HYPERTHYROIDISM
Pigmentation
occurs in about 10% of patients with primary thyrotoxicosis.
It is
usually diffuse and is broadly of Addisonian pattern but
involvement of the mucous membranes is uncommon and pigmentation of
nipples and genital skin is less striking.
Clinical
Manifestations
Diffuse
pigmentation appears at birth in the infant of a thyrotoxic mother.
The eyelids
are occasionally conspicuously pigmented.
Some
patients show chloasmal rather than diffuse pigmentation.
The
incidence of vitiligo is increased.
Hypermelanosis
associated with other diseases.
Increased
pigmentation is an unconstant feature of a wide variety of systemic
disorders and may be associated with malignant disease.
Chronic
infections:
Pigmentation
may occur in many chronic infections, but it is difficult to
determine the relative responsibility of the infection, malnutrition
and other factors. It has been suggested that the activity of the
reticulo-endothelia system (RES) is inversely related to
adrenocortical activity. With the stimulation of the RES by these
chronic infections and a consequent reduced adrenocortical activity,
this would lead to an enhanced pigmentation of the skin.
Systemic
infections:
Hyperpigmentation
may accompany certain chronic infections as malaria, kala-azar,
schistosomiasis and tuberculosis.
Subacute
bacterial endocarditis:
Diffuse
light-brown pigmentation is an indication of the later stages of sub
acute bacterial endocarditis.
Skin
diseases associated with hyperpigmentation:
Different
skin diseases may be associated with hypermelanosis. Some of these
include the following:
Discoid
lupus erythematosus.
Lichen
planus.
Chronic
eczema.
Dermatitis
herpetiformis.
Porphyia.
Chronic
photodermatitis and long time exposure to direct sunlight.
Malabsorption
diseases such as Gaucher‘s and Niemenn-Pick disease.
Neoplastic
diseases.
In cachectic
states, there may be diffuse hyperpigmentation of the skin as in
Addison‘s disease.
In the
ectopic ACTH syndrome, which may occur in patients with oat-cell
carcinoma of the bronchus, pigmentation is usual. The tumor has been
shown to produce a distinct MSH-like compound.
In an adult,
acanthosis nigricans is associated usually with an internal
malignancy, almost invariably an adenocarcinoma.
The
hypermelanosis affects the axillae, nipples and umbilicus, which
also show a warty papillomatosis.
These skin
changes may later become generalized. The mucous membranes are
frequently involved.
A diffuse
dermal melanosis, having a slaty-blue color, can occur secondary to
melanoma.
Pigmentation
is an uncommon manifestation of the lymphomas, occurring in 10% of
cases of Hodgkin‘s disease and in 1 or 2% of cases of
lymphosarcoma and lymphatic leukemia. The pigmentation is of
Addisonian type, but without involvement of the mucous membranes.
Malnutrition:
may be a factor in increasing skin pigmentation.
Skin
excoriation and
scratching due to chronic skin itchy diseases.
Mycosis
fungoides
May cause
diffuse progressive hyperpigmentation.
Cytostatic
drugs used for the treatment of these disorders also can produce
increased pigmentation of the skin.
Diseases of
the nervous system.
Diseases of
the nervous system particularly those involving the diencephalon and
the substantia nigra show pigmentations of the addisonian type.
Intense
pigmentation is a feature of Schilder‘s disease but some increase
in pigmentation is not uncommon in schizophrenia, emotional stress,
Parkinsonism, hepatolenticular degeneration and in ependymomas.
Asthma
Asthmatic
attacks may be preceded by 3 or 4 days of diffuse darkening of the
skin.
Collagen
diseases
Generalized
pigmentation in scleroderma may be intense and diffuse or of
Addisonian type, but without mucous membrane involvement.
Pigmentation
may be a conspicuous feature of morphoea and may indeed be the
presenting symptom.
Dermatomyositis
and systemic lupus erythematosus may be accompanied by
hyperpigmentation.
Pigmentation
is usually generalized occasionally observed in rheumatoid arthritis
and Still‘s disease.
Renal
failure
Chronic
renal disease with nitrogen retention is frequently accompanied by
increased pigmentation.
Anemia
Hyperpigmentation
of the skin occurs in vitamin B12 deficiency and is more common in
dark-skinned races . The pigmentation often has a rather dappled and
mottled appearance, and particularly affects the face, hands and
feet. Sometimes only the fingers are affected. Treatment with
vitamin B12 reverses the pigmentation of the skin back to normal.
