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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]

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]

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]

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]

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]

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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]

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.

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.

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.

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.

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.

Background Glutathione is an antioxidant agent used in the treatment of melasma. However, niosome is a drug delivery enhancer used in other skin diseases to increase the absorption of any active ingredient. Objective To assess the efficacy of niosome with topical glutathione gel 2% in the treatment of melasma versus topical glutathione gel 2% alone. Patients and methods In this comparative study, 19 patients complaining of melasma were divided into two groups. Group 1 was treated with glutathione gel 2% only, while group 2 was treated with glutathione gel 2% encapsulated in niosome. The split face method was used where right side of face for treatment and left side for placebo. Patients were photographed and examined clinically by Wood’s light and dermoscopy. All patients were evaluated clinically using a modified Hemi-Melasma Area and Severity Index (HEMI-MASI) score with the calculation of the reduction percentage and grading of the improvement. Moreover, histopathological examination was done before and after treatment. Results In Glutathione treated right side, hemi-MASI score after treatment was decreased with no significant difference when compared with base line; while in Glutathione gel with niosome treated right side; hemi-MASI score was significantly decreased. There was a high significant difference in reduction percentage of hemi-MASI score of both right sides of face of the two groups. No side effects were reported by patients of both groups. After treatment, both H and E and FM sections showed a decrease in basal hyperpigmentation in the case of epidermal melasma and a decrease in dermal melanophages in mixed melasma in both groups. Conclusion Topical glutathione gel alone without niosome is a weak melasma treatment. Niosome enhances glutathione gel absorption and efficacy without any side effects.

Laugier–Hunziker syndrome (LHS) is a rare, benign pigmentary disorder characterized by unique pigmentation over mucosa, nails, and acral sites, arising spontaneously during adulthood. It has no malignant potential or systemic involvement. It has a female preponderance (2:1 ratio). The pigmentary lesions in LHS respond poorly to therapy, and has high recurrence. Since LHS is a diagnosis based on exclusion, we discuss the differential diagnosis of mucocutaneous hyperpigmentation. We present a case of a 66-year-old man with LHS.

Abstract Background The nucleoside transport capabilities of the human equilibrative nucleoside transporter-3 (hENT3) are disrupted by mutations in SLC29A3 (10q22.2), which are genes for the nucleoside transporter and are the cause of the unusual autosomal recessive disease known as H syndrome. As a result, histiocytic cells invade a number of organs. Case presentation A 17-year-old Syrian male was admitted to the internal medicine department with a one-month history of polyuria, polydipsia, general weakness, and pallor. He had a history of progressive bilateral sensorineural hearing loss and failure to gain weight for three years. Physical examination revealed various abnormalities, including scrotal mass, small penis and testicles, absence of pubic and axillary hair, joint abnormalities, short stature, hallux valgus, fibrous protrusion near the navel, and hyperpigmented non-itchy painful skin plaques. Clinical signs along with laboratory test results confirmed hyperglycemia, primary hypogonadism, osteopenia, and growth hormone deficiency. After a review of the relevant medical literature, this patient’s presentation of hyperglycemia with hypogonadism, hyperpigmentation, hallux valgus, hearing loss, hematological abnormalities, and short stature suggested the diagnosis of H syndrome. The patient received treatment with insulin and testosterone, leading to a significant improvement in his presenting symptoms. Conclusions H syndrome is a very rare condition, and the fact that the first case has only recently been reported in Syria serves to emphasize how rare it is. H Syndrome should be suspected if a patient has short stature with signs of hyperglycemia and other endocrine and cutaneous abnormalities. We are reporting this case to increase physicians’ awareness of this exceedingly rare and unique syndrome.

