STUDY - Technical - New Dacian's Medicine
Hyperpigmentation
(Classical / Allopathic Medicine)
Hyperpigmentation,
also known as hypermelanosis or excessive skin coloring,
usually reflects overproduction, abnormal location, or
maldistribution of melanin - the dominant brown or black
pigment found in skin, hair, mucous membranes, nails, brain
tissue, cardiac muscle, and parts of the eye. This sign can
also reflect abnormalities of other skin pigments: carotenoids
(yellow), oxyhemoglobin (red), and hemoglobin (blue).
Hyperpigmentation
usually results from exposure to sunlight. However, it can
also result from a metabolic, endocrine, neoplastic, or
inflammatory disorder; chemical poisoning; use of certain
drugs; a genetic defect; thermal burns; ionizing radiation; or
localized activation by the sunlight of certain
photosensitizing chemicals on the skin.
Many types of
benign hyperpigmented lesions occur normally. Some, such as
acanthosis nigricans and carotenemia, may also accompany
certain disorders, but their significance is unproven. Chronic
nutritional insufficiency may lead to dyspigmentation -
increased pigmentation in some areas and decreased
pigmentation in others.
Typically
asymptomatic and chronic, hyperpigmentation is a common
problem that can have distressing psychological and social
implications. It varies in location and intensity and may fade
over time.
HISTORY:
Ask the patient when he first noticed the hyperpigmentation.
Ask the patient if other signs or symptoms, such as rash, accompany or precede the hyperpigmentation. Is it related to exposure to sunlight or seasonal changes?
Review the patient's medical history, especially noting endocrine disorders. Also, ask the patient if there is a family history of hyperpigmentation.
If the patient is female, ask if she's pregnant.
Ask the patient if he's been in contact with or ingested with chemicals, metals, plants, vegetables, citrus fruits, or perfumes.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient about other signs and symptoms, such as fatigue; weakness; muscle aches; chills; irritability; fainting; itching; cough; shortness of breath; swelling of the ankles, hands, or other areas; anorexia; nausea; vomiting; weight loss; abdominal pain; diarrhea; constipation; epigastric fullness; dark or pink urine; increased or decreased urination; menstrual irregularities; and loss of libido.
Ask the patient when he first noticed the hyperpigmentation.
Ask the patient if other signs or symptoms, such as rash, accompany or precede the hyperpigmentation. Is it related to exposure to sunlight or seasonal changes?
Review the patient's medical history, especially noting endocrine disorders. Also, ask the patient if there is a family history of hyperpigmentation.
If the patient is female, ask if she's pregnant.
Ask the patient if he's been in contact with or ingested with chemicals, metals, plants, vegetables, citrus fruits, or perfumes.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient about other signs and symptoms, such as fatigue; weakness; muscle aches; chills; irritability; fainting; itching; cough; shortness of breath; swelling of the ankles, hands, or other areas; anorexia; nausea; vomiting; weight loss; abdominal pain; diarrhea; constipation; epigastric fullness; dark or pink urine; increased or decreased urination; menstrual irregularities; and loss of libido.
PHYSICAL
ASSESSMENT:
Examine the skin. Note the color of hyperpigmented areas: Brown suggests excess melanin in the epidermis; slate gray or a bluish tone suggests excess pigment in the dermis. Inspect for other changes, such as thickened and leathered skin texture and changes in hair distribution.
Check the skin and sclera for jaundice, and note spider angiomas, palmar erythema, or purpura.
Take the patient's vital signs, noting fever, hypotension, or pulse irregularities.
Evaluate the patient's general appearance. Does he have exophthalmos, an enlarged jaw, an enlarged nose, or enlarged hands?
Palpate for an enlarged thyroid, and auscultate for a bruit over the gland.
Palpate muscles for atrophy and joints for swelling and tenderness.
Assess the abdomen for ascites and edema, and palpate and percuss the liver and spleen to evaluate their size and position.
If the patient is male, check for testicular atrophy and gynecomastia.
Examine the skin. Note the color of hyperpigmented areas: Brown suggests excess melanin in the epidermis; slate gray or a bluish tone suggests excess pigment in the dermis. Inspect for other changes, such as thickened and leathered skin texture and changes in hair distribution.
Check the skin and sclera for jaundice, and note spider angiomas, palmar erythema, or purpura.
Take the patient's vital signs, noting fever, hypotension, or pulse irregularities.
Evaluate the patient's general appearance. Does he have exophthalmos, an enlarged jaw, an enlarged nose, or enlarged hands?
Palpate for an enlarged thyroid, and auscultate for a bruit over the gland.
Palpate muscles for atrophy and joints for swelling and tenderness.
Assess the abdomen for ascites and edema, and palpate and percuss the liver and spleen to evaluate their size and position.
If the patient is male, check for testicular atrophy and gynecomastia.
SPECIAL
CONSIDERATIONS:
A Wood's lamp is a special ultraviolet light that helps enhance the contrast between normal and hyperpigmented epidermis. A skin biopsy can help confirm the cause of hyperpigmentation.
A Wood's lamp is a special ultraviolet light that helps enhance the contrast between normal and hyperpigmented epidermis. A skin biopsy can help confirm the cause of hyperpigmentation.
PEDIATRIC
POINTERS:
Bizarre arrangements of linear or streaky hyperpigmented lesions on a child's sun-exposed lower legs suggest phytophotodermatitis.
Congenital hyperpigmented lesions include Mongolian spots (which are benign) and sharply defined or diffuse lesions occurring in such disorders as neurofibromatosis xeroderma pigmentosum; Gaucher's, Niemann-Pick, and Wilson's diseases; Albright's, Fanconi's, and Peutz-Jeghers syndromes; and phenylketonuria.
Bizarre arrangements of linear or streaky hyperpigmented lesions on a child's sun-exposed lower legs suggest phytophotodermatitis.
Congenital hyperpigmented lesions include Mongolian spots (which are benign) and sharply defined or diffuse lesions occurring in such disorders as neurofibromatosis xeroderma pigmentosum; Gaucher's, Niemann-Pick, and Wilson's diseases; Albright's, Fanconi's, and Peutz-Jeghers syndromes; and phenylketonuria.
PATIENT
COUNSELING:
Advise patients to use corrective cosmetics, avoid excessive sun exposure, and apply sunscreen or sunblock when outdoors. Advise patients who stop using bleaching agents to continue using sunscreen because rebound hyperpigmentation can occur. Warn every patient with a benign hyperpigmented area to consult his healthcare provider if the lesion's size, shape, or color changes; this may signal developing skin cancer.
Advise patients to use corrective cosmetics, avoid excessive sun exposure, and apply sunscreen or sunblock when outdoors. Advise patients who stop using bleaching agents to continue using sunscreen because rebound hyperpigmentation can occur. Warn every patient with a benign hyperpigmented area to consult his healthcare provider if the lesion's size, shape, or color changes; this may signal developing skin cancer.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)