In
pernicious anemia there is an increased incidence of vitiligo and of
premature grayness of the hair.
In the
hemolytic anemia, hypermelanosis and hemosiderosis may develop on
the lower legs.
Hemochromatosis
Pigmentation,
bronzed or slaty-gray in color, involves first the exposed skin but
later it is generalized. It is present in some 90% of cases, but may
not be conspicuous. The diagnosis should be suspected when
pigmentation of this pattern occurs in middle-aged men, and will be
supported by the finding of an enlarged liver and diabetes and
confirmed by the high level of serum iron.
Hepatic
cirrhosis
A diffuse
hypermelanosis is seen in patients with liver cirrhosis.
Lichen
planus may be associated with primary biliary cirrhosis and as
lesions resolve they leave slaty-brown hypermelanotic macules.
Amyloidosis
Localized
pigmentation, often symmetrical, is seen in both lichen and macular
amyloidosis.
The macular
type of amyloidosis is often mistaken for post inflammatory
hyperpigmentation, but the lesions often have a distinctive
“ripple“ pattern and microscopic studies will reveal the
presence of amyloid. Melanophages are to be found in the papillary
dermis. The melanin contained in these dermal cells is derived from
degenerating basal keratinocytes and melanocytes.
Vitamin
deficiency
In severe
deficiency of vitamin A, generalized pigmentation may occur, as well
as pigmentation of the horny follicular papules.
Conjunctiva
pigmentation has been noted particularly in the Mongoloid races and
may be striking, especially in the bulbar conjunctiva.
Vitamin B12
and folate deficiency
Vitamin B12
and folate deficiency show diffuse, brown pigmentation is seen
occasionally in patients with folic acid deficiency and also in
vitamin B12 deficiency. Pigmentation of the fingertips and nails of
a patient with B12 deficiency is reported.
Pellagra
Pigmentation
is frequent in pellagra. It is often of Addisonian type but the
pigmentation is accentuated on the face and hands and on areas of
friction or pressure, or as a sequel to pellagrous dermatitis.
Drugs
Cloropromazine:
causes purple pigmentation or slate colored pigmentation.
Chloroquine:
causes bluish black hyperpigmentation
Estrogens:
causes skin melanosis
Other drugs
such as phenothiazine, antipyrine, tetracycline cause skin
pigmentation
Bismuth:
causes gum hyperpgimentation
Silver:
causes metallic blue pigmentation
Scurvy
Deficiency
of ascorbic acid is sometimes associated with pigmentation, which is
usually of Addisonian type.
Malabsorption
syndromes
In sprue and
other malabsorption syndromes pigmentation is of common occurrence.
It may be of Addisonian type but without involvement of the mucous
membranes, or may occur in well-defined patches on the face and neck
and occasionally on the trunk. The scaly inflammatory plaques, which
may develop in these syndromes, are usually followed by intense
pigmentation.
Vagabonds‘
disease
Vagabonds‘
disease classically occurs in those in whom lack of food is combined
with lack of cleanliness, and heavy infestation with pediculi. The
pigmentation is basically of Addisonian pattern and the mucous
membranes may be involved.
Hypermelanosis
is probably post inflammatory and related to the scratching from the
pediculosis infestation. Areas of hypomelanosis occur and there is a
decrease in the number of melanocytes, which show degenerative
changes.
Post-inflammatory
hypermelanosis.
Hypermelanosis
commonly follows acute or chronic inflammatory processes in the skin
as in lichen planus, herpes zoster, dermatitis herpetiformis,
papular urticaria and collagen diseases.
The
intensity and persistence of the hypermelanosis are greater in
dark-skinned subjects.
Post-inflammatory
hyperpigmentation may occur following trauma to the skin. It can
occur following dermabrasion and particularly in those who are
racially pigmented, of skin type 111 & 1V.
Collagen
diseases: such as
discoid lupus erythematosus.
Congenital
heart disease:
hyperpigmentation particularly central cyanosis occurs secondary to
congenital heart disease.
PITYRIASIS
ALBA
Pityriasis
alba is a non-specific dermatitis of unknown origin that
characteristically produces erythematous scaly patches, which
subsides to leave areas of depigmentation.
