COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
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Postinflammatory hyperpigmentation is a consequence of increased melanin synthesis in response to a cutaneous insult It can be diffused or localized and its distribution depends on the location of the original injury
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The development of unusual melanocytic lesions after exposure to UVA tanning beds has been reported Clinically, these lesions appear similar to the lentigines that occur after psoralen photochemotherapy84 The histologic examination of these lentigos has revealed melanocytic hyperplasia and cytologic atypia85 Therefore, patients with these lesions may be at an increased risk of skin cancer These patients should be cautioned about the hazards of tanning bed use and should have annual skin examinations
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PIPA is characterized by numerous melanophages in the superficial dermis An infiltrate of lymphohistiocytes may be seen around superficial blood vessels and in dermal papillae91
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PIPA is difficult to treat because it occurs in individuals susceptible to hyperpigmentation following inflammation
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melanosomes and melanin production,96 which can be explained by the effects of prostaglandins in the melanin synthesis pathway
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In recalcitrant disorders such as melasma, camouflage cosmetics can be used to give the patient a more natural appearance during the treatment process These products are opaque and do not allow the underlying skin tones to be seen The product is usually a thick cream that can be made to match a normal skin tone, thus masking the underlying abnormality Some companies have developed advanced techniques using a spectrophotometer to measure skin color The data from the spectrophotometer are used to create a pigment-rich foundation that exactly matches the patient s skin tone Because skin tones are so widely varied, these products provide the best solution for patients with hard-to-match skin tones Another option is to use a color that is complementary to the unwanted color For example, green can be used to cover red discolorations, or purple to cover yellow discolorations Yellow and white camouflage products are the most effective in treating melasma and other brown pigmentation disorders Patients then apply their normal facial foundation over the color camouflage in order to achieve the most natural look There are many brands of cover cosmetics available including Cover Blend, Covermark, Christian Dior, Dermablend, Hard Candy, Joe Blasko, MAC, and Neutrogena
All skin types are susceptible to pigmentation disorders Such alterations can be particularly prominent in people with dark skin tones Therapy is difficult and occasionally frustrating for patients and dermatologists alike as it requires protracted topical application of agents, sun avoidance, and, often, in-office chemical peels Unfortunately, there is no panacea to treat these intractable disorders and attempts at resolving the particular condition often entail trying many different therapies with varying degrees of success
1 Jimbow K, Quevedo WC Jr, Fitzpatrick TB, et al Some aspects of melanin biology: 1950 1975 J Invest Dermatol 1976;67:72
2 Bolognia JL, Pawelek JM Biology of hypopigmentation J Am Acad Dermatol 1988;19:217 3 Szabo G, Gerald AB, Pathak MA, et al Racial differences in the fate of melanosomes in human epidermis Nature 1969; 222:1081 4 Mosher D, Fitzpatrick T, Ortonne J, Hori Y Hypomelanoses and Hypermelanoses In: Freedberg IM, Eisen AZ, Wolff K, eds Fitzpatrick s Dermatology in General Medicine, 5th ed New York, NY: McGraw-Hill; 1999:996 5 Khlgatian MK, Hadshiew IM, Asawanonda P, et al Tyrosinase gene expression is regulated by p53 J Invest Dermatol 2002; 118:126 6 Park HY, Russakovsky V, Ohno S, et al The beta isoform of protein kinase C stimulates human melanogenesis by activating tyrosinase in pigment cells J Biol Chem 1993;268:11742 7 Lee JH, Park JG, Lim SH, et al Localized intradermal microinjection of tranexamic acid for treatment of melasma in Asian patients: a preliminary clinical trial Dermatol Surg 2006;32:626 8 Tomita Y, Torinuki W, Tagami H Stimulation of human melanocytes by vitamin D3 possibly mediates skin pigmentation after sun exposure J Invest Dermatol 1988;90:882 9 Wei Q, Wu X, Hammer JA III The predominant defect in dilute melanocytes