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Dermatologic diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Holly Edmonds, Dana Ward, Ann G. Martin, Susana Leal-Khouri
Ninety percent of pregnant patients develop hyperpigmentation, usually mild and generalized. There is accentuation of normally hyperpigmented regions such as the areolae, nipples, axillae, genitalia, perineum, anus, and inner thighs (1–3). Generally, hyperpigmentation appears during the first trimester, progresses until delivery, and regresses postpartum. However, anatomic sites already hyperpigmented (areola, nipples, and genitalia) usually do not return to their previous color. The cause of hyperpigmentation is controversial. Most investigators agree that an increase in the production of pituitary, placental, and ovarian hormones is responsible (4–6). Melanocyte-stimulating hormone (MSH), estrogen, and progesterone are strong melanogenic stimulants and may play an important role. MSH is increased during pregnancy and decreases postpartum (7–9). Studies have also shown that the placenta contains other bioactive molecules that stimulate melanocytes by upregulating tyrosinase activity (10).
Newer Agents in Systemic Treatment
Published in Vineet Relhan, Vijay Kumar Garg, Sneha Ghunawat, Khushbu Mahajan, Comprehensive Textbook on Vitiligo, 2020
Rachita Dhurat, Shilpi Agarwal
Clofazimine is an iminophenazine dye used as part of multidrug therapy treatment of leprosy. Hyperpigmentation is a noted side effect in the majority of patients. In the study by Shah, repigmentation was seen in patients treated with clofazimine, which was reversible on stopping treatment [7]. In other study done by Guha et al., there was no evidence of repigmentation of the affected areas in any of the patients treated [8].
Disorders of pigmentation
Published in Ronald Marks, Richard Motley, Common Skin Diseases, 2019
A very common type of localized hyperpigmentation is chloasma or melasma. This facial pigmentation may be part of the increased pigmentation of pregnancy or may occur independently. The cheeks, periocular regions, forehead and neck may be affected in this so-called ‘mask of pregnancy’ (Fig. 22.9).
The Approach of Intense Pulsed Light Treatment in Patients with Different Severities of Meibomian Gland Dysfunction
Published in Current Eye Research, 2023
Adverse events related to treatment (e.g. mild facial skin irritation and mild cutaneous hyperpigmentation) occurred to three patients receiving IPL treatment. After two patients reported skin irritation, doctors lowered energy exposure levels during the remaining IPL treatment sessions. These two patients had rosacea under control, and both had been out of systemic medicine for at least 1 month. Although their facial conditions were stable enough to receive IPL treatment, their skin was still more vulnerable than other patients without rosacea history. After consulting with dermatologists, we were suggested to lowering the energy exposure, which helped the patient to avoid skin irritation and to be tolerant of IPL treatment. The use of sun protection was emphasized again for patient with cutaneous hyperpigmentation, because this was usually caused by unexpected sun exposure after IPL treatment. A mild cutaneous hyperpigmentation will spontaneously relieve in months if sun block is kept well. All these patients recovered during follow-up observation. All subjects who failed to finish the treatment were affected by their personal issues rather than adverse events.
Permeation enhancer nanovesicles mediated topical delivery of curcumin for the treatment of hyperpigmentation
Published in Journal of Liposome Research, 2022
Raziya Khatoon Farooqui, Monika Kaurav, Manoj Kumar, M. S. Sudheesh, Ravi Shankar Pandey
The pigment of the skin melanin and hairs are produced in the melanocytes of the basal layer of the epidermis by the melanogenesis pathway which is controlled by the crucial regulator enzyme tyrosinase (Sanchez-Ferrer et al.1995, Slominski et al.2004). It plays a photo-protectant function against the ultraviolet (UV) induced damage (Brenner and Hearing, 2008). However, excessive production and accumulation of melanin cause hyperpigmentation and related problems such as inflammation, redness, dark spots, uneven skin coloration, lentigo, freckles, and premature aging (Kumar et al.2013, Ko et al.2014). It is also associated with facial hyperpigmentation or melasma, one of the most common dermatological problems (Shrotriya et al.2018). Hyperpigmentation is mainly caused because of genetic predisposition, long skin exposure to UV rays, hormonal imbalance, steroid therapy, aging, side effects of certain drugs, and sometimes during pregnancy (Hridya et al.2016). Commercially available agents used in the treatment of hyperpigmentation such as hydroquinone, antihistaminic, topical corticosteroids, and kojic acid, although found to be effective; their long-term use may induce many side effects such as itching, contact dermatitis, cytotoxicity, and even carcinogenicity (Hengge et al.2006, Draelos, 2007, Chang, 2009). Therefore, there is demand for a safe and effective alternative for better patient compliance along with enhanced hypopigmentation efficacy.
Outcomes of Repository Corticotropin Gel for Ocular Sarcoidosis
Published in Ocular Immunology and Inflammation, 2022
Daniel J. Oh, Arjun Singh, Levi N. Kanu, Ann-Marie Lobo-Chan, Peter W MacIntosh, Pooja Bhat
Most patients also experienced side/adverse effects while on RCI therapy including hyperpigmentation, hypertension, and alopecia. Three patients noted significant hyperpigmentation of the skin. ACTH has been implicated in hyperpigmentation of the skin and oral mucosa due its activating effect on MCRs so that high levels spur production of melanin and subsequent discoloration of the skin or mucosa.1 Three patients developed hypertension while on RCI therapy. One patient (Patient 4) developed hypertensive crisis with recorded blood pressure of 180 mmHg systolic and 110 mmHg diastolic. In Patient 2, hypertensive emergency developed with systolic blood pressures rising to 255 mmHg while on RCI therapy with acute kidney injury. She had underlying renal disease that worsened and 2 months after stopping RCI therapy, the patient developed renal failure needing dialysis. She is currently on a waiting list for a renal transplant. All three patients had been on oral prednisone either prior to or along with RCI, oral prednisone could not be weaned and whether this result was from a cumulative effect of corticosteroids and RCI or RCI alone is not clear.