Etiology
The exact
cause of pityriasis alba is not clear.
We found
that there are different predisposing factors for pityriasis
alb.These include the following:
Over
exposure to sunlight.
Children
spending long time in the swimming pools containing excess chlorine
and later long exposure to direct sunlight.
Gastro-
intestinal disturbances.
Fevers and
recurrent infections such as chronic tonsillitis.
Obese
children are more susceptible.
Over eating
especially at night and sleeping immediately after the night meal.
Excess
cosmetics and topical preparations.
Psychic,
hyperactive and irritable children.
Clinical
Features
Pityriasis
alba is usually a chronic skin eruption affecting predominantly
children. The clinical picture of the skin lesions varies from scaly
erythematous patches to depigmented plaques. The site involved is
mainly the face . Other sites like shoulders and the limbs may be
affected but to a lesser extent.
The skin
lesion is usually asymptomatic and the patients usually seek advice
due to cosmetic changes, due to the depigmentation at the site of
the lesion.
The course
is variable; healing of the patches may take few days or weeks and
may last for more than a year. Remission and relapse of the skin
lesions are not uncommon, where the new patches may appear at the
previous sites.
Fig. 327. Pityriasis Alba
|
Fig. 328. Pityriasis Alba
|
Fig. 329. Pityriasis Alba
|
Fig. 330. Pityriasis Alba
|
Diagnosis
Diagnosis of
pityriasis alba depends on the clinical picture .
The skin
lesions appear as erythematous, well demarcated covered by fine,
branny adherent scales or as a depigmented patches of a chronic
course eliciting minimal symptoms and affecting mainly children.
Differential
Diagnosis
Psoriasis
It is not
difficult to differentiate pityriasis alba from psoriasis, where the
latter patches show more dense silvery scales and may involve the
scalp and the extremities which are not the sites for pityriasis
alba.
Vitilligo
In vitilligo
the patches are more depigmented and whitish in color and may affect
extensive areas and if the scalp is involved the affected area shows
usually grayish hair.
Discoid
eczema
Discoid
eczema may simulate pityriasis alba clinically but the lesion of
discoid eczema is erythematous showing some vesiculation in the
acute stage, while in the chronic cases of discoid eczema the dry
scaly lesions, especially when it is solitary on the face may
simulate pityriasis alba.
The symptoms
such as itching are more in discoid eczema.
The lesion
of discoid eczema and the skin changes are more prominent.
Treatment
Treatment of
pityriasis alba is non-specific.
Emollient
creams may be helpful.
Mild steroid
such as hydrocortisone combined with salicylic acid, vioform or tar
is some times helpful.
15% oil of
pergamount applied in the morning may help repigmentation.
ERYTHEMA
DYSCHRONICUM PERSTANS
(Ashy
Dermatosis of Ramirez)
This is a
rare syndrome of unknown etiology that affects children and old age.
The disease simulates lichen planus clinically and histologically. .
It is sometimes called lichen pigmentosus. The exact relationship to
lichen planus is uncertain but there are close similarities and both
conditions may coexist.
Clinical
Manifestations
Skin lesions
manifest with numerous macules of varying colors, of gray with a
red, slightly raised and palpably infiltrated margin. They vary in
size and tend to coalesce over extensive areas of the trunk, limbs
and face.
Against the
general grayish background are macules of hypomelanosis or
hypermelanosis.
Histopathology
Vacuolar
degeneration of the basal layer.
The
epidermis contains much pigment and there is pigmentary
incontinence. The dermal vessels are sleeved with an infiltrate of
lymphocytes and histiocytes, and there are many melanophages.
Differential
Diagnosis
The
pigmented macules resemble very closely the lesions of the late
pinta, but the negative dark-field examinations; negative
serological tests for syphilis and lack of response to penicillin
are important features.
FACIAL
MELANOSIS
Hypermelanosis
involving predominantly the face and the neck is relatively common
and often presents a complex diagnostic problem.
|
Fig. 331. Facial
Melanosis (Cosmetics)
|
Etiology
Genetic and
racial factors
Dark skin
individuals
especially
type III & IV skin types, are more susceptible to
hypermelanosis.
Mongoloids.
Endocrine
factors play a major
role in cloasma and are implicated to some degree in other
melanosis. Addisonian pigmentation, the condition is more frequent
in women.