Background. Hyperpigmentation is a common side effect of different drugs with many of these having a well‐explained mechanism and some even having a characteristic distribution. However, it is a rare side effect of sertraline, a selective serotonin reuptake inhibitor (SSRI), with only a few reported cases. In addition, there are no specific characteristics of the lesions or the risk factors. Case Summary. This is a case report of a 24‐year‐old male with panic disorder, who developed hyperpigmentation over the face after 5 days of increasing the dosage of sertraline to 100 mg/day. There were no other significant findings from the physical examination or investigations. The patient was treated as a case of sertraline‐induced hyperpigmentation, and the dose was reduced to 75 mg/day and maintained at 50 mg/day after 1 week along with tablet propranolol 20 mg/day. He was also prescribed tablet tranexamic acid 500 mg/day and sunscreen with sun protection factor 50. The hyperpigmentation disappeared within 2 months, and the medication was gradually tapered after 7 months of treatment. Conclusion. Hyperpigmentation is a rare but distressing side effect of sertraline. It is a potentially curable side effect if recognized early. Early recognition and intervention can decrease unnecessary investigations and treatment. There are limited studies highlighting this unusual adverse effect of this commonly used SSRI. Hence, further studies are needed to better understand various aspects of this condition including the characteristics, patients at risk, and possible management. The development of diagnostic and treatment guidelines would decrease the dilemma of identification and management. [ABSTRACT FROM AUTHOR]

This article discusses the potential benefits of combining glutathione and resveratrol in the treatment of melasma, a hyperpigmentation disorder that primarily affects women. Glutathione is known for its antioxidant properties and ability to inhibit melanin production, while resveratrol regulates melanocytes and inhibits tyrosinase. The article presents a case series of five melasma patients who received oral glutathione and resveratrol treatment for 12 weeks, resulting in a significant reduction in hyperpigmentation. The combination therapy was well-tolerated, with only one patient reporting a headache as an adverse event. The authors suggest that further studies are needed to confirm these findings and explore the potential of glutathione and resveratrol in treating other pigmented skin disorders. [Extracted from the article]

This document is an editorial from the Journal of Clinical Medicine that provides an overview of current treatments for skin pigmentation disorders. It focuses on vitiligo, a condition characterized by the loss of skin pigmentation, and discusses various treatment options such as topical corticosteroids, phototherapy, and surgical interventions. The editorial also addresses hyperpigmentation disorders, specifically melasma, and highlights the challenges in its treatment. It mentions the use of topical applications, oral therapies, chemical peels, and laser procedures as treatment options. The document concludes by discussing the future of treating skin hyperpigmentation with lasers, emphasizing advancements in laser technologies and the potential use of machine learning and artificial intelligence. [Extracted from the article]

The article focuses on the dermoscopic features of familial gigantic melanocytosis (FGM), a rare genetic pigmentation disorder characterized by distinctive hyperpigmented and hypopigmented skin lesions. Topics include a detailed clinical presentation of FGM in a 25-year-old male patient, the importance of dermoscopy in differentiating FGM from other similar pigmentary conditions, and the findings from histopathological examination that confirm the diagnosis.

The article focuses on the use of dermoscopy and teledermatology in diagnosing and managing a case of erythema ab igne (EAI) alongside acute radiation dermatitis in a patient with lung cancer. Topics include the clinical features and diagnosis of both conditions, the role of dermoscopy in evaluating the skin lesions, and the implementation of teledermatology for follow-up treatment in an immobile patient.

Davener's dermatosis is a variant of frictional hypermelanosis characterized by midline hyperpigmented patches with indistinct borders, typically distributed along the skin overlying the bony protuberances of the lower thoracolumbar spine. Hereby, we report two children aged 10 and 12 years who presented with hyperpigmented skin lesions on the lower back. Both children had a history of exposure to prolonged friction at the affected site. The clinical diagnosis of Davener's dermatosis was made, supported by dermoscopic findings. The parents were educated regarding the benign nature of the condition and the required changes to be made in postural habits and avoidance of friction. [ABSTRACT FROM AUTHOR]

Reticulate pigmentary disorders can be classified into inherited or acquired and cutaneous drug- induced reticulate hyperpigmentation belongs to this last group. The list of the drugs involved is constantly increasing and chemotherapy agents are frequently implicated. We report a new case of chemotherapy-related reticulate hyperpigmentation to gemcitabine, even though a previous chemotherapy with nanoparticle, albumin-bound (Nab®) paclitaxel and gemcitabine may have promoted the onset of the disease. Reassurance of the patients is important in these cases, in order to continue the chemotherapy, and gradual fading of the hyperpigmentation is usually observed, as in our case. [ABSTRACT FROM AUTHOR]

