INTRODUCTION
? Human skin colour ? unique
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? Varies with race, climate, light exposure,
ethnic and individual skin constitution,
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lifestyle and anatomical regional variations? Basic pigments ? MELANIN, Hb, caretenoids
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MELANOCYTE? Dendritic cells
? Develop from melanoblasts
? Light microscopy: clear cells in and immediately
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beneath the basal layer of epidermis.
? On H&E stain: an avg 1 melanocyte / 10
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keratinocytes.EPIDERMAL MELANIN UNIT
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1 melanocyte 36 keratinocytesFUNCTION OF MELANIN
Protection - scattering and absorbing UV
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lightNeutraliser of toxic, free radical oxygen
derivatives, by products of various
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inflammatory processes.
Impart different colour to hair - black,
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blond,brunette,redCLASSIFICATION OF
PIGMENTARY DISORDERS
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Hyperpigmentary
Hypopigmentary
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DepigmentaryHYPOPIGMENTARY AND
DEPIGMENTARY DISORDERS
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Developmental anomaly ? nevusdepigmentosus
Genetic ? albinism, piebaldism,tuberous
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sclerosis, phenylketonuria
Endocrine ? Addison's disease,
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hyperthyroidismNutritional ? kwashiorkar, ulcerative
colitis
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Chemicals & Drugs ? phenol,
corticosteroids, retinoic acid
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Post inflammatoryMechanical - burns, radiation
Infective ? p.versicolor, leprosy, syphilis,
herpes
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Non infective - P.alba, morphea,psoriasis, DLE
Miscellaneous ? vitiligo, halo nevus
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Affecting hair alone - alopecia areataVITILIGO
Common disorder characterised by well circumscribed milky
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white macules (due to loss of melanocytes) with scallopedmargin
Pathogenic mechanisms:
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Autoimmune destruction of melanocytes
An intrinsic defect in melanocytes, their adhesive
properties and/or factors critical to their survival
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Defective defense against oxidative stress leading to
destruction of melanocytes
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HPE
absence of
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melanin granulesand gross lack of
dopa positive
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melanocytes in
the basal layer.
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Can affect themelanocytes of
the hair.
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Leukotrichia
WOOD'S Lamp Examination
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Koebner's phenomenon
Childhood vitiligo
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positive family history,
few lesions,
segmental,
difficult to Rx,
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better prognosisAssociations
Dm,
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Thyroid Disorders,Pernicious Anemia,
Addison's Disease
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Pityriasis versicolorPityriasis Alba
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TREATMENT : MEDICAL
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TREATMENT : SURGICALdone only in stable vitiligo + refractory to
medical treatment
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1.Grafting ? punch,split skin thickness,blister
2.Tattooing
3.Dermabrasion
4.Melanocyte culture and transplantation
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HYPERPIGMENTARY
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DISORDERS
Classification is based on level of
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hyperpigmentation and extent ofinvolvement.
MACULAR PIGMENTATION ?
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Small macule ? freckles,lentigenesLarge macule ? caf?-au-lait spots,mongolian
spot,Becker's nevus
Irregular pigmentation ? PIH
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Generalised diffuse ? tanningDIFFUSE PIGMENTATION
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Addison's diseaseNutritional disorders ? Vit B12 defiency,
Pellagra
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Connective tissue diseases ? systemicsclerosis
Metabolic ? cirrhosis,Wilson's disease
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Malignancy--- Content provided by FirstRanker.com ---
DRUGS ?
Focal ? FDE (barbiturates , phenolphthalein)
Diffuse ? clofazamine, antimalarials, busulfan
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FACIAL MELANOSIS ?
heterogenous ,multifactorial ,can be patchy and
diffuse,most common over the face and neck
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Eg: melasma, lichen planus pigmentosusMELASMA
Acquired ,circumscirbed, pigmentary
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disorder
characterized by symmetrically
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distributed brown macules with definedborders involving the face
CAUSES
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sunlight ,hormonal (pregnancy),
genetic,
toxic (cosmetics),
drugs(OCP).
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Pathogenesis
Increase in melanocyte number and
activity
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increase in formation,size and
melanization of melanosomes
CLASSIFICATION
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1.Clinical :
Acc to distribution ?
central facial,
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malar,mandibular
Acc. to wood `s lamp ?
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epidermal,dermal,
mixed
2.Histopathological :
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epidermal,
dermal
TREATMENT
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1. Sun protection
2. Topical depigmenting agents
Steroids + hydroquinone + retinoids ?in
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combination(Kligman's)
Azelaic acid
Kojic acid
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Glycolic acid3. Chemical peels
4. Lasers
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WOOD'S LAMP
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high pressure mercuryarc
fitted with a compound
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filter made of barium
silicate with 9% nickel
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oxide "Wood's filter".opaque to al light rays
except a band between
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320 and 400 nm with a
peak at 365 nm.
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Technique of Wood's lampexamination
The lamp allowed to warm up for about 1 minute.
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Examination room perfectly dark & windowless.The light source4 to 5 inches from the lesion.
Washing the area
Examine
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Applications of Wood's lamp
Tinea capitis
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Pityriasis VersicolorMalassezia furfur emits a yellowish-white or copper-orange
fluorescence
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Applications of Wood's lampPseudomonas species produce a pigment 'pyoverdin' or
'fluorescein' which shows green fluorescence
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Erythrasma - Corynebacterium minutissimum shows coral red
fluorescence
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P. acnes - imparts orange-red fluorescence to the comedonesMelasma - Wood's lamp can be used to determine the depth of
melanin in the skin.
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Wood's lamp is therefore helpful in making a diagnosis ofvitiligo
Detection of excess porphyrins in the teeth, urine, stool
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samples, red blood cel s and blister fluid in different forms of
porphyrias
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