Other Pigmented lesions

1. Giti Sadeghian Skin diseases and leishmaniasis Research center Other Pigmented lesions

2. Freckles a small patch of light brown colour on the skin, often becoming more pronounced through exposure to the sun.

3. Freckles, or ephelides are clusters of concentrated melaninized cells which are most easily visible on people with a faircomplexion. • No increased number of melanocytes, • but overproduce melanin granules (melanosomes) changing the coloration of the outer skin cells called (keratinocytes).

4. Freckels

5. Freckels • The formation of freckles is triggered by exposure to sunlight. • The exposure to UV-B radiation activates melanocytes to increase melanin production, which can cause freckles to become darker and more visible.

6. Freckles are predominantly found on the face, although they may appear on any skin exposed to the sun, such as arms or shoulders.

7. Freckles • Freckles are rare on infants, and more commonly found on children before puberty. • Upon exposure to the sun, freckles will reappear if they have been altered with creams or lasers and not protected from the sun, but do fade with age in some cases.

8. Etiology • Freckles are thought to develop as a result of a combination of • genetic tendency (inheritance) • and sun exposure. • Two people receiving the same sun exposure may not have an equal chance of developing freckles. • People with blond or red hair, light-colored eyes, and fair skin are especially susceptible to the damaging effect of UV rays.

9. Treatment • 1-Several safe methods are available to help lighten or reduce the appearance of freckles. 2-multiple or a combination of treatments may be required for best results. • 3- Not everyone's skin will improve with similar treatments,

10. Treatment • Bleaching or fading creams: • hydroquinone • kojic acid • Mandelic asid • Higher concentrations of hydroquinone (over 2%) require a prescription. • most effective in combination with sun avoidance and sun protection.

11. Retinoids: • Retinoids: Sometimes used in conjunction with other bleaching creams, tretinoin (vitamin A acid, Retin-A), tazarotene (Tazorac), and adapalene (Differin) also may help lighten freckles when applied consistently over a period of several months.

12. Cryosurgery: • Cryosurgery: A light freeze with liquid nitrogen in the physician's office can be used to treat some types of freckles. Not all spots respond to this form of therapy.

13. Laser treatment: • Laser treatment: Multiple types of lasers may help lighten and decrease the appearance of freckles safely and effectively. • Intense Pulsed Light treatments are another method to lighten and remove freckles.

14. Chemical peels • Chemical peels can also help lighten freckles and improve irregular pigmentation. • Glycolioc asids • TCA

15. lentigo • A lentigo is a small pigmented spot on the skin with a clearly defined edge, surrounded by normal-appearing skin. • It is a harmless hyperplasia of melanocytes which is linear in its spread.

17. lentigo

20. Lentigines are distinguished from freckles(ephelis) based on the : • 1-proliferation of melanocytes. • 2-Freckles have a relatively normal number of melanocytes but an increased amount of melanin. • 3-Freckles will increase in number and darkness with sunlight exposure, whereas lentigines will stay stable in their color regardless of sunlight exposure.

21. Lentigo simplex • Lentigo simplex(juvenile lentigo) is the most common form of lentigo. • A single lesion or multiple lesions (lentigines) may be present at birth or more commonly first develop in early childhood. • Lentigo simplex is not induced by sun exposure, and it is not associated with any medical diseases or conditions.

22. Lesions appear as: • Round or oval shaped macule (flat spot or patch) 3-15mm in diameter • Margin or edge of the macule can be jagged or smooth • A single even colour ranging from light brown to black • Lesions are symptomless, i.e.: not painful or itchy

23. The cause of lentigo simplex is unknown. Multiple lentigines can occur without associated conditions, in which case the condition is referred to as : • lentigines profusa or generalised lentigines.

24. multiple lentigines occur • Peutz-Jeghers syndrome,is an autosomal dominant inherited disorder characterized by intestinal hamartomatous polyps in association with a distinct pattern of skin and mucosal macular melanin deposition.Xerodermapigmentosumis a rare autosomal recessive genetic disorder of DNA repair in which the ability to repair damage caused by ultraviolet • LAMB syndrome, Acronym for Lentigines, Atrialmyxomas, Mucocutaneousmyxomas, and Blue nevi. • LEOPARD syndrome(L)entigines (E)lectrocardiographic conduction defects (0)cularhypertelorism (P)ulmonarystenosis (A)bnormalities of the genitals (R)etarded growth (D)eafness or hearing loss

25. What treatments are available? • chemical peels, • cryotherapy, • laser treatments

26. Solar Lentigo • A solar lentigo also known or senile lentigo, is a dark lesion caused by: • natural or artificial ultraviolet (UV) light. • Solar lentigines may be single or multiple. • Solar lentigines are benign, but they do indicate excessive sun exposure, a risk factor for the development of skin cancer.

27. Signs and Symptoms • Solar lentigines typically appear on areas exposed to natural or artificial UV light. • They appear as well-defined, light brown to black, flat spots. • In people who have been treated with • PUVA, solar lentigines may occur in areas of the skin not exposed to UV light.