This article discusses the use of intense pulsed light (IPL) therapy for treating hypertrophic scars, post-inflammatory hyperpigmentation, and post-inflammatory hypopigmentation. Hypertrophic scars are thick and raised scars that can be cosmetically and functionally problematic. The case report presents a successful treatment of a hypertrophic scar using IPL therapy, demonstrating its potential as a safe and non-invasive option. The article provides details on the treatment parameters and the patient's progress throughout the treatment course. IPL technology has been effective in treating various skin conditions and offers an alternative treatment option for patients who have concerns about using steroids. The article emphasizes the importance of further research on IPL technology and its potential benefits. [Extracted from the article]

Background/Objectives: Multiple underlying pathomechanisms may lead to melasma, but there has been no report on the use of optical coherence tomography (OCT) to reveal specific pathomechanisms in individual patients and provide individualized treatments accordingly. Using real-time OCT images, we studied the pathomechanisms of melasma in 12 female patients and the effects of individualized treatments. Methods: Patients were divided into good and bad improved groups according to the improvement in hyperpigmentation at month 4. Results: In the bad improved group, all melanin or confetti melanin had significantly decreased at month 2 or month 4 while granular melanin ratio at month or month 4 significantly increased, the most parameters of dendritic-sharped cells (DCs) before and after treatment were not significantly different, the collagen area or collagen density at month 4 significantly decreased. In the good improved group, there was slightly low all melanin/confetti melanin at month 4 and high granular melanin at month 4 in comparison to the bad improved group. Moreover, most of the parameters in the DCs at month 4 significantly increased while most parameters in collagen at month 4 significantly decreased. Conclusions: OCT is useful in revealing the involved pathomechanisms of melasma in individualized patients. Positive treatment results can be achieved through individualized therapy regimen targeting the pathomechanisms.

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.

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, microwave-assisted, 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.

Both sotorasib and adagrasib are approved for use in metastatic KRASG12C-mutated NSCLC after cancer progression on chemotherapy and immunotherapy. Hepatoxicity is a commonly encountered adverse effect of both agents, and little data exists about the safety of sequential use of these agents when hepatotoxicity is encountered. In this case report, we describe a patient who developed recurrent hepatotoxicity with sotorasib and was able to switch to adagrasib without hepatotoxicity and subsequently experienced a prolonged cancer response. We also describe a previously unreported adagrasib adverse effect of photoinduced skin hyperpigmentation.

Skin hyperpigmentation is a worldwide condition associated with augmented melanogenesis. However, conventional therapies often entail various adverse effects. Here, we explore the safety range and depigmentary effects of polysaccharides extract of Tricholoma matsutake (PETM) in an in vitro model and further evaluated its efficacy at the clinical level. An induced-melanogenesis model was established by treating B16–F10 melanoma cells with 8-methoxypsoralen (8-MOP). Effects of PETM on cell viability and melanin content were examined and compared to a commonly used depigmentary agent, α-arbutin. Expressions of key melanogenic factors and upstream signaling pathway were analysed by quantitative PCR and western blot. Moreover, a placebo-controlled clinical study involving Chinese females with skin hyperpigmentation was conducted to measure the efficacy of PETM on improving facial pigmented spots, melanin index, and individual typology angle (ITA°). Results demonstrated that PETM (up to 0.5 mg/mL) had little effect on the viability and motility of B16–F10 cells. Notably, it significantly suppressed the melanin content and expressions of key melanogenic factors induced by 8-MOP in B16–F10 melanoma cells. Western blotting results revealed that PETM inhibited melanogenesis by inactivating c-Jun N-terminal kinase (JNK), and this inhibitory role could be rescued by JNK agonist treatment. Clinical findings showed that PETM treatment resulted in a significant reduction of facial hyperpigmented spot, decreased melanin index, and improved ITA° value compared to the placebo-control group. In conclusion, these in vitro and clinical evidence demonstrated the safety and depigmentary efficacy of PETM, a novel polysaccharide agent. The distinct mechanism of action of PETM on melanogenic signaling pathway positions it as a promising agent for developing alternative therapies.