External
agents: light and
photodynamic chemicals are essential factors.
Occupational
melanosis.
Riehl‘s
melanosis, erythrosis and poikiloderma of Civatte.
Cosmetics are
frequently a cause of facial melanosis.
Tar
derivatives and
compounds in cosmetics.
Nutritional:
and other factors may be involved. Some cases occur in children and
in others there is no history of contact with cosmetics.
Idiopathic :
certain types of facial melanosis may be of unknown cause.
Clinical
Features
Brownish-gray
pigmentation develops quite rapidly over the greater part of the
face but is more intense on the forehead and temples.
Smaller
pigmented macules, often perifollicular, lie beyond the indefinite
margin.
The
pigmentation may extend to the chest, neck and scalp, and
occasionally involves hands and forearms. Horny plugs fill the
follicles and there may be some scaling.
PERIORBITAL
HYPERPIGMENTATION
This is
hyperpigmentation that usually involves the periorbital areas and
may extend to the eyelids and cheeks .The pigmented areas are either
deep brown or appear as black halos around the orbits.
Etiology
Different
factors may predispose to periorbital hyperpigmentation mainly:
- Sleep
disturbance.
- Exhaustion
to the periorbital muscles as a result of reading, TV and others.
- Stress and
emotional instability.
- Biliary
diseases.
- Cachexia.
- Hereditary
factors.
|
Fig. 332. Periorbital Hyperpigmentation
|
Treatment of
Periorbital Melanosis
Cold milk
compresses applied to the periorbital area twice daily followed by a
bleaching agent such as hydroquinone (Eldoquine 2%).
POIKELODERMA
OF CIVATTE
This skin
disorder occurs in middle-aged women on the sun-exposed areas. The
age incidence suggests that an unknown endocrine factor or age
change may also play some part.
Clinical
Features
Reddish-brown
reticulate pigmentation with telangiectasia and atrophy develops in
irregular more or less symmetrical patches on the lateral cheeks and
the sides of neck but spares the area shaded by the chin.
MONGOLIAN
SPOTS
These are
seen in 90% of Mongoloid babies and less frequently in Negroid
babies, and usually affect the lumbosacral region. These are poorly
circumscribed areas of slate-brown or blue-black that is sometimes
very extensive and may be mistaken for bruises.
They usually
fade in early childhood, but the aberrant extrasacral spots can
persist. The dermal melanocytes in the persistent Mongolian spots
have an extracellular sheath as is also seen in the nevus of Ito.
|
Fig. 333. Mongolian spots
|
NEVUS OF OTA
(Oculodermal
melanocytosis)
Clinical
Features
The
hyperpigmentation affects one side of the face in the area supplied
by the ophthalmic and maxillary divisions of the trigeminal nerve.
Occasionally it is bilateral. It is usually congenital but may
appear later in life. It is more prevalent in the Japanese but is
observed in other races.
|
Fig. 334. Nevus of ota
|
The color is
variable, but usually is either slate-brown or blue.
The sclera
is involved and there may be hyperpigmentation of the cornea, iris,
retina, ocular muscles and orbit. Sometimes there is pigmentation of
the hard palate.
Deafness
occurring in a patient with nevus of Ota has been reported.
Melanomas may develop in the skin, eye and brain of these patients,
more frequently in white patients than in the Japanese.
NEVUS OF ITO
In this
condition the increased pigmentation affects the area supplied by
the posterior supra clavicular and lateral brachial cutaneous
nerves.
|
Fig. 335. Nevus of Ito
|
BLUE NEAEVUS
These
commonly occur on the hands and feet, usually early in life.
The more
cellular and elevated lesions may rarely undergo malignant change.
|
Fig. 336. Blue Nevus
|
POIKELODERMA
CONGENITALE
(Thomson Syndrome)
Poikeloderma
congenitale is a rare disease, appears early in infants usually in
the first six months after birth, characterized by telengectasia,
atrophy, and skin pigmentation.
Clinical
Features
Skin lesions
The skin
lesions appear first on the face and hands and extend to neck and
trunk where, the lesions at the end stage closely resemble chronic
radiodermatitis.
The cheeks
are first and most severely involved, but the forehead, chin, neck
and ears seldom escape. The hands, forearms and lower legs are next
affected and the buttocks and thighs are frequently involved.
|
Fig. 337. Poikeloderma
|
Photosensitivity
Light
sensitivity is a feature of many cases. Light sensitivity may be so
severe provoking a bullous response that tends to diminish after
early childhood; it may persist into adult life.
