COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE in .NET

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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

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

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

PIPA is difficult to treat because it occurs in individuals susceptible to hyperpigmentation following inflammation

melanosomes and melanin production,96 which can be explained by the effects of prostaglandins in the melanin synthesis pathway

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

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