosis resulting from the chemical peel. The strong efficacy with minimum downtime and no adverse events could be linked to the synergistic action of the ingredients in the novel HQ‐ and TCA‐free professional peel technology. [ABSTRACT FROM AUTHOR]

Introduction: Linear and whorled nevoid hyper-melanosis (LWNH) is a rare, asymptomatic condition mainly affecting the Blaschka lines. Case report: We report the case of a 5-year-old female patient who presented with clinically ill-defined brown macules on the trunk and upper limbs. Wood lamp examination highlighted clearly demarcated lesions, while dermoscopy identified hyperpigmented areas arranged in a parallel manner. The diagnosis of LWNH was established, and the patient was reassured of the benign nature of the disease. Conclusions: LWNH is a benign skin condition that can be associated with systemic comorbidities. Future promising therapeutic options are much-needed additions to this complex disease approach. [ABSTRACT FROM AUTHOR]

Background: Facial hypermelanosis is a major cosmetic issue that causes severe social embarrassment and psychological pain, particularly among Asians and dark-skinned individuals. Aim: This study assesses the safety and effectiveness of Q-switched 1064/532 nm nanosecond/picosecond lasers in removing benign hypermelanosis in dark-skinned individuals, evaluating the possible associated side effects. Material and methods: A total of 30 participants (80% females and 20% males) with Fitzpatrick skin types IV–V–VI who presented superficial benign hypermelanoses on the facial and décolleté area were enrolled. All patients underwent to one to two laser treatment sessions with a 1064/532 nm Q-switched laser system. Three months after the final laser session, results were assessed by comparing before- and after-treatment photos and using a quartile scale for lesion clearance (4-point Investigator Global Assessment scale). Results: All patients observed global improvements in their pigmented lesions: 53% of patients achieved excellent clearance, 30% of patients achieved good to moderate clearance, 10% of patients achieved slight clearance, and 7% of patients did not respond to the therapy. No serious adverse event occurred. Photos showed the clinical improvement achieved at 3 months follow-up. Conclusions: The Q-switched 1064/532 nm laser proved to be a key tool for treating benign hypermelanosis in all skin types, including dark-skinned persons. [ABSTRACT FROM AUTHOR]

Melasma is a commonly occurring pigmented skin condition that can significantly affect one's appearance, described as symmetric hyperpigmentation that presents as irregular brown to gray-brown macules on various facial areas, such as the cheeks, forehead, nasal bridge, and upper lip, along with the mandible and upper arms. Due to its complex pathogenesis and recurrent nature, melasma management is challenging and the outcomes following treatment are not always deemed satisfactory. Solely treating hyperpigmentation may prove ineffective unless paired with regenerative techniques and photoprotection, since one of the main reasons for recurrence is sun exposure. Hence, the treatment protocol starts with addressing risk factors, implementing stringent UV protection, and then treatment using different strategies, like applying topical treatments, employing chemical peels, laser and light therapies, microneedling, and systemic therapy. This review aims to provide a summary of the effectiveness and safety of the frequently employed laser and light therapies for treating melasma, focusing on laser therapy as a treatment for melasma. [ABSTRACT FROM AUTHOR]

Galli–Galli disease (GGD) is a rare genodermatosis that exhibits autosomal dominant inheritance with variable penetrance. GGD typically manifests with erythematous macules, papules, and reticulate hyperpigmentation in flexural areas. A distinct atypical variant exists, which features brown macules predominantly on the trunk, lower limbs, and extremities, with a notable absence of the hallmark reticulated hyperpigmentation in flexural areas. This review includes a detailed literature search and examines cases since GGD's first description in 1982. It aims to synthesize the current knowledge on GGD, covering its etiology, clinical presentation, histopathology, diagnosis, and treatment. A significant aspect of this review is the exploration of the genetic, histopathological, and clinical parallels between GGD and Dowling-Degos disease (DDD), which is another rare autosomal dominant genodermatosis, particularly focusing on their shared mutations in the KRT5 and POGLUT1 genes. This supports the hypothesis that GGD and DDD may be different phenotypic expressions of the same pathological condition, although they have traditionally been recognized as separate entities, with suprabasal acantholysis being a distinctive feature of GGD. Lastly, this review discusses the existing treatment approaches, underscoring the absence of established guidelines and the limited effectiveness of various treatments. [ABSTRACT FROM AUTHOR]

