Postinflammatory Pigmentary Alteration

Synonyms: Postinflammatory pigmentary change.

Clinical Presentation (Fig. 11A):

■ Pigmented macules and patches

■ Sites of a previous dermatitis

■ More prominent in dark-skinned individuals

■ Fading gradually over months or years

Histopathology (Figs. 11B and C):

■ Little or no infiltrate of lymphocytes around venules of the superficial plexus and along the dermoepidermal junction

■ Hints of vacuolar alteration sometimes

■ Melanophages in the papillary dermis and in the upper part of the reticular dermis range from few to many

■ Papillary dermis thickened sometimes by subtle fibroplasia

Differential Diagnosis:

■ Hyperpigmentation in mycosis fungoides (parakeratosis variegata) is accompanied by features typical of mycosis fungoides, that is, lymphocytes are accompanied by scant spongiosis in the epidermis.

Pathophysiology:

■ Lymphocytes of an inflammatory process, nearly always of an interface type destroy keratinocytes of the basal layer; melanin comes to be situated in the dermis, where it is ingested by macrophages.

References:

1. Pandya AG, Guevara IL. Disorders of hyperpigmentation. Dermatol Clin 2000; 18(1):91-98, ix.

2. Ruiz-Maldonado R, Orozco-Covarrubias ML. Postinflammatory hypopigmentation and hyperpigmentation. Semin Cutan Med Surg 1997; 16:36-43.

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