PIGMENTARY

DISORDERS

Pigmentary disoders:
- Hypomelanoses
- Hypermelanoses

Hypomelanoses:
- Piebaldism
- Idiopathic guttate
- Vitiligo
hypomelanoses
- Pinta
- drugs:
- Albinism
- arsenical
- Leprosy
- chloroquine
- Pityriasis alba
- hydroquinone
- Pityriasis versicolor
- retinoid

Hypermelanoses:
- Lentigines
- Nevus melanositic
- Berloque dermatitis - melasma
- Pityriasis versicolor -Berloque dermatis
- Drugs
- 5 Fluoro Uracil
- Cyclophosphamide
- Topical Bleomycine

VITILIGO

Definition
It

is

an

acquired,

often

disfiguring, anomaly of the

skin

manifested

by

depigmented white patches

surrounded by anormal or a
hiperpigmented.

Etiology
Complex :
Genetic predisposition.
Precipitating factors.

Clinical Manifestation
Macula has a chalk or
milk-white color.
Several variation :
Trichrome vitiligo.
Quadrichrome vitiligo.
Pentachrome vitiligo.
Inflammatory vitiligo.

Hypopigmentation maculas on the face, neck and

Chest

Hipopigmentation on the glans penis

Hypopigmentation macula on the finger

Morbus Hansens tuberculoid type

Hypopigmentation maculas of Tinea versicolor

Hypopigmentation maculas of Tinea versicolor

Hypopigmentation maculas of Idiopathic guttate

hypomelanosis

Types of Vitiligo
1. Focal vitiligo.
2. Segmental vitiligo

3. Generalized vitiligo.
4. Other cutaneus abnormalities.

Incidence

1 - 2% of the population
(0.14 - 8.8%).

Prevalence
All races are affected.

Sex : male = female.

Developed at any age.
Peak age of onset : 10 - 30

years.

Histopathology
Absence of dopa-positive
melanocytes.

Langerhans
increased.

cell

no

Pathogenesis
Autoimmunity.
Neurohumoral.
Exogenous chemical exposures.

Diagnosis
Anamnesis.
Clinical manifestation.
Histopathology.

Treatment
Spontaneus repigmentation (15 - 25%).

Psoralen

ultra

violet

repigmentation (50 70%).

Systemic steroid.
Surgical therapy.

(PUVA):

INTRODUCTION
Definition
Also known as chloasma
Melasma a common aquired
symetrical hypermelanosis characterized
by irregular light-brown to grey brown
macules and patches on sun-exposed
areas of the skin.

EPIDEMIOLOGY
Age of onset young adults
Sex Female >> male
(10% men )
Race more frequent in person with
brown or black constitutive skin
colour

ETIOLOGY
The precise cause is as yet unknown, but
the contributing factors include :
Genetic
Endocrine disfunction
Pregnancy
Drugs
Cosmetics
UltraViolet light
exposure

PATHOGENESIS
Unknown.

preparation alone post

menopauseal women
melasma,
despite sun exposure
pregnancy melasma, (combination of
estrogen and progestational agent) as used
for contraception frequent melasma.
Estrogen

HISTOPATOLOGY
melanin
Basal and suprabasal higher than
normal level of melanin
Dermalblue-gray, melanin laden
macrophages occur in perivascular
superficial & mid-dermal
Epidermal

HISTOPATOLOGY
Ultrastructure

shows :

melanocytes
melanogenesis

Transfer of melanosomes
Size & percentage of melanosomes in

keratinocyte

PHYSICAL EXAMINATION

Large patches of epidermal or

dermal commonly involve :
Cheeks
Forehead
Nose
Mustache area
Eyebrows
Chin

PHYSICAL EXAMINATION
Three typical patern of distribution :
Centrofacial : cheeks, forehead,

upperlip, nose and chin

Malar : nose and cheeks
Mandibular : less common

Clinical manifestation
Macular lesions:
- serrated
- irreguler
- geographic border
- usually symetry

Hyperpighmentation on the cheek

Hyperpigmentation maculas on both of cheeks

Clinical manifestation:
Type of hypermelanosis:
- brown (epidermal)
- blue-grey (dermal)
- brown-grey (mixed)

Woods lamp examination

Epidermal type: lesions of contrast with
around normal skin
Dermal type : lesions of no contrast with
around normal skin
Mixed type
: there are lesions contrast
or no with around normal

TREATMENT
The

principles of therapy :

Protection from sunlight

Inhibition of the activity of melanocytes

Inhibition of the synthesis of melanin

Removal of melanin
Disruption of melanin granules

TREATMENT
Protection from sunlight
Sunscreen : Sun protection factor (SPF)
Cosmetics : acylglutamate (cleanser)
Systemic drug: chloroquin, Vit.C & E,

TREATMENT
Inhibition of the activity of
melanocytes
Avoiding :
Exposure to sunlight
Pregnancy
Birth control pills
Scented cosmetics
Phototoxic drugs

TREATMENT
Inhibition of the syntesis of
melanin
Topical hydroquinone 2% - 4%
Kojic acid 2 4 %
Azeleic acid 20 %.

TREATMENT
Removal of melanin
Trichloroacetic acid (TCA)
Jesners Solution
Glycolic acid 70 %
Disruption of melanin granules
Pigmented laser

DIFFERENTIAL DIAGNOSE
Post inflamatory hypermelanosit
Tinea Versicolor
Acquired brachial Cutaneus dyschromatos
Tar Melanosis
Pellagra
Photocontact dermatitis

Thank You