Background Pigmented contact dermatitis (PCD) is a noneczematous form of allergic contact dermatitis characterized by dermal hyperpigmentation. Allergen avoidance is the cornerstone of therapy, but it is difficult to achieve. The use of immunosuppressives seems rational, but data are lacking. Objectives To compare outcomes with azathioprine (AZA), leflunomide and allergen avoidance (AA) in patients with PCD. Methods A comparative study was conducted on 28 patients with patch test-positive PCD who were randomly allocated to one of three treatment groups: AZA 2 mg kg–1 daily for 24 weeks + AA (n = 10); leflunomide (LEF) 20 mg daily for 24 weeks + -AA (n = 8); AA alone (n = 10). Patients were followed up for an additional 24 weeks. The Dermal Pigmentation Area and Severity Index (DPASI) score and Hindi Melasma Quality of Life scale (MELASQOL) were used to assess hyperpigmentation and quality of life (QoL). respectively. Results Hair colorants (n = 12) and paraphenylenediamine (n = 8) were the most common allergens. Mean (SD) DPASI score decreased from 30.97 (3.69), 32.35 (3.90) and 31.86 (3.47) to 13.78 (4.25), 21.67 (2.99) and 20.64 (3.82) at 48 weeks in the three groups, respectively (P < 0.001); the maximum percentage decline was seen with AZA (56%). Mean (SD) MELASQOL score was reduced in the three treatment groups from 48.0 (6.46), 46.75 (3.69) and 46.6 (4.65) to 19.6 (6.98), 24.5 (5.80) and 24.0 (5.49), respectively, at 48 weeks (P < 0.001). Reductions in DPASI and Hindi MELASQOL scores were significantly correlated. The most frequent adverse event was transaminitis in both the AZA and LEF groups. Conclusions Patients on AZA achieved a statistically significantly greater reduction in DPASI and MELASQOL score; therefore, AZA may fulfil an unmet need in PCD treatment. An objective reduction in hyperpigmentation was paralleled by an improvement in QoL score, reiterating the need for active management of this disease. [ABSTRACT FROM AUTHOR]

Incontinentia pigmenti (IP) is a rare genetic disorder characterized by skin lesions along the lines of Blaschko. Most patients with IP have a genetic deletion in the IKBKG gene, which is located on the X chromosome. Males with this deletion typically do not survive, while females can display a range of symptoms depending on X-inactivation. This study describes a duplication variant in the IKBKG gene found in two families with IP, resulting in different phenotypes in males and females. The findings suggest that mosaicism, or the presence of different genetic variations in different cells, can contribute to the expression of IKBKG-related disorders in males. [Extracted from the article]

