Tuesday, April 29

Post inflammatory hypopigmentation

Post inflammatory hypopigmentation - Causes and treatment
What is post inflammatory hypopigmentation?
Hypopigmentation is the partial or total loss of skin pigment.
Many inflammatory skin conditions lead to hypopigmentation, post cessation of the inflammation. Skin inflammation is caused by skin injuries, reactions, infections and dermatological procedures. In most of the cases, the hypopigmentation improves with the resolution of the causative factor. For complete recovery and repigmentation, it may take several days to several months.

Post inflammatory hypopigmentation is very common and appears post skin inflammation. It can affect both the genders of all ages. In persons with darker skin tone it becomes over emphasized. Basically the depigmentation occurs due to loss of melanin pigment, inhibition of melanogenesis, dysfunction of melanocytes, or loss of melanocytes. If there is complete destruction of melanocytes or melanocyte death, the post inflammatory hypopigmentation may become permanent. The size, shape and distribution of hypopigmentation is directly related to original causative inflammation.

Causes of post inflammatory hypopigmentation

The causes of post inflammatory hypopigmentation [1] include many inflammatory skin conditions, skin trauma and injuries, dermatological procedures and infective diseases.
Skin injuries and trauma
Abrasions (grazes)
Avulsions
Burns
Crush injury
Freezing
Hematomas
Incisions (cuts)
Insect bites
Lacerations
Puncture and penetration wounds
Surgical incision closures
Skin inflammatory conditions
Allergic contact dermatitis
Atopic dermatitis
Bullous pemphigoid
Discoid lupus erythematosus
Eczema
Granuloma annulare
Lichen planus
Lichen striatus
Psoriasis
Scleroderma
Seborrheic eczema
Skin infections and diseases
Acne
Carbuncle
Cellulitis
Chickenpox
Cutaneous candidiasis
Herpes simplex
Herpes zoster (shingles)
Impetigo
Tinea Versicolor
Dermatological procedures
Chemical peels
Cryotherapy
Dermabrasion
Dermaplaning
Laser resurfacing
Laser therapy
Microdermabrasion
Punch grafts
Tattoos

Post inflammatory hypopigmentation treatment and management

  • The primary cause of the post inflammatory hypopigmentation must be diagnosed and treated. In many cases the hypopigmentation improves over time post resolution of the inflammation. The treatment and management options of post inflammatory hypopigmentation include sun exposure, phototherapy, topical repigmenting medication, laser therapy, camouflage procedures, skin transplants and autologous melanocyte transplantation.

    Coal tar topical preparations have been successively used for stimulating repigmentation. Coal tar causes increased skin sensitivity to sunlight, so treated area should be protected from sunlight. Coal tar in combination with topical steroid has been found to be more effective.

  • Topical pimecrolimus is an immunomodulating agent found useful in treating atopic dermatitis which results in repigmentation. Long term use of the topical application is considered to have increased risk of lymph node or skin cancer.

    Exposure to sunlight or phototherapy with ultraviolet light induces the melanogenesis. The dose of exposure must be closely monitored so as not cause sunburn or tan.

    Choi KH et al [2] in their study "Treatment of Vitiligo with 308-nm xenon-chloride excimer laser: therapeutic efficacy of different initial doses according to treatment areas"
  • concluded that 308-nm xenon-chloride excimer laser was effective in inducing repigmentation of the hypopigmentation patches of vitiligo.

    Camouflage procedures like tattoo had been successfully used to cover small areas of post inflammatory hypopigmentation.

    In cases where the melanocyte loss is permanent, skin transplants and autologous melanocyte transplantation have been successfully done to manage post inflammatory hypopigmentation. In autologous melanocyte transplantation, cultured melanocytes are introduced into the hypopigmentation skin.

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    Reference:
    1.Vachiramon, V. and Thadanipon, K. (2011), Postinflammatory hypopigmentation. Clinical and Experimental Dermatology, 36: 708–714. doi: 10.1111/j.1365-2230.2011.04088.
    2.Choi KH, Park JH, Ro YS. Treatment of Vitiligo with 308-nm xenon-chloride excimer laser: therapeutic efficacy of different initial doses according to treatment areas. J Dermatol. 2004 Apr;31(4):284-92.

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