Skin pigmentation and texture changes after hair removal with the normal-mode ruby laser

Promising clinical results have been obtained with the normal mode ruby laser for removal of unwanted hair. Melanin within the hair follicles is thought to act as target for the ruby laser pulses, whereas epidermal melanin is thought to be a competitive chromophore, responsible for potential side effects. This study aimed (i) to objectify postoperative changes in skin pigmentation and texture and (ii) to evaluate the importance of variations in preoperative skin pigmentation for the development of side effects 12 weeks after 1 treatment with the normal-mode ruby laser. A total of 17 volunteers (skin types I-IV) were laser-treated in the hairy pubic region (n = 51 test areas). A shaved test area served as control. Skin reflectance spectroscopical measurements, 3-dimensional surface contour analysis and ultrasonography objectified postoperative changes in skin pigmentation and texture. Blinded clinical assessments revealed postoperative hyperpigmentation (2% of test areas) and hypopigmentation (10%), whereas no textural changes were seen. Reflectance spectroscopically-determined pigmentary changes depended on the degree of preoperative skin pigmentation, fairly pigmented skin types experiencing subclinical hyperpigmentation and darkly pigmented skin types experiencing subclinical hypopigmentation. Three-dimensional surface profilometry documented similar pre- and postoperative surface contour parameters, indicating that the skin surface texture is preserved after laser exposure. Ultrasonography revealed similar skin thicknesses in laser-exposed and untreated control areas. It is concluded that normal-mode ruby laser treatment is safe for hair removal in skin types I-IV.

Extensive mongolian spots with involvement of the scalp

A Chinese infant boy had extensive Mongolian spots in the occipital, gluteal, sacrococcygeal, and lumbar areas. The occurrence of a Mongolian spot in the scalp area has not been previously reported. Awareness of such an occurrence is important so that a false accusation of child abuse is not made.

Hereditary ochronosis: hyperpigmented skin overlying cartilaginous structures

Hereditary ochronosis, or alkaptonuria, results from deficiency of homogentisic acid oxidase. It is an autosomal recessive condition found in geographically isolated populations. The excess homogentisic acid deposits in collagenous structures, leading to unusual pigmentation of the skin overlying cartilaginous structures, but on occasion pigment is also seen in the sclera, in sweat after oxidation, and classically, in urine when left standing at room temperature. This case report highlights the pathogenesis and expression of this rare disorder.

Lipodermatosclerosis and atrophie blanche

An overview of the causes, diagnosis and treatment of lipodermatosclerosis and atrophie blanche

An intriguing case of LEOPARD syndrome

We report a 9-year-old boy affected by LEOPARD syndrome, who also had ichthyosis, axillary freckling, two café au lait spots, and one neurofibroma. The diagnosis of LEOPARD syndrome has been made on clinical grounds, whereas the ichthyosis and neurofibroma have been histologically confirmed. The analogies between LEOPARD syndrome and neurofibromatosis have been discussed. Finally, we maintain this case is an example of the multiple lentigines syndrome/LEOPARD syndrome spectrum.

Malignant melanoma in situ arising in the nail unit of a child

A very rare case of malignant melanoma in situ of the nail unit of a child is presented. Clinically, a pigmented streak was present on the finger nail of a 3-year-old girl, and the lesion increased in size and in darkness of the color associated with periungual pigmentation in the following two years. Histopathologically, sections showed proliferation of atypical melanocytes, arranged mostly in single units but some in nests, in and above the basal layer of the epithelium and admixed with long dendrites and a few mitotic figures. Pigmented lesions of nail units of children often show fading or loss of pigmentation clinically; however, a biopsy should be done when they show augmentative changes which clinically suggest malignancy, because subungual malignant melanoma can exist even in children, and proper biopsy can detect it in its early stages.