Introduction • Ageing is a natural process of life. With increasing age, the skin suffers progressive morphological and physiological decrement. Hyperpigmentation, Wrinkles, and roughness of skin are some of the symptoms of aged skin. Exposure to sunlight, pollution, stress, nicotine, etc aggravates Skin aging. This study aimed to determine the efficacy and safety of polyherbal formulation and compare its efficacy with the standard drug tretinoin in subjects of moderate to advanced Photoaged facial skin. Ingredients of polyherbal formulation are Aarade baqla (Vicia faba), Jau (Hordeum vulgare), Nakhud (Cicer arietinum),Masoor (Lens esculenta), Tukhm e turb (Raphanus sativus), Khardal (Brassica nigra), Haldi (Curcuma longa), Kateera (Cochlospermum religiosum). Methods • This was a randomized open-label standard controlled study. 82 eligible subjects were allocated equally into test and control groups by computer-generated random numbers. In the test group, a paste of 15 gm polyherbal formulation in milk, and the control group, 0.025% Tretinoin 1 gram was used topically on the face once a day for two months. The response was assessed by the clinician using following different scales for different parameters. Assessment of Skin hyperpigmentation • It was assessed by the Skin Hyperpigmentation Index online calculator (SHI). It describes the ratio of two scores, namely the hyperpigmented skin of the affected area and normal sun protected skin from the same patient. The image was recorded with a Digital microscope-Win7 from a hyperpigmented area and normal sun-protected area. Both the images were uploaded on https://shi.skinimageanalysis.com/ and calculated the mean value of hyperpigmentation. SHI ranges from 1 (no hyperpigmentation) to 4 (maximum hyperpigmentation) where scores between 1 and 2 showed as light hyperpigmentation, 2–3 as medium hyperpigmentation, and scores between 3 and 4 as severe hyperpigmentation. Assessment of Fine wrinkles • Fine wrinkles number was determined by digital photography. The photographs were taken through Canon EOS 1500D DSLR Camera with an 18-55 mm Lens. Three images were taken of each subject’s face (right, left, and center full face) on Baseline and Day 15th, 30th, 45th, and 60th to assess visible changes/improvement in their fine wrinkles score. Assessment of Nasolabial Fold • Modified Fitzpatrick Wrinkle Scale (MFWS) was used to assess Nasolabial folds. The scale comprised four main classes of Nasolabial wrinkling: 0, 1, 2, and 3 representing absent, fine, moderate, and deep wrinkles, respectively, and three inter classes i.e., 0.5, 1.5, and 2.5 to estimate wrinkle depth. The definitions of the entire classes of the scale are as follows: Class 0 = No wrinkle. No visible wrinkle; continuous skin line; Class 0.5 = Very shallow yet visible wrinkle; Class 1= Fine wrinkle. Visible wrinkle and slight indentation; Class 1.5= Visible wrinkle and clear indentation. <1-mm wrinkle depth; Class 2= Moderate wrinkle. Visible wrinkle, 1- to 2-mm wrinkle depth; Class 2.5= Prominent and visible wrinkle. More than 2-mm and less than 3-mm wrinkle depth; Class 3=Deep wrinkle. Deep and furrow wrinkle; more than 3-mm wrinkle depth. Assessment of Forehead lines score • Forehead lines were assessed (number and depth) by a Validated Grading Scale for Forehead Lines. The Forehead Lines Grading Scale is a 5- point photonumeric rating scale that was developed to objectively quantify resting (static) and hyperkinetic (dynamic) forehead lines. The scale ratings are 0 for no wrinkles, 1 for no wrinkles present at rest but fine lines with facial expression, 2 for fine wrinkles present at rest and deep lines with facial expression, 3 for fine wrinkles present at rest and deeper lines with facial expression, and 4 for deeper wrinkles at rest and deeper furrows with facial expression. Assessment of lateral canthal lines • The number of lateral canthal lines was determined by a Validated Grading Scale for Crow’s Feet. The Crow’s Feet Grading Scale is a 5- point photonumeric rating scale developed to objectively quantify the severity of crow’s feet. This scale was applied to two separate evaluations of crow’s feet: at rest (static) and with expression (dynamic). The scale ratings are 0 for no wrinkles, 1 for very fine wrinkles, 2 for fine wrinkles, 3 for moderate wrinkles, and 4 for severe wrinkles. Assessment of Facial Skin Roughness • The Allergan Skin Roughness Scale was used for facial skin roughness assessment. The area of assessment for the Allergan Skin roughness Scale is the area between the nasolabial fold to the preauricular cheek and from the inferior orbital rim to the mandible. The Allergan Skin Roughness Scale assigns a grade from none (0) to extreme (4) that describes the severity of skin coarseness, crosshatching, and elastosis in the midface area. The scale grading are 0 (None) Smooth visual skin texture, 1 (Minimal) Slightly coarse and uneven visual skin texture, 2 (Moderate) Moderately coarse and uneven visual skin texture; may have early elastosis, 3 (Severe) Severely coarse visual skin texture, cross-hatched fine lines; may have some elastosis, and 4 (Extreme) Extremely coarse visual skin texture, cross Hatched deep creases; extreme elastosis. Assessment of Facial Dullness • Dullness was assessed on a clinical basis with an arbitrary scoring ranging from 0 to 9 where 0-3=mild, 3.5-6=moderate, and 6.5-9=severe facial skin dullness. Assessment of quality of life • Subjects’ life quality was assessed by the Dermatology Life Quality Index questionnaire. It consists of 10 questions. Each question is scored on a four-point Likert scale: Very much = 3, A lot = 2, A little = 1, Not at all = 0, Not relevant = 0 and Question unanswered = 0. The DLQI is calculated by adding the score of each question, resulting in a maximum of 30 and a minimum of 0. Where, 0-1= no effect at all on patient’s life, 2-5 = small effect on patient’s life, 6-10 = moderate effect on patient’s life, 11-20 = very large effect on patient’s life, 21-30 = extremely large effect on patient’s life. Results • Both groups showed a significant improvement in Fine Wrinkles, Forehead Lines, Crow’s Feet, Roughness, Dullness, Nasolabial Fold, Hyperpigmentation, and Quality of Life parameters. (P < .001) A large number of subjects in the control group reported mild to moderate redness, itching, dryness, and blackening of the skin, while in the test group, absolutely no side effects were reported during treatment. Conclusion • The effects in both groups were substantial, but the polyherbal formulation is safe and effective for use in photoaged facial skin. It may be a more feasible easily accessible cheap and safe formulation to prevent skin aging and restore skin elasticity and make skin brighter. Further studies to evaluate the efficacy of formulation on objective parameters using standard instruments should be done for appropriate measurements of parameters. [ABSTRACT FROM AUTHOR]

