Dark side of pigment problems often not serious

Winston-Salem, N.C. - Pigmented lesions come in many forms, and while many do not require treatment, they sometimes serve as signs of seriousconditions, says Zoe D. Draelos, M.D.

Often, a decision to treat hyperpigmentation is based on the patient's desire to improve the cosmetic appearance of the skin, says Dr. Draelos, clinical associate professor, department of dermatology, Wake Forest University School of Medicine, Winston-Salem, N.C., and a Dermatology Times editorial adviser.

"The dermatologist can perform a shave removal to try to remove as much of the pigment as possible," says Dr. Draelos. "If the pigment recurs, a subsequent removal or another alternative procedure can be done."

Pigmented AKs Actinic keratoses (AKs) are rarely hyperpigmented, but the condition does occur, notes Dr. Draelos, who is also primary investigator at Dermatology Consulting Services, High Point, N.C. Hyperpigmentation of an AK does not necessarily carry clinical significance in terms of risk of malignancy, she says.

"Typically we treat it with cryo-surgery, using liquid nitrogen to remove the clinically damaged cells," she says.

Café au lait spots Café au lait spots generally carry no medical significance, says Dr. Draelos, and most people continue to accept these birthmarks.

Lightening of the pigment is an option for people who desire it, she says.

Laser treatment can lighten the color, but generally does not eliminate all the hyperpigmentation, she says. Treating too deeply can leave a scar that results in a worse appearance than the original discoloration, she adds.

Minocycline Patients on minocycline therapy can develop an unusual grayish pigment on their skin, or even on internal organs.

"It can appear in unusual sites, such as the gingiva, the sclera, or in nail beds, but most commonly it appears in old acne lesions of the face," says Dr. Draelos. "While it's not considered to be damaging, it is a reason to discontinue minocycline treatment."

A substitute antibiotic outside the tetracycline family should be prescribed, she says, and the pigmentation will resolve without medical intervention.

Time treats iron Hemosiderin pigment, seen especially on the lower legs following an injury, must be phagocytized and removed by white blood cells, Dr. Draelos says.

"The pigment derives from the iron in hemoglobin, and in the legs it has an unusual coppery, brownish-red color," she notes.

There is no medical treatment for removing the pigment, she says. Patients must rely on the "tincture of time" to remove the hemosiderin, and in patients with poor blood circulation, she adds, the pigmentation may be permanent.

Disclosure: Dr. Draelos has no financial interest in any company that manufactures or markets skin lightening products.