Keratoses:
keratoses develop on exposed skin from adolescence onwards
presenting with large warty keratoses of hands, wrists, feet and
ankles.
Squamous
carcinoma may develop in the keratoses or in the surrounding
atrophic skin.
Hair:
Eyebrows and lashes, pubic and axillary hair is often sparse or
absent.
Scalp hair
is often sparse, fine and may be absent.
Nails:
are normal or small and dystrophic.
Teeth:
are often normal, but microdontia and early caries have been
reported.
Eyes:
bilateral cataracts have developed, usually between the fourth and
seventh year.
Physical
development: is
frequently retarded; most patients are of small stature and some are
dwarfs. The dwarfism is proportionate with slender, delicate limbs,
small hands, feet, and short stubby fingers. The skull may be small
and the features bird-like, sometimes with a saddle-nose.
Expectation of life appears to be normal.
Endocrine
abnormalities:
Hypogonadism
of slight or severe degree is frequent.
Hyper
parathyroidism appears also to be increased.
Mental
development is usually normal, but some cases may be retarded.
Diagnosis of
Poikeloderma
The
essential features in differential diagnosis are:
The age of
onset.
The
distribution of the lesions.
The
combination of atrophy, telangiectasia and mottled pigmentation is
more intense on light-exposed skin.
Differential
Diagnosis
Werner‘s
syndrome:
The skin
changes are essentially sclerodermatous, and both skin and ocular
lesions develop later than in the Rothmund-Thomson syndrome.
Dyskeratosis
congenita:
Reticulate
pigmentation develops between the ages of 5 and 13, and is most
marked on the neck, trunk and thighs. Atrophy and telangiectasia may
appear later. The nail changes are constant and severe.
Progeria the
child is often small but otherwise normal during the first year,
thereafter development is retarded. The scalp hair, brows and lashes
are lost and the skin assumes an increasingly senile appearance.
Cockayne‘s
syndrome:
Light
sensitivity is a conspicuous feature after the first year, but there
is no poikiloderma.
Hypohidrotic
ectodermal dysplasia:
There is
combinations of conical teeth, hypotrichosis and partial or complete
anhidrosis. The skin is atrophic but not poikilodermatous.
Xeroderma
pigmentosum:
In the mild
forms there is only freckle-like macules.
Rothmund-Thomson
syndrome:
Telangiectasia
is the conspicuous feature.
Focal dermal
hypoplasia:
Telangiectasia
is often irregular, linear and present at birth.
Bloom‘s
syndrome:
Eerythema,
and not poikiloderma, is the essential change.
ACROKERATOTIC
POIKILODERMA
This
syndrome, probably is determined by an autosomal dominant gene Clinical
features
-
Vesiculopustular eruption of hands and feet in infancy and
childhood.
-
Extensive eczema from 3 or 6 months to 5 years;
-
Persistent poikiloderma, sparing only the face, scalp and ears,
-
Warty
papules on hands, feet, elbows and knees.
-
Pallor
and lividity.
-
Lead line
on gums
Treatment of
Hypermelanosis
Treatment of
the cause.
Avoid
excessive exposure to sun.
Sunscreens
can be used before exposure to sunlight.
Cosmetic
camouflage may also be indicated.
Skin
bleaching agents
Skin-bleaching
preparation: hydroquinone (Eldoquine 2-4%) may help in some cases.
Care should
be taken in using strong concentrations especially in children and
those with delicate skin. Local irritation is very common and
hypopigmentation, pigmented colloid milium and even vitilligo like
reactions may develop with the long use of this potent hydroquinone.
Side effects
of hydroquinone
It should be
noted that hydroquinones are not very effective for post
inflammatory hyperpigmentation. The monobenzyl ether of hydroquinone
is responsible for many therapeutic and cosmetic disasters and the
compound should be used only to bleach away the remaining pigmented
areas in patients with extensive vitiligo.
Several
other substituted phenols such as 4-isopropylcatechol can produce
cutaneous depigmentation: however, this compound and others are
irritant and may produce local sensitization.
Lasers are
recently used effectively and safely in treatment of pigmented skin
lesions. Q-switched ruby, Pulsed dye laser and other types can be
used with variable degrees of improvement. The results are better in
those who have fair or white skin color.