This study investigates the encapsulation of bakuchiol, a renowned compound for hyperpigmentation treatment, utilizing transfersomes as a delivery system. The transfersomes were fabricated using the thin-film hydration technique and subjected to thorough characterization across various parameters. The resulting transfersome formulation, after optimization, demonstrated notably high encapsulation efficiencies, with bakuchiol registering at 86.7±3.6%, accompanied by a narrow particle size distribution (179.9 ± 5.4 nm). In vitro release studies unveiled cumulative release percentages of 71.98±6.52% for bakuchiol over a 24-hour period. Ex vivo permeation studies further affirmed heightened retention of bakuchiol within the skin layers compared to control group. Stability assessments indicated that the optimized transfersome remained stable at 5°C for at least 90 days. These findings underscore the remarkable potential of transfersomes in facilitating the delivery of bakuchiol, offering a compelling and viable alternative for hyperpigmentation formulations. [ABSTRACT FROM AUTHOR]

BACKGROUND: Congenital adrenal hyperplasia is an autosomal recessive disorder caused by a defect in adrenal steroidogenesis. The non-classical variant begins at puberty and is manifested by menstrual irregularities, hirsutism, genital hyperpigmentation, clitoral hypertrophy, accelerated growth, and elevated levels of testosterone and other androgens. Individuals with these non-classical forms of the disease are born with normal-appearing genitalia and begin clinical manifestations with the steroidogenic stimulus characteristic of adolescence. CLINICAL CASE: A 16-year-old female patient seen at the endocrinology clinic for menstrual irregularities and hirsutism, menarche at 13 years of age with menstrual irregularities (oligomenorrhea) and recession of the frontal hairline, breast and pubic hair development grade 4 on the Tanner scale for both features. The diagnosis of late-onset 21-hydroxylase blockade (non-classical form) was established. Initial treatment consisted of metformin and cyproterone, with marked relieve of hyperandrogenism and correction of menstrual irregularities. CONCLUSIONS: Late-onset non-classical congenital adrenal hyperplasia is due to a homozygous point mutation of the CYP21A2 gene, which in turn is due to a coding error at position 281 of the 21-hydroxylase protein, consisting of a substitution of the amino acid valine for leucine and resulting in complete inactivation of both alleles of the enzyme. [ABSTRACT FROM AUTHOR]

Post‐inflammatory hyperpigmentation is a common consequence of inflammatory dermatoses. It is more common in patients with darker skin and has significant morbidity. This systematic review summarizes treatment outcomes for post‐inflammatory hyperpigmentation to help physicians better predict clinical response and improve patient outcomes. Embase, MEDLINE, PubMed databases and clinicaltrials.gov were searched in accordance with PRISMA guidelines using a combination of relevant search terms. Title, abstract and full text screening were done in duplicate. Studies were included if they met our predetermined PICOS framework criteria. Results are presented in descriptive form. In total, 41 studies representing 877 patients were included. Complete response was achieved by laser and energy‐based devices in 18.1% (n = 56/309) of patients, topicals in 5.4% (n = 20/369) and combination therapies in 2.4% (n = 4/166). Partial response was achieved by combination modalities in 84.9% (n = 141/166) of patients, topicals in 72.4% (n = 267/369), laser and energy‐based devices in 61.2% (n = 189/309) and peels in 33.3% (n = 5/15). Poor to no response occurred with peels in 66.7% (n = 10/15) of patients, topicals in 22.2% (n = 82/369), laser and energy‐based devices in 18.1% (n = 56/309) and combination modalities in 12.7% (n = 21/166). Additionally, in 2.6% (n = 8/309) of patients treated with laser and energy‐based devices, post‐inflammatory hyperpigmentation worsened. Adverse events were reported in 10 patients, all while using topical treatments. In conclusion, the current treatment approaches yielded unsatisfactory rates of complete response. However, combination therapies, laser and energy‐based devices and topical therapies showed high rates of partial response. Of note, the majority of post‐inflammatory hyperpigmentation cases included were associated with acne, and therefore, the findings and conclusions drawn may have limited applicability to other types of post‐inflammatory hyperpigmentation. [ABSTRACT FROM AUTHOR]

