Exogenous ochronosis: a comprehensive review of the diagnosis, epidemiology, causes, and treatments.

Exogenous ochronosis (EO) can be an unintended psychologically troubling condition for patients who are already being treated for longer-term hyperpigmentation disorders such as melasma. Early diagnosis is key in order that the offending agent can be stopped to prevent further disfiguring discoloration. EO can be diagnosed in the right clinical setting with the aid of dermatoscopy, which can assist in early diagnosis and may negate the need for a biopsy. Laser modalities using Q-switched lasers of longer wavelengths and combination laser dermabrasion treatments have shown the most significant results with minimal adverse events. However, further large-scale studies are needed to determine optimal treatment modalities. Although considered uncommon, the incidence of EO will likely continue to increase with the growth of immigrant populations and the use of skin-lightening agents above the FDA's recommended over-the-counter concentrations, without the guidance of a dermatologist.

Exogenous ochronosis in a Chinese patient: use of dermoscopy aids early diagnosis and selection of biopsy site.

The diagnosis of exogenous ochronosis is often challenging and requires a high index of suspicion. Herein, we report a case of exogenous ochronosis in a Chinese patient. The condition was caused by the use of bleaching agents, including creams containing hydroquinone. We demonstrate the use of dermoscopy as an invaluable tool for the early recognition of the condition, as well as in the selection of an appropriate site for a skin biopsy.

Facial hyperpigmentation: causes and treatment.

By midcentury, the U.S.A. will be more ethnically and racially diverse. Skin of colour will soon constitute nearly one-half of the U.S. population, and a full understanding of skin conditions that affect this group is of great importance. Structural and functional differences in the skin, as well as the influence of cultural practices, produce variances in skin disease and presentation based on skin type. In the skin of colour population, dyschromia is a growing concern, and a top chief complaint when patients present to the physician. A thorough understanding of the aetiology and management strategies of facial hyperpigmentation is of importance in caring for those afflicted and also in the development of new therapies.

Exogenous ochronosis in ethnic Chinese Asians: a clinicopathological study, diagnosis and treatment.

BACKGROUND: Exogenous ochronosis is believed to be an uncommon complication of treatment with hydroquinone- containing skin-lightning agents. It is widely believed that the condition is found almost exclusively in dark-skinned individuals and uncommon in other skin-types. AIMS: To show that exogenous ochronosis may be present in ethnic Chinese Asians. MATERIALS & METHODS: Facial skin biopsies were obtained from suspicious lesions in ethnic Chinese patients presenting at a private dermatology clinic. Clinical photographs, ultraviolet (UV) photographs and digital dermatoscopic pictures were also obtained. RESULTS: 15 patients of ethnic Chinese origin had histologically-confirmed exogenous ochronosis. DISCUSSION: The difficulties in differentiating exogenous ochronosis from melasma are discussed and there is a likelihood of under-reporting as the clinical presentation of the condition may be misleading. CONCLUSION: Exogenous ochronosis may exist amongst ethnic Chinese patients with fairer skin-types, contrary to the commonly-accepted perception that it is more prevalent in darker skin-types.

Exogenous ochronosis. An update on clinical features, causative agents and treatment options.

Exogenous ochronosis is clinically and histologically similar to its endogenous counterpart; however, it exhibits no systemic effects and is not an inherited disorder. It is characterized by an asymptomatic hyperpigmentation of the face, sides and back of the neck, back, and extensor surfaces of the extremities. The associated ochronotic discoloration most commonly results from use of products containing hydroquinone. It also occurs following use of antimalarials and products containing resorcinol, phenol, mercury or picric acid. The etiology of hydroquinone-induced hyperpigmentation in exogenous ochronosis remains speculative. The majority of patients with this condition are Black, but it has been reported to occur in Hispanics and Caucasians. Exogenous ochronosis is prevalent among South African Blacks, but is believed relatively uncommon within the US. The reasons for this phenomenon are not clear, but it could be a result of the use of skin care products containing resorcinol in combination with hydroquinone or the use of hydroquinone in a hydroalcoholic lotion. Treatment of this condition is difficult. The offending agent must be avoided, but improvement occurs only slowly. A number of topical agents have been studied as have dermabrasion and the use of lasers. Controlled studies in larger numbers of patients are require to determine the true efficacy of newer treatments.

Probable coexisting exogenous ochronosis and mercurial pigmentation managed by dermabrasion.

A patient with blue-gray discoloration of the face is described. Her history revealed that she had used bleaching creams containing mercury and hydroquinone for many years. Biopsy specimens of the hyperpigmented areas showed deposits that were compatible with both mercury deposition and the diagnosis of exogenous ochronosis. Dermabrasion was successfully employed to remove these deposits.