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Basic dermatology in children and adolescents
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Kalyani Marathe, Kathleen Ellison
The severity of acne can vary, and patients can present with one or both types of acne: comedonal and inflammatory. Noninflammatory acne, also referred to as comedonal acne, is characterized by open and closed follicularly based comedones. Closed comedones may present as 1–2 mm white papules, commonly called whiteheads (Figure 10.19); open comedones appear clinically as blackheads (Figure 10.20). Inflammatory acne consists of papules, pustules, nodules, and cysts. These lesions have the potential for more serious scarring. Patients with acne can have postinflammatory hyperpigmentation, which presents as pink to brown 1–3 mm macules in the areas of former acne after inflammatory papules have resolved. Postinflammatory hyperpigmentation can appear more pronounced in darker skin tones.
Histopathology
Published in Dimitris Rigopoulos, Alexander C. Katoulis, Hyperpigmentation, 2017
Postinflammatory hyperpigmentation can be seen in numerous conditions, and the intensity of it varies with skin type. Conditions that are almost always followed by hyperpigmentation are fixed drug eruption and phototoxic dermatitis. Postinflammatory hyperpigmentation may consist of two components, increased epidermal pigmentation and melanophages in the dermis (Figure 23.15).3,35While epidermal hyperpigmentation resolves relatively quickly, melanophages in the dermis may stay for weeks and months.
Differential diagnoses of psoriasis
Published in M. Alan Menter, Caitriona Ryan, Psoriasis, 2017
Lichen planus can present and remain localized to the genitals.26,57,85 Clinically, it presents as itchy, red or purple papules, plaques, annular, hypertrophic, and erosive lesions.26,57,85 It may occur on the penis, vulva, anogenital region, and oral mucosa (see Figure 12.28).26,57,85 Lichen planus can affect the vulva in isolation or at the same time as a generalized eruption.17,57,85,86 Vulval lesions are erythematous to violaceous papules or annular plaques, and erosions with or without Wickham's striae.57 Lesions may ulcerate.17,57,85,86 In males, lichen planus may present as phimosis.26,57 The male genitalia is the most frequently reported site for the annular subtype of lichen planus.17,57 Occasionally an erosive form is seen.26,57,85 In most cases, genital lichen planus is self-limiting, although some patients may remit and relapse.26,57 Postinflammatory hyperpigmentation may be seen and can persist for months to years.57 Chronic mucosal erosive lichen planus is associated with a risk of progression to squamous cell carcinoma.26,57 Histopathology characteristically demonstrates hyperkeratosis, irregular acanthosis with typical saw-tooth appearance of the rete pegs, an increased granular layer, and disruption of the basal layer with a closely apposed dermal band-like lymphocytic infiltrate.57
Improvement in linear depressed atrophic scar using 755-nm picosecond alexandrite laser vs. ablative fractional carbon dioxide laser
Published in Journal of Cosmetic and Laser Therapy, 2022
Da Woon Lee, Hyeongrae Ryu, Hwan Jun Choi, Eun Soo Park
The AFL effectively ablates the epidermis and dermis without significantly increasing the risk of complications associated with fractional photothermolysis. The laser induces efficient tissue regeneration by creating small columns of wound in a homogeneous and fine pixel-like pattern, surrounded by healthy normal tissue (18). The column stimulates collagen remodeling, and flattens the skin surface to improve the scar contour (19). Studies report increased tolerance levels of patients and scar improvement by 25% to 50% (20). Many studies have reported improvement of depressed acne scars by maximizing the effects of tissue regeneration and collagen remodeling of ablative laser (12,21), especially in laceration. However, postinflammatory hyperpigmentation (PIH) remains a major complication that can persist for months in dark-skinned patients, especially after treatment with ablative devices (22).
Postinflammatory hypopigmentation: a comprehensive review of treatments
Published in Journal of Dermatological Treatment, 2022
Pamela N. Madu, Nicole Syder, Nada Elbuluk
Postinflammatory hyperpigmentation remains a common and challenging pigmentary condition that can serve as a source of psychological distress in affected patients. Further understanding of the pathogenesis of postinflammatory hypopigmentation is needed to aid in the development of targeted based therapies. Topical, photo-based, and procedural therapies have been tried in a limited number of patients with variable success. Currently, the literature on postinflammatory hypopigmentation consists largely of case reports and small case series. The majority of studies discuss treatment of PIH in patients of skin phototypes I-IV. More robust clinical studies and more studies in skin phototypes V and VI are necessary to better understand the pathogenesis of this condition and to further evaluate the safety and efficacy of current and novel therapies for PIH in all skin types.
Novel tretinoin 0.05% lotion for the once-daily treatment of moderate-to-severe acne vulgaris: assessment of safety and tolerability in subgroups
Published in Journal of Dermatological Treatment, 2020
Julie C Harper, Wendy E Roberts, Joshua A Zeichner, Eric Guenin, Varsha Bhatt, Radhakrishnan Pillai
Despite consensus recommendations for the use of retinoids as a first-line acne treatment (1,2), they remain underutilized (3–5). One important barrier to their widespread use has been their potential to cause skin irritation (6). Most patients will experience some degree of erythema, dryness, scaling, burning, and/or pruritus with retinoid use (7–9). These symptoms characterize a retinoid-specific irritant contact dermatitis which can occur in up to 95% of patients, and is moderate or severe in ∼25% of patients, and leading to treatment discontinuation in 15% of patients (10). In addition, cutaneous irritation from retinoid treatment can cause or exacerbate postinflammatory hyperpigmentation (PIH) in acne patients who are especially susceptible; such as Hispanics, those with darker skin and African Americans (11). Consequently, a retinoid formulation which is less irritating could be very beneficial, especially as retinoids have the ability to improve both acne and PIH (12).