Introduction: Dark under‐eye circles or periorbital hyperpigmentation constitute a prevalent and challenging cosmetic problem with diverse etiologies and types. While modifying exacerbating habits can provide partial relief for the pigmentary and vascular factors associated with this condition, and despite the abundance of available treatment options, there is currently a lack of gold‐standard evidence‐based treatments proposed for curing this disorder. Objectives: This study aimed to assess the safety and effectiveness of carboxytherapy in treating periorbital hyperpigmentation. Material and Methods: In this 4‐week single‐arm clinical trial, 20 eligible Iranian patients with symmetric periorbital hyperpigmentation received weekly intradermal carboxytherapy. The treatment involved administering 10–20 mL of CO2 at a rate of 20 mL/min and a temperature of 15°C for a duration ranging from a few seconds to 1 min. Follow‐up assessments were conducted 1 month after the final session. The primary outcome was defined as the changes in ΔE or the variations in pigmentation observed between the orbital and extra‐orbital skin before and after the trial. Results: The patients reported satisfaction with the statistically significant reduction in hyperpigmentation achieved through carboxytherapy in the lateral (p = 0.002), middle (p = 0.001), and medial (p = 0.001) regions of the periorbital area. The total response rate of the patients was estimated at 20%. Patient satisfaction exceeded ΔE changes, with no significant linear relationship (p = 0.084). Conclusion: Carboxytherapy can be proposed as an effective and safe treatment for periorbital hyperpigmentation. [ABSTRACT FROM AUTHOR]

Background: Gingival hyperpigmentation, characterized by excessive melanin deposition in the gingival tissues, is a common esthetic concern affecting individuals worldwide. Various treatment modalities have been employed to address this condition, including surgical techniques using scalpels and lasers. However, comparative studies evaluating patient responses and recurrence rates following gingival depigmentation using these techniques are limited. Objective: This clinical study aimed to assess patient responses and recurrence rates following gingival depigmentation procedures using laser and scalpel techniques. Methods: A total of 100 patients with gingival hyperpigmentation were randomly assigned to either the laser or scalpel group. Clinical evaluations were performed pre-operatively and post-operatively to assess pigmentation severity, post-operative pain, discomfort, healing time, and recurrence rates. Statistical analysis was conducted to compare outcomes between the two groups. Results: Both laser and scalpel techniques effectively reduced gingival pigmentation, with comparable pre-operative pigmentation severity scores. However, the laser group exhibited significantly lower post-operative pain and discomfort scores compared to the scalpel group. Additionally, the laser group had a shorter mean healing time and lower recurrence rate compared to the scalpel group. Conclusion: Laser gingival depigmentation offers advantages over traditional scalpel techniques in terms of patient comfort, healing time, and long-term outcomes. These findings support the use of laser therapy as a preferred option for gingival depigmentation procedures, with the potential to enhance patient satisfaction and quality of life. Further research is warranted to optimize laser parameters and validate these findings in larger cohorts and longer follow-up periods. [ABSTRACT FROM AUTHOR]

Background: Hori's nevus is a common and challenging dermatological condition, often complicated by post‐inflammatory hyperpigmentation following treatment. Platelet‐rich plasma (PRP) has demonstrated efficacy in the treatment of hyperpigmentation disorders such as melasma and periorbital darkening. Given the benefits and minimally invasive nature of PRP treatments, exploring its application in managing Hori's nevus through further investigation is worthwhile. Aims: To evaluate the safety and effectiveness of intradermal PRP therapy for the treatment of Hori's nevus. Methods: Ten female patients received bilateral intradermal PRP injections every 2 weeks for a total of four treatments. The modified dermal pigmentation and severity index (mDPASI), mean melanin index (MI), brightening score, patient self‐assessment, and clinical photographs were evaluated at 2, 4, 8, and 12 weeks post‐treatment. Adverse events were also recorded to determine treatment safety. Results: At 12 weeks post‐treatment, mDPASI decreased 38.86%, from 0.929 ± 0.617 to 0.568 ± 0.415 (p < 0.05). The mean melanin index decreased 12.75%, from 208.650 ± 26.319 to 182.052 ± 17.028 (p < 0.05). In addition, the mean brightness score evaluated by two experts was 1.4, indicating 25–50% improvement. At the end of the study, 50% of the patients reported 50–75% improvement. Side effects included pain, mild edema, and bruising, which resolved spontaneously within 3 days. No serious side effects were found. Conclusion: Our results suggest that intradermal PRP therapy may be a safe and effective alternative for the treatment of Hori's nevus and can complement conventional interventions. However, further research with a larger sample size, control groups, and longer follow‐up is needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Introduction: Infraorbital hyperpigmentation represents one of the most prevalent conditions in cosmetic dermatology. To treat this condition, many patients prefer natural remedies. This study explored the efficacy of topical castor oil cream in treating patients with infraorbital hyperpigmentation. Methods: We conducted an exploratory single‐arm clinical trial at the Shahid Faghihi Dermatology Clinic and Molecular Dermatology Research Center of Shiraz University of Medical Sciences, Shiraz, Iran, during 2021–2022. Using the convenience sampling method, we enrolled 25 patients with infraorbital hyperpigmentation. We instructed the patients to apply topical castor oil cream twice daily for 2 months. The darkness, melanin, and erythema levels were evaluated by VisioFace® 1000 D and SkinColorCatch® devices. We used a visual analog scale to assess skin laxity, wrinkles, and patient satisfaction. Data analysis was done with Stata version 14.2. Results: The data of 22 patients with a mean age of 40.92 ± 7.33 years were analyzed. The VisioFace® scores decreased significantly by the end of the study [right eyes: mean difference (MD): ‐5.63 (95% CI: −7.12 to −4.15), p < 0.001; left eyes: MD: ‐5.91 (95% CI: −7.46 to −4.36), p < 0.001]. Moreover, castor oil cream significantly reduced the melanin level, wrinkles, and skin laxity in the infraorbital region (p < 0.05). Conclusions: Castor oil cream seems to be an effective alternative for treating infraorbital hyperpigmentation. Randomized clinical trials are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