REFERENCES
-
Haake
AR, Scott GA. Physiologic distribution and differentiation of
melanocytes in human fetal and neonatal skin equivalents. J Invest
Dermatol 1991; 96: 71-7.
-
Medrano
EE, Nordlund JJ. Successful culture of adult human melanocytes
obtained from normal and vitiligo donors. J Invest Dermatol 1990;
95: 441-5.
-
Morelli
JG, Yohn JJ, Lyons MM et al. Leukotrienes C4 and D4 as potent
mitogens for cultured human neonatal melanocytes. J Invest
Dermatol 1989; 93: 719-22.
-
Snell
RS. Hormonal control of pigmentation in man and other mammals. In:
Montagna W, Hu F, eds. Advances in the Biology of the Skin. Vol
VIII. The Pigmentary System. Oxford: Pergamon, 1967: 447-66.
-
Zimmerman AA, Becker SW, Jr. Melanoblasts and melanocytes in fetal
negro skin. Illinois Monographs in Medical Science Vol 6, no 3.
Urbans: University of Illinois Press, 1959.
-
Seiji
M, Iwashita S. Intracellular localization of tyrosinase and site
of melanin formation in melanocyte. J Invest Dermatol 1965; 45:
305-14.
-
Toda K,
Fitzpatrick TB. In: Kawamura T et al. eds. Biology of Normal and
Abnormal Melanocytes. Tokyo: Tokyo University Press, 1971: 265-78.
-
Gordon
PR, Gilchrest BA. Human melanogenesis is stimulated by
diacylglycerol. J Invest Dermatol 1989; 93: 700-2.
-
Fulk
CS. Primary disorders of pigmentation. J Am Acad Dermatol 1984;
10: 1-16.
-
Maso
MJ, Schwartz RH, Lambert C. Dermatopathia pigmentosa reticularis.
Arch Dermatol 1990; 126: 935-9.
-
Lunec
J, Fisher C, Parker GV et al. Pigment cells are able to synthesise
MSH peptides. J Invest Dermatol 1988; 91: 407.
-
Gilchrest BA, Vrabel MA, Flynn E et al. Selective cultivation of
human melanocytes from newborn and adult epidermis. J Invest
Dermatol 1984; 83: 370-6.
-
Fitzpatrick TB. The validity and practicality of sun-reaction skin
types I through VI. Arch Dermatol 1988; 124: 869-71.
-
Kaidbey KH, Poh Agin P, Sayre RM et al. Photoprotection by melanin
- a comparison of black and caucasian skin. J Am Acad Dermatol
1979; 1: 249-60.
-
Thompson GW, Diehl AK. Partial unilateral lentiginosis. Arch
Dermatol 1980; 116: 356.
-
Nordlund JJ, Lerner AB, Braverman IM et al. The multiple
lentigines syndrome. Arch Dermatol 1973; 107: 259-61.
-
O‘Neill JF, James WD. Inherited patterned lentiginosis in
Blacks. Arch Dermatol 1989; 215: 1231-5.
-
Barnes
CM. Incontinentia pigmenti: a report of a case with persistent
activity into adult life. Cutis 1978; 22: 621-4.
-
Moss
C, Ince P. Anhidrotic and achromians lesions in incontinentia
pigmenti. Br J Dermatol 1987; 116: 839-49.
-
Hays
GB, Lyle CB, Wheeler CE. Slate-gray color in patients receiving
chlorpromazine. Arch Dermatol 1964; 90: 471-6.
-
Hashimoto K, Wiener W, Albert J et al An electron microscopic
study of chlorpromazine pigmentation. J Invest Dermatol 1966; 47:
296-306.
-
Mahler
R, Sissons W, Watters K. Pigmentation induced by quinidine
therapy. Arch Dermatol 1986; 122: 1062-4.
-
Marriott P, Borrie PF. Pigmentary changes following chloroquine.
Proc Roy Soc Med 1975; 68: 535-6.
-
Adam
BA, Ismail R, Sivanesan S. Busulfan hyperpigmentation. J Dermatol
1980; 7: 405-11.
-
Gordon
G, Sparano BM, Iatropoulos MJ. Hyperpigmentation of the skin
associated with minocycline therapy. Arch Dermatol 1985; 121:
618-23.
