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Transtornos Pigmentares

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Melanócitos
Wood Lamp
 
Pigmentation disorders
  • Hypopigmentation
    • AKA Leucoderma → reduction in skin color
    • Hipomelanoses
      • Hipomelanoses hereditárias
          • Esquema Saurat
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          Generalidades | Abordagem
          • Melanocitopénicos vs melanopénicos
          • Congénitos vs adquiridos
          • Hipomelanótico vs amelanótico
          • Padrão: circunscrito, difuso, linear, guttate
          • Melanin cause
            • Hypochromia VS. Achromia (Wood lamp essential)
          Sinal de alarme: sinais de envolvimento ocular
          • Fotofobia
          • Diminuição da acuidade visual
          • Nistagmus
          • Transiluminação da íris
          • Hipoplasia da fóvea
        • Melanoblast migration
        • Disruption of melanin synthesis
        • Disruption of melanosome formation
        • Disruption of melanosome transportation and transfer to keratinocytes
      • Hipomelanoses Adquiridas
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          Vitiligo
        • Localizadas
            • Idiopathic Guttate Hypomelanosis
            Progressive Macular Hypomelanosis
          • Post-inflammatory
            • Pitiryasis alba
            • Psoriasis, lupus erythematosus, eczema, pityriais lichenoides
          • Infectious
            • Pitiryasis versicolor
            • Leprosy (look for hypoestesia in endemic areas)
          • Neoplasitic (benign or malignant)
            • Halo nevi
            • Melanoma-associated leukoderma
            • Achromic mycosis fungoides
        • Disseminadas
          • Endocrine: dysthyroidism, panhypopituitarism, hypoandrogenism (in genitals)
          • Malnutrition (copper, selenium)
          • Viral infections
            • Chemical
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          • Medicamentos
            • retinoids, corticosteroids, hydroquinone, imiquimod
            • Lightening of hair: chloroquine, imatinib, desatinib, sunitinib
      • Medidas gerais de tratamento das hipomelanoses
        • Fotoproteção
        • Suplementação com vitamina D
    • Vascular cause
      • Localized: Bier spots
      • Diffuse cause: anemia
  • Hyperpigmentation
    • Exogenous pigment
      • Tattoos
      • Homogentisic acid (Exogenous Ochronosis)
      • Tesaurismose
      • Infeções: ex. Pitiríase Versicolor
    • Endogenous pigment
      • Hemosiderin (ochre red color)
      • Homogentisic acid (ocronose endógena) na alkaptonuria
      • Porfirinas
      • Carotenes
      • Ferro
      • Keratinization disorders
      • Amiloidose
      • Endogenous lipofuscins
      • Melanina → Hipermelanoses
        • Melanodermia (blackish-brown) → melanin in the epidermis
          • Epidermal hypermelanosis: increase in melanin in epidermis without increase in number of melanocytes
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              Melasma
            • Heliodermia “bronze”, tanning beds
            • Friction melanosis
            • Leucomelanoderma of the vagabound
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              Radiodermites
            • Efélides (genetically controlled - MC1R)
            • Café au lait spots - NF1, Legius, McCune Albright
          • Epidermal hypermelanocytosis: increase in the number of melanocytes in the epidermis
            • Lentigos
        • Cerulodermia (blue-gray color) → melanin in the dermis
      • Causas sistémicas com afetação cutânea
        • Monogenic hereditary forms of skin hyperpigmentation
        • Adquiridas
          • Endocrine
          • Metabolic
            • Hemocromatose
            • Chronic kidney disease (accumulation of MSH)
            • Porfirias
            • Défices vitamínicos (pellagra, vitB12, folato, vitA)
          • Neoplásicas
          • Medicamentos
            • Fixed drug eruption
            • Tesaurismose
            • Flagellated hyperpigmentation of bleomycin
      • Hematologic origin
        • Intravascular stasis
        • Pseudochromidrosis plantaris in athletes
        • Pubic lice infestation
        • Hemochromatosis
        • Wilson
  • Abnormal skin coloring/Dyschromia
    • Disappear when pressure is applied on the skin
    • Cromhidrosis
    • Bilirrubina → icterícia
 
Mechanisms
  • Quantitative or qualitative abnormalities in melanin pigment
  • Abnormalities in the distribution of melanin or hemoglobin derivatives
  • Abnormal presence of endogenous or exogenous pigment or theckening of the epidermis
 

Hipopigmentação

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Os melanossomas são estruturas lisossómicas dos melanócitos equivalentes aos grânulos densos das plquetas e os grânulos líticos dos linfócitos NK.
 
 

Transtornos pigmentares - Hiperpigmentação

  • Linear
    • Pigmentary demarcation lines
    • Linear postinflammatory hyperpigmentation
    • Flagellate pigmentation from Bleomycin
    • Shiitake Dermatitis (Flagellate Mushroom Dermatitis)
    • Hyperpigmentation Along the lines of Blashko
  • Reticulated
    • Exclude reticulated erythema (ex. livedo reticularis, early stage erythema ab igne)
    • Exclude poikiloderma (eg. poikiloderma of Civatte, dermatomyositis, lupus erythematosus)
    • Prurigo Pigmentosa
    • Dyskeratosis Congenita
    • Naegeli-Franceschetti-Jadassohn Syndrome
    • Dermatopathia Pigmentosa Reticularis
    • X-linked reticulate pigmentary disorder
    • Dowling-Degos disease
    • Reticulate acropigmentation of Kitamura
  • Dyschromatoses
    • Dyschromatosis Symmetrica Hereditaria
    • Dyschromatosis Universalis Hereditaria
    • Acquired Barchial Cutaneous Dyschromatosis
  • Related to Keratinocytic (epidermal) disorders
    • Acanthosis nigricans
    • Confluent and reticulated papillomatosis
    • Terra firma-forme dermatosis
    • Nevoid hyperkeratosis of the nipple and areola
    • Epidermal nevus
 
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Hipopigmentação
  • Acromia ≠ hipocromia
  • Hipopigmentação pós inflamatória
    • Regiões flexurais no eczema atópico
  • Hipomelanose guttata adquirida
  • Pitiríase alba
 
 
Post-inflmmatory Hyperpigmentation
Erythema Dyschromicum Perstans | Ashy dermatosis | dermatosis cenicienta
Drug induced hyperpigmentation or discoloration
Tesaurismose
 
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