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Background: This study aimed to evaluate the use of fat grafting enriched with platelet-rich plasma through a computerized-assisted mapping for esthetic restoration in progressive hemifacial atrophy (Parry-Romberg disease). Methods: This prospective study was conducted on 53 patients presented by Parry-Romberg disease and was corrected by facial fat grafting (FFG) enriched with platelet-rich plasma (PRP). A computerized software program was used to design a detailed map to achieve clinical symmetry with fat grafting application, as the anatomical subunits direct 3-dimensional volumetric symmetric, and compartments direct isolated recipient-specific grafting. Also, volumetric asymmetry was assessed through outlines of facial contour, projection, and proportions for both sides and comparing the mirror image of unaffected side as a template. Results: Objective ultrasound and photogrammetric measurements showed a significant improvement in facial symmetry postoperatively compared to preoperative (P < 0.05), with no significant differences between 12 and 18 months after surgery. The FACE-Q score regarding comparison before surgery and 18 months after surgery showed a statistically significant improvement in all modules (P < 0.001) with overall satisfaction concerning outcome of 82.7 ± 0.8. Conclusion: Enriched fat grafting with platelet-rich plasma (PRP) is a good alternative to reconstruct soft tissue defects for patients with progressive hemifacial atrophy (Parry-Romberg disease) with a minimally invasive approach and low complications. It provides volumetric replacement, enhancement of skin texture, and improvement of hyperpigmentation with restoration of facial contour for an esthetic pleasing appearance. Isolated replacement in accordance with the anatomical facial subunits and fat compartments allows three-dimensional reconstruction and maximizes fat retention. [ABSTRACT FROM AUTHOR]

The total melanin synthesis in the skin depends on various melanogenic factors, including the number of viable melanocytes, the level of melanogenic enzymes per cell, and the reaction rate of the enzymes. The purpose of this study is to examine the effects of L-cysteine (L-Cys), L-ascorbic acid (L-AA), and their derivatives on the tyrosinase (TYR) activity and autoxidation of L-3,4-dihydroxyphenylalanine (L-DOPA) in vitro and the viability and melanin synthesis of B16/F10 cells under different conditions. L-Cysteinamide (C-NH2), glutathione (GSH), L-Cys, L-AA, and N-acetyl L-cysteine (NAC) inhibited the catalytic activity of TYR in vitro. L-AA, C-NH2, L-ascorbic acid 2-O-glucoside (AAG), and 3-O-ethyl L-ascorbic acid (EAA) inhibited the autoxidation of L-DOPA in vitro. L-DOPA exhibited cytotoxicity at 0.1 mM and higher concentrations, whereas L-tyrosine (L-Tyr) did not affect cell viability up to 3 mM. L-AA, magnesium L-ascorbyl 2-phosphate (MAP), and L-Cys attenuated the cell death induced by L-DOPA. C-NH2 decreased the intracellular melanin level at the basal state, whereas L-AA, MAP, and AAG conversely increased it. C-NH2 reduced the number of darkly pigmented cells via in situ L-DOPA staining, whereas L-AA, MAP, GSH, and AAG increased it. C-NH2 decreased the intracellular melanin level at the alpha-melanocyte-stimulating hormone (α-MSH)-stimulated state, while NAC and GSH increased it. L-AA and C-NH2 decreased the intracellular melanin level at the L-Tyr-stimulated state, but NAC and GSH increased it. L-Ascorbyl tetraisopalmitate (ATI) showed no or minor effects in most experiments. This study suggests that L-AA can either promote or inhibit the different melanogenic factors, and C-NH2 can inhibit the multiple melanogenic factors consistently. This study highlights the multifaceted properties of L-Cys, L-AA, and their derivatives that can direct their therapeutic applications in hyperpigmentation, hypopigmentation, or both disorders. [ABSTRACT FROM AUTHOR]