is in melanosome distribution and not cell shape, supporting a role for myosin V in melanosome transport J Muscle Res Cell Motil 1997;18:517 10 Ogawa K, Hosoya H, Yokota E, et al Melanoma dynein: evidence that dynein is a general motor for microtubule-associated cell motilities Eur J Cell Biol 1987;43:3 11 Nordlund JJ The melanocyte and the epidermal melanin unit: an expanded concept Dermatol Clin 2007;25:271 12 Seiberg M, Paine C, Sharlow E, et al Inhibition of melanosome transfer results in skin lightening J Invest Dermatol 2000;115:162 13 Nystedt S, Emilsson K, Larsson AK, et al Molecular cloning and functional expression of the gene encoding the human proteinase-activated receptor 2 Eur J Biochem 1995;232:84 14 Seiberg M Keratinocyte-melanocyte interactions during melanosome transfer Pigment Cell Res 2001;14:236 15 Seiberg M, Paine C, Sharlow E, et al The protease-activated receptor 2 regulates pigmentation via keratinocyte-melanocyte interactions Exp Cell Res 2000;254:25 16 Wallo W, Nebus J, Leyden JJ Efficacy of a soy moisturizer in photoaging: a doubleblind, vehicle-controlled, 12-week study J Drugs Dermatol 2007;6:917 17 Quast T, Wehner S, Kirfel G, et al sAPP as a regulator of dendrite motility and melanin release in epidermal melanocytes and melanoma cells FASEB J 2003;17:1739 18 Cardinali G, Bolasco G, Aspite N, et al Melanosome transfer promoted by keratinocyte growth factor in light and dark skin-derived keratinocytes J Invest Dermatol 2007Sep 20 [Epub ahead of print] 19 Valverde P, Healy E, Jackson I, et al Variants of the melanocyte-stimulating hormone receptor gene are associated with red hair and fair skin in humans Nat Genet 1995;11:328
20 Rees JL The genetics of sun sensitivity in humans Am J Hum Genet 2004;75:739 21 Inoue K, Hosoi J, Ideta R, et al Stress augmented ultraviolet-irradiation-induced pigmentation J Invest Dermatol 2003;121:165 22 Quevedo WC, Fitzpatrick TB, Pathak MA, et al Role of light in human skin color viariation Am J Phys Anthropol 1975;43:393 23 Hermanns J, Petit L, Martalo O, et al Unraveling the patterns of subclinical pheomelanin-enriched facial hyperpigmentation: effect of depigmenting agents Dermatology 2000;201:118 24 Goukassian D, Eller M, Yaar M, et al Thymidine dinucleotide mimics the effect of solar simulated irradiation on p53 and p53-regulated proteins J Invest Dermatol 1999;112:25 25 Gilchrest BA, Eller MS DNA photodamage stimulates melanogenesis and other photoprotective responses J Investig Dermatol Symp Proc 1999;4:35 26 Cui R, Widlund HR, Feige E, et al Central role of p53 in the suntan response and pathologic hyperpigmentation Cell 2007; 128:853 27 Barsh G, Attardi LD A healthy tan N Engl J Med 2007;356:2208 28 Wood JM, Gibbons NC, Schallreuter KU Melanocortins in human melanocytes Cell Mol Biol (Noisy-le-grand) 2006;52:75 29 D Orazio JA, Nobuhisa T, Cui R, et al Topical drug rescue strategy and skin protection based on the role of Mc1r in UVinduced tanning Nature 2006;443:340 30 Mandry Pag n R, S nchez JL Mandibular melasma P R Health Sci J 2000;19:231 31 Bose SK, Ortonne JP Pigmentation: dyschromia In: Baran R, Maibach, HI, eds Textbook of Cosmetic Dermatology, 2nd ed London, UK: Dunitz Martin, Ltd; 1998:396-367 32 In: Arnold HL, Odom RB, James WD, eds Andrews Diseases of the Skin: Clinical Dermatology 8th ed Philadelphia, PA: WB Saunders;1990:991-994 33 McLeod SD, Ranson M, Mason RS Effects of estrogens on human melanocytes in vitro J Steroid Biochem Mol Biol 1994;49:9 34 Sanchez NP, Pathak MA, Sato S, et al Melasma: a clinical, light microscopic, ultrastructural, and immunofluorescence study J Am Acad Dermatol 1981;4:698 35 Bleehen SS, Ebling FJG, Champion RH Disorders of the skin colours In: Champion RH, Burton JH, Ebling FJG, eds Textbook of Dermatology 5th ed Oxford, UK: Blackwell Science; 1992:1596- 97 36 Schauer E, Trautinger F, Kock A, et al Proopiomelanocortin-derived peptides are synthesized and released by human keratinocytes J Clin Invest 1994;93:2258 37 Imokawa G, Yada Y, Morisaki N, et al Biological characterization of human fibroblast-derived mitogenic factors for human melanocytes Biochem J 1998; 330:1235 38 Kang HY, Hwang JS, Lee JY, et al The dermal stem cell factor and c-kit are overexpressed in melasma Br J Dermatol 2006;154:1094 39 Grimes PE, Yamada N, Bhawan J: Light microscopic, immunohistochemical, and ultrastructural alterations in patients with melasma Am J Dermatopathol 2005;27:96 40 Gilchrest BA, Fitzpatrick TB, Anderson RR, et al Localization of melanin pigmentation in the skin with Wood s lamp Br J Dermatol 1977;96:245