30. To prevent solar lentigines: • avoid exposure to sunlight in midday (10 AM to 3 PM), • wear sun-protective clothing (tightly woven clothes and hats), • and apply sunscreen (SPF 30 UVA and UVB block).

31. Age Spots (Solar Lentigo, Liver Spots)

32. Lentigines may evolve slowly over years, or they may be eruptive and appear rather suddenly. Pigmentation may be homogeneous or variegated, with a color ranging from brown to black.

33. Treatment • If solar lentigines are cosmetically bothersome, your physician may:1-Freeze the area lightly with liquid nitrogen. 2-Laser( QS -Ablative lasers) Prescribe a bleaching cream (hydroquinone), but this is often not successful.

34. Actinic keratoses • Actinic keratoses (AK), also called solar keratoses, are scaly, crusty growths (lesions) caused by damage from the sun’s ultraviolet (UV) rays. • face, bald scalp, lips, and the back of the hands, • often elevated, rough in texture, and resemble warts.

35. If left untreated, up to 10% percent of AKs develop into squamous cell carcinoma (SCC), the second most common form of skin cancer. In rarer instances, AKs may also turn into basal cell carcinomas, the most common form of skin cancer.

36. Actinic keratosis affects more than 58 million Americans.

37. Actinic keratoses are scaly spots or patches on the top layer of skin. With time the spots or patches may become hard with a wart-like surface.

38. Treatment consists of the following categories: • 1-Medical therapy • 2-Surgical destruction of the lesion • Pharmacologic treatment • Topical 5-fluorouracil (5-FU) • Imiquimod cream • Ingenol mebutate gel (cytotoxic agents). • Topical diclofenac gel upregulate apoptosis.

39. Surgery • Types of surgery : • Cryosurgery • Curettage, • shave excision, • and conventional excision - For lesions suggestive of invasive cancer

40. Cosmetic resurfacing procedures • Including : • medium and deep chemical peels, dermabrasion, • and ablative laser resurfacing

41. seborrheic keratosis • A seborrheic keratosis usually appears as a brown, black or light tan growth on the face, chest, shoulders or back. • The growth has a waxy, scaly, slightly elevated appearance. • Seborrheic keratoses don't become cancerous, but they can look like skin cancer.

42. Seborrheic keratoses are very common on the back. They appear as waxy light tan, brown or black growths that look as if they were dripped onto the skin by a candle. Some can grow large, up to 1 inch (2.5 centimeters) across.

43. A seborrhoeic keratosis is a harmless warty spot that appears during adult life as a common sign of skin aging. Some people have hundreds of them. Seborrhoeic keratosis (or seborrheic keratosis, using American spelling) is also called SK, basal cell papilloma, senile wart,

44. Seborrhoeic keratoses are extremely common. over 90% of adults over the age of 60 years have one or more of them. • males and females of all races, • beginning to erupt in the 30s or 40s. • uncommon under the age of 20 years.

45. What is the treatment for seborrhoeickeratoses? • Reasons for removal may be that it is unsightly, itchy, or catches on clothing. • Methods used to remove seborrhoeickeratoses include: • Cryotherapy (liquid nitrogen) for thinner lesions (repeated if necessary) • Curettage and/or electrocautery • Ablative laser surgery • Shave biopsy (shaving off with a scalpel) • Focal chemical peel with trichloracetic acid

46. Postinflammatoryhyperpigmentation • PIP is temporary pigmentation that follows injury (e.g. thermal burn) or inflammatory disorder of the skin (e.g. dermatitis, infection). • It is mostly observed in darker skin types. • More severe injury results in postinflammatory hypopigmentation, which is usually permanent.

47. Who gets postinflammatory pigmentation? • Occure in anyone, • more common in darker skinned individuals, • more pronounced in sun-induced skin conditions such as • phytophotodermatitis and • lichenoid dermatoses (skin conditions related to lichen planus, such as erythema dyschromicum perstans).

48. Some medications may also darken postinflammatory pigmentation. • These include : • antimalarial drugs, • clofazimine, • tetracycline, • anticancer drugs such as bleomycin (flagellate erythema), doxorubicin, 5-fluorouracil and busulfan.

49. What causes postinflammatoryhyperpigmentation? • damage to the epidermis and/or dermis • Inflammation in the epidermis stimulates melanocytes to increase melanin synthesis and to transfer the pigment to surrounding keratinocytes (epidermal melanosis). • If the basal layer is injured (e.g. lichen planus), melanin pigment is released and subsequently trapped by macrophages in the papillary dermis (dermal melanosis or pigment incontinence). Dermal pigment tends to be a grey brown.

50. Postinflammatory pigmentation tends to become darker and more noticeable with sun exposure, so sun protection and broad-spectrum sunscreens are an important part of management. • Although peeling agents may reduce epidermal pigmentation, nothing has been found useful to eradicate dermal melanosis.