Abstract Objective To determine whether intra-mucosal injection of injectable platelet-rich fibrin (i-PRF) can promote healing after Diode Laser Gingival Depigmentation (DLGD). Methodology A total of 20 arch sites of hyperpigmented gingiva of 10 patients underwent DLGD. For each patient, two arch sites were randomly assigned for either intra-mucosal injection of i-PRF (G1-i-PRF) (n=10 sites) or no treatment (G2-Control): (n=10 sites). Wound Healing Score (WHS), patient satisfaction, and Pigmentation Index (DOPI) were measured at 1 week and 1 and 3 months postoperatively. Histological assessment of tissue specimens was performed at baseline and 1 week. Results The percentage change in WHS at 1 week was significantly higher in G1 (58.34±15.43) compared to G2 (37.50±11.79). At day 1, 50% of patients in G1 were pain free compared with 75% in G2, who had mild pain. Mean DOPI decreased significantly at 3 months in both groups (P-value

Introduction: Melasma is a widely prevalent acquired condition characterised by gray-brown pigmentation with a predilection on the face, affecting the quality of life. Tranexamic Acid (TXA) has been used for managing melasma orally and topically, while mesotherapy is a well known modality in cosmetology. Need for the study: There is a paucity of literature comparing the efficacy of topical and intralesional microinjections of TXA. A novel device (Meso-Ice®) has recently been commercialised for mesotherapy, working on the principle of electroporation technology for drug diffusion, which has not yet been evaluated for managing melasma using TXA. Aim: To compare the efficacy of TXA mesotherapy using the novel device versus topical TXA in patients with melasma. Materials and Methods: This is a randomised clinical trial assessing the comparative efficacy of Group 1: Mesotherapy using the novel device with TXA injection (4 mg/mL) and Group 2: Topical TXA gel (3%) for treating melasma. The severity of melasma will be assessed using the Melasma Area and Severity Index (MASI) at baseline, four weeks, and eight weeks. One-way Analysis of Variance (ANOVA) will be used to compare intra-group variables, and the paired t-test will be used for inter-group comparison. A p-value of

Background: Treatment of infraorbital dark circles and under‐eye puffiness is challenging due to its multifactorial nature and lack of broadly applicable, effective treatments. A daily skincare treatment option that is multimodal, effective, and tolerable across a broad patient population is an unmet need. Aim: A multicorrective topical eye cream (MTEC) formulated with Tetrahexyldecyl (THD) ascorbate (vitamin C), prebiotic Inula Helenium, bioavailable peptides, botanical extracts, chrysin, and caffeine is hypothesized to improve the appearance of infraorbital dark circles and under‐eye puffiness by targeting microvasculature congestion and permeability, melanin accumulation and hemoglobin degradation‐related pigmentation, and skin health. Methods: An IRB approved, open‐label, 12‐week clinical study set out to evaluate the efficacy and tolerability of the MTEC across a broad patient population including varying ethnicities and Fitzpatrick Skin Types (FST). Female subjects (n = 40) ages 35–60 years old, with moderate‐to‐severe under‐eye dark circles, moderate under‐eye puffiness, and mild‐to‐moderate fine lines were enrolled into the study. Objective (Chromameter, VISIA® imaging, and Laser Doppler) and subjective assessments (clinical grading and self‐assessment questionnaire) were conducted at baseline and post‐baseline timepoints. Results: Thirty‐seven subjects completed the study, and the MTEC efficaciously demonstrated short‐term and long‐term improvements in objective and subjective assessments across a broad patient population. Specifically, the MTEC demonstrated significant improvement of infraorbital dark circles, mainly by the reduction in microvasculature congestion and permeability, melanin, and hemoglobin degradation‐related pigmentation. Conclusion: Topical application of the MTEC may offer an effective and tolerable treatment option for infraorbital dark circles and puffiness. [ABSTRACT FROM AUTHOR]