Alkaptonuric ochronosis: report of two affected brothers

Alkaptonuric ochronosis is a rare inborn metabolic disorder. Because of the deficient activity of the enzyme homogentisic acid oxidase, homogentisic acid accumulates in plasma, is deposited in various tissues and is excreted in large amounts in urine. Dark brown discoloration of urine on exposure to air or after addition of alkaline solution is characteristic. We describe two brothers with typical alkaptonuric ochronosis with dark urine, blue pigmentation of auricles and axillae, focal brown hyperpigmentation of sclerae, and anthropathy.

Diffuse hyperpigmentation of the skin: a clinicopathologic approach to diagnosis

There are multiple causes of diffuse hyperpigmentation of the skin (DHP) and determination of the exact etiology can sometimes be difficult. A systematic classification based on both clinical and pathological findings that should aid the clinician who is confronted with this situation is presented in this article. The skin diseases that cause DHP are classified based on the pigment characteristics (melanin, non-melanin), pigment distribution (epidermal, epidermal-dermal, dermal) and density of melanocytes (normal, increased). The intent of this review is to provide a "histopathological tool" that increases diagnostic accuracy in the evaluation of a patient with DHP.

Cutaneous hyperpigmentation and polyglandular autoimmune syndrome type II

Primary adrenal insufficiency (Addison's disease) may initially present with cutaneous hyperpigmentation. Addison's disease, when associated with autoimmune thyroid disease and/or insulin-dependent diabetes mellitus, is referred to as polyglandular autoimmune syndrome type II. We present the case of a patient who initially was diagnosed as having Grave's disease and eventually Addison's disease due to persistent cutaneous hyperpigmentation, fatigue, weight loss, hypotension, hyponatremia, peripheral eosinophilia, and positive results of a synthetic corticotropin stimulation test. Addison's disease, polyglandular autoimmune syndrome type II, and cutaneous hyperpigmentation are reviewed.

Atrophic pigmented dermatofibrosarcoma presenting as infraorbital hyperpigmentation

BACKGROUND

Pigmented dermatofibrosarcoma is a rare tumor of the skin and constitutes 1-5% of all dermatofibrosarcoma. Most cases present as polypoid multinodular growth. Occasional cases may be atrophic. We report an extraordinary case with progressive infraorbital atrophy.

OBSERVATION

A 24-year-old woman came to us for a diffuse bluish atrophic lesion over the left infraorbital area. The lesion progressed gradually over 2 years. Histologic examination revealed mature spindle cell proliferation in the lower dermis and hypodermis. Interspersed were some heavily pigmented melanocytes.

CONCLUSION

We report an unusual case of progressive bluish discoloration and atrophy of the infraorbital area. This is a rare manifestation of dermatofibrosarcoma.

Drug-induced oral mucosal hyperpigmentation

This paper reports on a patient who developed oral hyperpigmentation and the literature on drug-induced oral hyperpigmentation is reviewed.

Localized hypertrichosis associated with periorbital neurofibroma: clinical findings and differential diagnosis

BACKGROUND

Congenital localized hypertrichosis in the periorbital region is an uncommon finding. The authors report two patients with hypertrichosis and cutaneous hyperpigmentation overlying a periorbital neurofibroma.

METHODS

In addition to a complete ophthalmic and systemic examination, the patients underwent computed tomography of the head and biopsy of the tumor.

RESULTS

Case 1 previously had received a diagnosis of neurofibromatosis type I. On examination, hyperpigmentation, hypertrichosis, and swelling in the right supraorbital region were noted. A computed tomographic scan showed a tumor in the same region. The tumor was removed, and a plexiform neurofibroma was diagnosed. Case 2 was admitted with hyperpigmentation, hypertrichosis, and swelling of the left half of her face. Other signs of neurofibromatosis were absent. A computed tomographic scan showed a tumor, which was underlying the skin changes. Results of histologic examination of the biopsy specimen showed a plexiform neurofibroma.

CONCLUSION

Neurofibroma-associated hypertrichosis should be considered in the differential diagnosis of congenital localized hypertrichosis.