Background: The most common cause of facial melanoses is melasma. There is no universally efficacious melasma therapy and the gold standard therapy (triple combination cream) has multiple long term adverse effects. Topical glutathione is a relatively novel drug acting on key melasma pathology features. Objectives: This is first study to compare efficacy, safety and quality of life (QoL) impact of topical glutathione (2%) with topical tranexamic acid (TA) (3%) in adult melasma patients. Design: Randomized, prospective, parallel and open label. Methods: This study compared topical glutathione (2%) (Group A, n = 30) with topical TA (3%) (Group B, n = 30) in 60 adult melasma patients for 3 months. Evaluation of efficacy was done through Modified Melasma Area Severity Index (mMASI score) & Physician Global Assessment (PGA) score on 30, 60 and 90 days. QoL was assessed through Melasma Quality of Life score (MELASQOL) and photographs were taken at 0 &90 days. Adverse effects were reported every 30 days. Results: Both groups exhibited improvement in mMASI & PGA score at 30 days, but statistically significant improvement (p 0.05) with no serious adverse effects. Conclusion: Topical glutathione showed better efficacy, QoL improvement and comparable safety to topical TA over 3 months in melasma.

Introduction: Confluent and reticulated papillomatosis is a rare dermatological disorder of the epidermis, with a benign course and uncertain etiopathogenesis, characterized by the slow and progressive appearance of brownish or pink papules with a peripheral reticulate pattern, preferentially located at the center of the trunk, armpits and neck. It affects all races, genders and age groups, with a predilection for adolescents and young adults with higher phototypes. Case report: Two years ago, a 14-year-old male patient presented the appearance of speckled papules, with a rough surface, brownish, confluent, periaxillary, and a peripheral reticulate pattern. There was no response to treatment with the use of urea cream, topical antifungal agents and rubbing alcohol on the lesions. Direct mycological examination was negative. Fasting blood glucose, glycosylated hemoglobin, fasting insulin, and HOMA insulin resistance index were normal. The histopathological examination showed hyperkeratosis, papillomatosis, thinning of the granulosa and focal interpapillary acanthosis, confirming the clinical diagnosis of Confluent and Reticulated Papillomatosis. Treatment with 100 mg/day doxycycline associated with 0.1% adapalene at night for 60 days was established, with excellent improvement of the condition. Conclusion: Confluent and reticulated papillomatosis is a rare dermatosis with a benign course that must be recognized early in order to avoid misdiagnosis and inaccurate therapy, in addition to high costs for patients.

Hyperpigmentation (HP) is an unfavorable skin disease that typically caused by injury, inflammation, or photoaging and leads to numerous physical and psychological issues in patients. Recently, development and application of natural whitening substances, particularly compound curcumin (CUR), is one of the most prevalent treatments for HP. However, it is still a formidable challenge to improve the percutaneous delivery of CUR due to its inadequate solubility in water and excellent barrier function of skin. To overcome the limitations of conventional delivery and increase the percutaneous absorption of CUR, the efficient delivery of CUR is urgently required. Herein, we developed a new malic acid-sorbitol deep eutectic solvent (MS/DES) gel microneedle loaded with CUR as a transdermal delivery system for HP treatment. The MS/DES gel produces three-dimensional (3D) network structure by self-assembly of hydrogen bond interactions, which conferred the CUR-MS/DES-GMN with sufficient mechanical properties to successfully penetrate skin tissue while also helping to enhance the drug's release rate. The CUR-MS/DES-GMN exhibit high biocompatibility and mechanical property in vivo of mice. The zebrafish experiments also show that CUR-MS/DES gel has significant effect of anti-pigmentation. Therefore, the designed CUR-MS/DES-GMN system provides a novel strategy for HP treatment based on self-assembly of naturally molecules.

H syndrome is a very rare auto inflammatory syndrome which is characterized by a constellation of symptoms mostly beginning with the letter H. Hypertrichosis, Hyperpigmentation, Hyperlipidemia, Hyperglycemia, Hypogonadism, Hepatomegaly, Hearing loss, Heart anomalies and short Height.Here we report a 14 years old boy with the diagnosis of H syndrome who was being treated for diabetes since he was 2 years old.