Background: Post‐inflammatory hyperpigmentation (PIH) is a common complication after laser surgeries. Recent studies applied epidermal growth factor (EGF) on the lasered area after laser surgery to decrease the incidence of PIH with controversial results. Therefore, a comprehensive literature review of randomized controlled trials (RCTs) was conducted to investigate the issue. Methods: Two reviewers independently searched the literatures, extracted, and analyzed the data. A total of seven RCTs involving 169 patients were included to evaluate the efficacy of EGF on recovery and PIH prevention after laser surgery. Results: The results show that the incidence of PIH in the EGF group was relatively lower than that in the control group, although the difference was not statistically significant (OR 0.64, 95% CI 0.33 ~ 1.25, p = 0.19). However, the EGF groups had a significant decrease in melanin index (MI) scores at the 1st month after the laser surgery when compared to the control groups (SMD −1.57, 95% CI −2.83 ~ −0.31, p = 0.01). In addition, the patients on the EGF side rated significantly higher satisfactory scores (SMD 0.49, 95% CI 0.22 ~ 0.76, p = 0.0004). There was no significant difference as regard to changes in MI at the 2nd week and 2nd month, erythema index (EI), and trans‐epidermal water loss (TEWL) at days 3 and 7 after laser therapy, respectively. Conclusion: The current meta‐analysis found a limited temporary inhibitory effect of EGF‐containing topical products on PIH with no significant effect on reducing post‐laser erythema or promoting epidermal barrier repair. More studies are needed in the future due to the small sample size and marked intergroup heterogeneities. [ABSTRACT FROM AUTHOR]

This article discusses a rare case of localized cutaneous cryptococcus in a 30-year-old male patient with dark skin. The patient had a single raised lesion on his nose that started as a small, pus-filled lesion after a wire injury. The patient was also diagnosed with ankylosing spondylitis and was receiving treatment with adalimumab, a TNF-alpha inhibitor. Dermatoscopic examination revealed various features, including follicular plugs, white structures, orange structureless areas, and polymorphic vessels. The patient was treated with oral itraconazole, and after 8 weeks, the lesions healed with residual postinflammatory hyperpigmentation. The article emphasizes the usefulness of dermatoscopy in diagnosing and monitoring the treatment of deep mycosis, particularly in patients receiving TNF-alpha inhibitors. [Extracted from the article]

Purpose: This study aimed to investigate the correspondence between intraretinal hyperreflective foci (IHRF) identified on optical coherence tomography (OCT) B‐scans with hyperpigmentation on colour fundus photography (CFP) or hyperreflectivity on infrared reflectance (IR) images in eyes with age‐related macular degeneration (AMD). Methods: Flash CFP, IR images and OCT B‐scans obtained at the same visit were evaluated. Individual IHRF identified on OCT B‐scans were assessed for the qualitative presence or absence of a hypotransmission tail into the choroid. The corresponding IR image obtained at the time of OCT acquisition was analysed for the presence or absence of hyperreflectivity in this region. The IR images were manually registered to the CFP image, and CFP images were inspected for the presence or absence of hyperpigmentation at the location of IHRF. Results: From 122 eyes, a total of 494 IHRF were evaluated. For the primary analysis of qualitative presence or absence of hyperpigmentation on CFP and hyperreflectivity on IR at the locations corresponding to IHRF on OCT, 301 (61.0%) of the IHRFs demonstrated evidence of hyperpigmentation on CFP, while only 115 (23.3%) showed evidence of hyperreflectivity on IR. The qualitative determination of the presence or absence of an abnormality on CFP or IR were significantly different (p < 0.0001). 327 (66.2%) of the IHRF showed hypotransmission, and 80.4% of these IHRF showed hyperpigmentation on CFP, though only 23.9% (p < 0.0001) demonstrated hyperreflectivity on IR. Conclusions: Less than two‐thirds of IHRF evident on OCT manifest as hyperpigmentation on colour photos, though IHRF with posterior shadowing are more likely to be evident as pigment. IR imaging appears to be even more poorly sensitive for visualizing IHRF. [ABSTRACT FROM AUTHOR]

A 25‐year‐old female Carney complex patient with a PRKAR1A mutation who had undergone surgery to remove teratomas visited our dermatology department. She was suspected of having a malignant melanoma in a teratoma. On clinical examination, a black nodule was found within the cyst. On histopathological examination, the black lesion was composed of heavily pigmented round cells with vesicular nuclei and single prominent nucleoli. Additionally, there were large cells with irregularly shaped nuclei. Upon immunohistochemical examination, the large, irregularly shaped cells were positively stained with Melan A, HMB45, S‐100 protein, SOX10, CD10 (focally), and BRAFV600E, but negatively stained with PRAME. Based on the histopathological features, we diagnosed the patient with pigmented epithelioid melanocytoma (PEM) in a teratoma of a Carney complex patient. This is the first case of PEM developing from a teratoma. Since PEM lesions may spread to regional lymph nodes, careful follow‐up is necessary. [ABSTRACT FROM AUTHOR]

