J Korean Med Sci.  2016 Dec;31(12):2042-2050. 10.3346/jkms.2016.31.12.2042.

Acquired Bilateral Dyspigmentation on Face and Neck: Clinically Appropriate Approaches

• Lee YJ
• Park JH
• Lee DY
• Lee JH

• KMID: 2355637
• DOI: http://doi.org/10.3346/jkms.2016.31.12.2042

Abstract

Facial dyspigmentation in Asian women often poses diagnostic and therapeutic challenges. Recently, a distinctive bilateral hyperpigmentation of face and neck has occasionally been observed. This study was performed to investigate the clinico-pathological features of this dyspigmentation as well as proper treatment approaches. We retrospectively investigated the medical records including photographs, routine laboratory tests, histopathologic studies of both lesional and peri-lesional normal skin and patch test of thirty-one patients presented acquired bizarre hyperpigmentation on face and neck. The mean age of patients was 52.3 years and the mean duration of dyspigmentation was 24.2 months. In histologic evaluations of lesional skin, a significantly increased liquefactive degeneration of basal layer, pigmentary incontinence and lymphocytic infiltration were noted, whereas epidermal melanin or solar elastosis showed no statistical differences. Among 19 patients managed with a step-by-step approach, seven improved with using only topical anti-inflammatory agents and moisturizer, and 12 patients gained clinical benefit after laser therapy without clinical aggravation. Both clinical and histopathologic findings of the cases suggest a distinctive acquired hyperpigmentary disorder related with subclinical inflammation. Proper step-by-step evaluation and management of underlying subclinical inflammation would provide clinical benefit.

Keyword

Facial Dyspigmentation; Hyperpigmentation; Subclinical Inflammation; Anti-inflammatory Agents; Laser Therapy

MeSH Terms

Anti-Inflammatory Agents
Asian Continental Ancestry Group
Female
Humans
Hyperpigmentation
Inflammation
Laser Therapy
Medical Records
Melanins
Neck*
Patch Tests
Retrospective Studies
Skin
Anti-Inflammatory Agents
Melanins

Figure

• 

  Fig. 1 Clinical photographs. Pigmentation was prominent on lateral face, perioral and neck. (A) M/51 Brownish mottled patch developed on face and neck 6 months ago. (B) F/55 Slate-greyish colored patch developed for 12 months on lateral face and neck. (C) F/33 Grey colored patch slowly developed over 5 years.

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  Fig. 2 Histopathological evaluations of lesion and peri-lesional normal skin. Marked vacuolar degeneration of basal layer and melanin pigment deposition are found in lesional skin biopsy (A, B). (A) Haematoxylin and eosin staining × 200, (B) HMB45 immunostaining × 200.

• 

  Fig. 3 Histologic evaluation of lesion (A) and perilesional normal skin (B). Distinctive (over grade 2+) liquefactive degeneration of basal layer is observed in lesion (A) compared with peri-lesional normal skin (B). (A, B) Haematoxylin and eosin staining × 200.

• 

  Fig. 4 Clinical photographs (patient No. 14). This female, 45-year-old patient developed hyperpigmentation on lateral face and chin about 12 months ago. Moderate degree (grade 3) of basal layer liquefaction was evident in the biopsy specimen. Topical agent without laser therapy was used. Considerable improvement in pigmentation was noticed in the comparison before treatment (A) and 6 months later (B).

• 

  Fig. 5 Clinical photographs of patients 6 and 10. These patients were treated with topical tacrolimus 0.1% for 6 months due to vacuolar degeneration of basal layer at initial work-up. Laser treatment was subsequently added. (A, D) Before treatment in patient 6 and 10, respectively. (B, E) Six months after topical tacrolimus 0.1%, same respective order. (C, F) Eighteen months after treatment (topical tacrolimus 0.1% 6 months followed by laser for 12 months), same respective order.

• 

  Fig. 6 Step-by-step approach for refractory facial hyperpigmentation. In step 1, underlying allergic tendency is checked by with thorough history-taking and/or blood work. In step 2, the degree of inflammation and resiliency of dermis are determined. In step 3, the topical agent is used to reduce inflammation for at least several months. In step 4, possible adequate methods for removal of remnant pigments are considered.

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