Johannes Flores DAYRIT 医师
皮肤科医师
How to manage post-rejuvenation facial dyschromias in skin of color
Objectives: The objective of the study is to describe case series on exogenous ochronosis and iatrogenic dyschromia, identify predisposing factors and assess the efficacy of treatments
Introduction: Post-rejuvenation facial dyschromias in skin of color may be a consequence of long term application of hypopigmenting drugs and cosmeceuticals or rejuvenation procedures such as chemical peels and pigment lasers. The clinical manifestations and predisposing factos have not been meticulously defined and consensus on proper treatment has not yet been established. Exogenous ochronosis is a paradoxical hyperpigmentation observed in patients who self-medicated with topical hydroquinone for the treatment of melasma. Management options are limited.
Materials / method: Once a diagnosis of exogenous ochronosis and iatrogenic dyschromia has been established either by dermoscopy or biopsy , patients were instructed to discontinue all previously applied topical drugs or cosmeceuticals. They were treated with skin barrier repair creams, topical antioxidants and sunscreens. Hyperpigmentation was treated with Q-switched or picosecond lasers to fragment dermal pigments. Er:YAG and 675 nm lasers were utilized to promote dermal remodelling and skin rejuvenation. The patients were followed up and improvements were documented by standardized photography.
Results: Treatment of ochronosis with Q-switched Nd:YAG and Er:YAG have been used on 9 cases and the results were variable. Long term follow up of 3 patients who underwent monthly 1064 nm then 675 nm laser treatments x 6 sessions showed significant improvement . Iatrogenic dyschromia cases were treated with the Er:YAG and 577 nm vascular laser with variable results. 2 patient who were treated with 675 nm laser and injectable polynucleotides showed modest improvement.
Conclusion: The management of exogeneous ochoronosis and iatrogenic dyschromias still remain to be standardized. Treatment should targetl specific pathogenetic mechanisms and promote healing and regeneration of damaged epidermis and dermis.
