Another pattern is orificial, with depigmented areas surrounding orifices nares, mouth, vagina, urethra, and anus. Treatment of choice for limited disease is mid- to high-potency topical corticosteroids, although topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, can also be very beneficial. If treatment is successful, repigmentation usually occurs within 3 to 4 months. Narrow-band ultraviolet B and PUVA topical or systemic psoralens followed by ultraviolet [UV] A exposure therapy twice weekly is effective treatment for extensive disease.
Unresponsive areas can be camouflaged with make-up or self-tanning creams containing dihydroxyacetone. Epidermal grafting can help some patients with stable disease. Oval ash leaf hypopigmented macules are the earliest cutaneous sign of tuberous sclerosis. Such light patches can occur at birth or in early infancy; they are often multiple and irregularly scattered on the body.
Ash leaf spots can resemble nevus depigmentosus, a single, stable, well-circumscribed hypomelanotic macule present at birth. Idiopathic guttate hypomelanosis is a common benign acquired disorder characterized by small, well-defined, round white macules on the sun-exposed areas of the legs and forearms. The patches are usually asymptomatic and can resemble vitiligo.
Women are more commonly affected. Treatment is not necessary. Summary Suggested Readings. See, Play and Learn Images. Research Clinical Trials Journal Articles. Resources Find an Expert. Start Here. Also in Spanish. Diagnosis and Tests. Treatments and Therapies. Living With. Clinical Trials. Article: Cutaneous lupus concerns from the patient perspective: a qualitative study. Skin colour Suntan in dark skin.
Generalised hyperpigmentation or hypermelanosis may rarely arise from excessive circulating melanocyte -stimulating hormone MSH when it often has a bronze hue. It occurs:. A differential diagnosis is carotenoderma , in which the skin colour takes on a yellow-orange hue due to ingestion of coloured fruit and vegetables. Localised pigmentation may be due to melanin, haemosiderin , or externally-derived pigment.
Localised hyperpigmentation Diffuse lentiginosis. This is not effective for melanin located in the dermis or to reduce pigmentation caused by carotene , drugs, or tattoos. The following agents can be used to lighten epidermal melanosis alone or, more effectively, in combination:. Resurfacing using chemical peels , laser especially picosecond laser , intense pulsed light IPL or dermabrasion may be effective but unfortunately risks further damage to the epidermis and formation of more pigment.
Cautious cryotherapy to small areas of postinflammatory pigmentation can be effective but risks causing permanent hypopigmentation. Cosmetic camouflage using make-up is sometimes the best advice. Generalised reduction in melanin pigmentation at birth congenital may be racial in origin or due to albinism. Pituitary failure resulting in lack of MSH rarely results in acquired generalised hypomelanosis.
Pallor is much more frequently due to blood loss or anaemia.
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