Objectives: Vitamin C (ascorbic acid) is widely used in dermatology for skin depigmentation. However, there are very few clinical studies on the efficacy of vitamin C in gingival depigmentation. This preliminary case series aims to present the clinical effectiveness, histologic changes, and patient-reported outcomes of intraepidermal vitamin C injections (oral mesotherapy) for managing patients with gingival melanin hyperpigmentation. Method and materials: Five patients were administered locally injectable vitamin C (once per week for 4 to 5 visits) in maxillary or mandibular anterior pigmented gingiva. The depigmentation effect was evaluated using the Dummett Oral Pigmentation Index (DOPI) and Gingival Pigmentation Index (GPI). Digital photographs were used to assess gingival luminescence (L*) and pigmented surface area (PSA). Parameters were recorded at baseline and at 1 and 3 months. Melanocyte histopathologic count was determined at baseline and at 3 months. Pain, gingival color change, and patient satisfaction scores were also assessed. Results: Median GPI, DOPI, and PSA were significantly reduced (P ≤ .05) from baseline to 1 month. There was no statistically significant change from 1 month to 3 months. L* value significantly increased from baseline to 3 months. A median pain score of 3 (scale of 0 to 10) was observed on the day of the procedure. A score of 3 (scale of 0 to 4) was reported for the gingival color and scores 3 and 4 (scale of 0 to 4) for the overall patient satisfaction. Conclusion: Oral mesotherapy using locally injectable vitamin C is a nonsurgical, minimally invasive, and efficient technique for gingival depigmentation. Indian patients were satisfied with the gingival color obtained and the overall treatment experience. Clinical importance: As all the branches of medicine, specifically dentistry, direct to minimally invasive approaches, mesotherapy shows great importance to reduce the surgical interventions, especially when esthetic outcomes are needed. Oral mesotherapy using locally injectable vitamin C can be a useful nonsurgical technique for achieving gingival depigmentation in the esthetic zone. [ABSTRACT FROM AUTHOR]

BackgroundKey cellular players regulating human skin pigmentation include melanocytes in the epidermis that synthesize melanin, neighboring keratinocytes that receive and distribute melanin in the upper layers, and fibroblasts in the dermis that affect overlying melanocytes and keratinocytes. In addition, endocrine factors from the blood supply (endothelial cells) and inflammation-related factors play a role. Thus, new strategies for affecting pigmentation need to consider these multiple cell lines to adequately cover various causes and disease processes associated with hyperpigmentation.MethodsPathophysiologic mechanisms and cellular pathways involved in melanogenesis were thoroughly reviewed with particular emphasis on the cellular interplay involved in the process. A complex system of interlinking and independent pathways was defined and described demonstrating differing pathways for altered pigmentary disorders - melasma associated with endothelial cell interactions; post inflammatory hyperpigmentation associated with keratinocyte inflammatory mediators (PGE2 in particular); and photodamage involving all 4 cell types. In vitro validation studies were then undertaken to define differing cell group gene expression profiles with selected peptides and other active agents. Melanocytic production of pigment was then tested with these agents to identify key potential players capable of limiting pigmentation.ResultsHexapeptide-12 and lactoferrin (melanocytes), Hexapeptide-11 (in keratinocytes), and phosphatidylserine (endothelial cells) were identified as major inhibitors of melanogenesis based on their gene expression profiles. This was confirmed by secondary melanin production tests performed on melanocytic lines. Additional active agents were also identified as inhibitors of melanocytic production of melanin, and together, these constituents formed the basis for a novel formulation for use in pigmentary disorders.ConclusionA comprehensive scientific narrative of the various facets relating to pigmentation has been presented including differing pathways affecting varied cell lines that effect pigment production. Based on this concept, actives were tested using gene expression studies as well as in vitro melanogenic model testing in different cell lines. Using this novel multi-faceted approach, we have selected and validated a series of active agents to be used in a formulation targeting the complex problem of hyperpigmentation. J Drugs Dermatol. 2022;21(11):1206-1220. doi:10.36849/JDD.7013.

This case report explores a rare manifestation of Becker’s nevus, where the patient exhibited an unusual dermatomal distribution featuring a hyperpigmented, irregular patch with associated hypertrichosis on the T4 segment. While Becker’s nevus is a well-known dermatological condition typically observed in the upper back region, instances of dermatomal distribution are exceptionally uncommon. This case presents a unique occurrence of segmental Becker’s nevus, highlighting the atypical presentation of this condition.

Addison's disease, also known as primary adrenal insufficiency (PAI), is a rare endocrine disorder characterized by a decrease in all three adrenal hormones. This case report describes a 32-year-old female who presented with generalized weakness, fatigue, weight loss, and hyperpigmentation. Based on her symptoms and laboratory findings, a diagnosis of Addison's disease was made. She was started on hormone replacement therapy, and her symptoms improved significantly.