RESUMEN
Exposure to silver-containing compounds can result in reversible discoloration of the skin, presenting as an irregular brown or black macule, which can have a clinical appearance similar to melanoma. Both the clinical scenario and the histopathology are unique. Silver nitrate darkens with exposure to light, and the area can appear to change over time. On microscopic examination, there are coarse pigmented granules dispersed throughout the corneal layer, and largely absent from the remainder of the epidermis-although the precise location may depend on the duration of topical exposure. While argyria, its irreversible counterpart, has been well-characterized, only a single source has previously reported the histopathology of transient topical silver nitrate exposure. We present two cases, review the clinical and histopathologic differentials, and detail the distinctive histopathology that enables a diagnosis to be suggested in this clinical mimicker of melanoma.
Asunto(s)
Argiria/patología , Córnea/patología , Melanoma/patología , Nitrato de Plata/administración & dosificación , Piel/patología , Administración Tópica , Adulto , Anciano , Antiinfecciosos Locales/administración & dosificación , Antiinfecciosos Locales/efectos adversos , Antiinfecciosos Locales/química , Argiria/diagnóstico , Córnea/metabolismo , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Melanoma/diagnóstico , Nitrato de Plata/efectos adversos , Nitrato de Plata/química , Piel/metabolismoRESUMEN
IMPORTANCE: The removal of café-au-lait macules (CALMs) in patients with darker skin phototypes poses a significant challenge due to limited available therapeutic options and increased risk of adverse effects, including permanent scarring and further dyspigmentation. Herein, we demonstrate the novel use of non-ablative fractional photothermolysis for the safe removal of CALMs in individuals with Fitzpatrick skin type (FST) IV-V. OBSERVATIONS: Retrospective analysis of four patients (FST IV-V) with CALMs revealed that three of these patients had greater than 50% clearance after multiple treatment sessions with the non-ablative fractional 1,550-nm erbium-doped fiber laser. CONCLUSIONS AND RELEVANCE: This report demonstrates the utility and safety of non-ablative fractional resurfacing in the treatment of CALMs in darker skin phototypes. Lasers Surg. Med. 49:84-87, 2017. © 2016 Wiley Periodicals, Inc.