Background: Paclitaxel (PTX) is a microtubule‐stabilizing antineoplastic that has been shown to damage healthy tissues like the skin. Hyperpigmentation can be found among the adverse effects caused by PTX, but the literature is limited and the mechanisms driving PTX‐induced pigmentary alterations are unknown. Objectives: This study aimed to describe the pigmentary alterations caused by PTX and to determine the effects of PTX on melanocytes. Methods: Pigmentary skin alterations were measured in 20 gynecological cancer patients under PTX treatment by using specific probes, which determine the melanin index and the pigmentation level. Melanocytes were incubated with paclitaxel to analyze melanogenesis markers gene expression, melanin content, and transcription factors activation. Results: Paclitaxel induced alterations in the skin pigmentation with no visible clinical manifestations. Gynecological cancer patients under paclitaxel treatment had an increase in the melanin index and pigmentation levels. In vitro, PTX exposure to melanocytes increased the expression of melanogenesis markers, melanin content, and induced activation of ERK and MITF. Conclusions: The results suggest that PTX alters pigmentation in patients with no clinically visible manifestations, and these alterations might be driven by its capacity to stimulate melanogenesis on melanocytes through the MITF activation pathway. [ABSTRACT FROM AUTHOR]

The aim was to describe the characteristic dermatoscopic features of hyperpigmented macules on the faces of young children. Sixteen patients with typical clinical presentations of hyperpigmented macules on the faces of young children were included in this study. The lesions were evaluated using a dermatoscope. The clinical and dermatoscopic features were analyzed and summarized. There were 12 boys and 4 girls enrolled in the study. The hyperpigmented macules had an age of onset ranging from 1 to 18 months (mean, 6.12 months). The hyperpigmentation was distributed on the forehead and/or temple, as follows: forehead (n = 8 [50%]); temple (n = 3 [18.8%]); and both sites (n = 5 [31.2%]). Fifteen patients (93.7%) had pseudoreticular pigmentation, 1 patient (6.3%) had reticular pigment with pseudoreticular pigment, and 100% had erythema and linear/branching vessels. Light brown pseudoreticular pigment and linear vessels were shown to be the 2 major dermatoscopic manifestations of hyperpigmented macules on the faces of young children. [ABSTRACT FROM AUTHOR]

Background: Solar lentigines are common hyperpigmented lesions typically appearing after 50 years of age and associated with negative psychological effects in affected individuals. Topical depigmenting products, such as hydroquinone and even the Kligman's formula, are usually ineffective for treating lentigines. Stabilized cysteamine has been recently shown to be as effective as the modified Kligman's formula for treating melasma. In this study, we evaluated the therapeutic effect of a stabilized cysteamine on solar lentigines. Methods: A vehicle‐controlled, double‐blind, and randomized study was performed on 30 patients with solar lentigines. Stabilized cysteamine or vehicle control creams were applied on solar lentigines on the dorsum of the hands daily for 12 weeks. Clinical measurements with colorimetry and visual analog scale were performed at baseline, 4, 8, and 12 weeks. Results: Statistically significant results were obtained in the cysteamine group versus the vehicle control group. Stabilized cysteamine provided a 40% reduction in colorimetric values (p < 0.002) versus a 2% reduction in the vehicle group (p < 0.405). Cysteamine also provided a 40% reduction in VAS (p < 0.001) versus a 2% reduction in the vehicle group (p < 0.245). Conclusion: Significant improvement of solar lentigines was observed after 12 weeks of application of stabilized cysteamine by all evaluation methods. Stabilized cysteamine represents a highly effective topical treatment for solar lentigines and can be considered as one of the first topical therapies effective on this hyperpigmentary disorder. [ABSTRACT FROM AUTHOR]