-
Bronner AK, Hood AF. Cutaneous complications of chemotherapeutic
agents. J Am Acad Dermatol 1983; 9: 645-63.
-
Masu
S, Seiji M. Pigmentary incontinence in fixed drug eruptions. J Am
Acad Dermatol 1983; 8: 525-32.
-
Toda
K. Alteration of racial differences in melanin distribution in
human epidermis after exposure to ultraviolet light. Nature (New
Biol) 1972; 236: 143.
-
Bleehen SS. Freckles induced by PUVA treatment. Br J Dermatol
1978; 99 (Suppl. 16): 20.
-
Rhodes
AR, Stern RS, Melski JW. The PUVA lentigo: an analysis of
predisposing factors. J Invest Dermatol 1983; 81: 459-63.
-
Person
JR, Rogers RS. Ashy dermatosis. Arch Dermatol 1981; 117: 701-4.
-
Wiklund DA, Weston WL. Incontinentia pigmenti. Arch Dermatol 1980;
116: 701-3.
-
Schroeder TM, Tilgen D, Kruger J et al. Formal genetics of
Fanconi‘s anemia. Hum Genet 1976; 32: 257-88.
-
Delacretaz J, Rutschmann JP. Allbright‘s syndrome and associated
disorders. Dermatologica 1960; 112: 107-20.
-
Griffiths WAD. Reticulate pigmentary disorders - a review. Clin
Exp Dermatol 1984; 9: 439-50.
-
Kenney
JA Jr. Pigmentary disorders in black skin. Clin Dermatol 1989; 7:
1-10.
-
Jimbow
M, Jimbow K. Pigmentary disorders in oriental skin. Clin Dermatol
1989; 7: 11-27.
-
Benmaman O, Sanchez JL. Treatment and camouflaging of pigmentary
disorders. Clin Dermatol 1988; 6: 50-61. Macaron C, Winter RJ,
Traisman HS et al. Vitiligo and juvenile diabetes mellitus. Arch
Dermatol 1977; 113: 1515-17.
-
Koranue RV, Sachdeva KG. Vitiligo. Int J Dermatol 1988; 27:
676-81.
-
Naughton GK, Eisinger M, Bystryn J-C. Detection of antibodies to
melanocytes in vitiligo by specific immunoprecipitation. J Invest
Dermatol 1983; 81: 540-42.
-
Ortonne J-P et al., eds. In: Vitiligo and other Hypomelanoses of
Hair and Skin. New York: Plenum Medical, 1983: 129.
-
Padgett GA, Reiquam CW, Gorham JR et al. Comparative studies of
the Chediak-Higashi syndrome. Am J Pathol 1967; 51: 553-71.
-
Ashley
JR, Littler CM, Burgdorf WHC et al. Bronze baby syndrome: report
of a case. J Am Acad Dermatol 1985; 12:325-8.
-
Pariser RJ. Generalized argyria. Arch Dermatol 1978; 114: 373-7.
-
King
RA, Witkop CJ. Hair-bulb tyrosinase activity in oculocutaneous
albinism. Nature 1976; 263: 69-71.
-
Okoro
AN. Albinism in Nigeria. Br J Dermatol 1975; 92: 485-92.
-
Witkop
CJ, Quevedo WC, Fitzpatrick TB et al. Albinism. In: Scriver CR et
al., eds. The Metabolic Basis of Inherited Comings DE, Odland GF.
Partial albinism. J Am Med Assoc 1966; 195: 519-23.
-
Falabella R. Grafting and transplantation of melanocytes for
repigmenting vitiligo and other types of leukoderma. Int JDermatol
1989; 28: 363-72.Disease 6th edn. New York: McGraw Hill, 1989.
-
Zaynoun ST, Aftimos BG, Tenekjian KK. Extensive pityriasis alba: A
histological, histochemical and ultrastructural study. Br J
Dermatol 1983; 108: 83-90.
-
Watkins DB. Pityriasis alba: a form of atopic dermatitis. Arch
Dermatol 1962; 83: 915-19.
-
Wells
BT, Whyte BT, Kierland R. Pityriasis alba. A ten year survey and
review of the literature. Arch Dermatol 1960; 82: 183-9.
-
Watkins DB. Pityriasis alba: a form of atopic dermatitis. Arch
Dermatol1962; 83: 915-19.
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