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Disorders of Pigmentation
Dr. Andrei Metelitsa
Clinical Pearls in Medicine
12 Night Italy & Dalmatian Coast Adriatic Sea CME Cruise
May 28 – June 09, 2015
Andrei Metelitsa, MD, FRCPC, FAAD
Co--Director, Institute for Skin Advancement
Co
C
Clinical
Associate Professor,
f
Dermatology
University of Calgary, Canada
www.seacourses.com
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Disorders of Pigmentation
Dr. Andrei Metelitsa
Clinical Pearls in Medicine
12 Night Italy & Dalmatian Coast Adriatic Sea CME Cruise
May 28 – June 09, 2015
Learning Objectives
Hyperpigmentation
 Melasma
 Drug-Induced
 PIH
 Neurofibromatosis
 Hypo/Depigmentation
yp
pg
 Vitiligo
 Tuberous Sclerosis
 Pityriasis Alba
 Tinea Versicolor

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Disorders of Pigmentation
Dr. Andrei Metelitsa
Clinical Pearls in Medicine
12 Night Italy & Dalmatian Coast Adriatic Sea CME Cruise
May 28 – June 09, 2015
1. Disorders of Hyperpigmentation
www.seacourses.com
3
Disorders of Pigmentation
Dr. Andrei Metelitsa
Clinical Pearls in Medicine
12 Night Italy & Dalmatian Coast Adriatic Sea CME Cruise
May 28 – June 09, 2015
Melasma
Seen primarilyy in women (at
( least 90% of
patients)
 Increased prevalence in individuals who are
Hispanic Asian or of African descent
Hispanic,
 Most common location is the face, followed by
the forearms
 Symmetric
S
t i patches
t h off hyperpigmentation
h
i
t ti with
ith
irregular borders due to increased melanin
within the epidermis and/or dermis

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Disorders of Pigmentation
Dr. Andrei Metelitsa
Clinical Pearls in Medicine
12 Night Italy & Dalmatian Coast Adriatic Sea CME Cruise
May 28 – June 09, 2015
Melasma Treatment

Dailyy sun protection is critical
 Sunblock is preferred

Topical agents
 Hydroquinone
 Azelaic Acid
 Kojic Acid
 Retinoids
 Kligman formula


Chemical peels
p
Lasers
 Fractionated non-ablative
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Disorders of Pigmentation
Dr. Andrei Metelitsa
Clinical Pearls in Medicine
12 Night Italy & Dalmatian Coast Adriatic Sea CME Cruise
May 28 – June 09, 2015
Drug-Induced Pigmentation






Minocycline
Antidepressants (imipramine)
Amiodarone
Antimalarials
Chlorpromazine
Heavy metals www.seacourses.com
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Disorders of Pigmentation
Dr. Andrei Metelitsa
Clinical Pearls in Medicine
12 Night Italy & Dalmatian Coast Adriatic Sea CME Cruise
May 28 – June 09, 2015
Postinflammatory Hyperpigmentation
Very common
Typically affects dark‐skinned people Usually develops following previous inflammation or injury to the skin
 Typically resolves within 1 year



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Disorders of Pigmentation
Dr. Andrei Metelitsa
Clinical Pearls in Medicine
12 Night Italy & Dalmatian Coast Adriatic Sea CME Cruise
May 28 – June 09, 2015
Neurofibromatosis
www.seacourses.com
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Disorders of Pigmentation
Dr. Andrei Metelitsa
Clinical Pearls in Medicine
12 Night Italy & Dalmatian Coast Adriatic Sea CME Cruise
May 28 – June 09, 2015
2. Disorders of Hypo/Depigmentation
www.seacourses.com
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Disorders of Pigmentation
Dr. Andrei Metelitsa
Clinical Pearls in Medicine
12 Night Italy & Dalmatian Coast Adriatic Sea CME Cruise
May 28 – June 09, 2015
Vitiligo





Acquired, idiopathic disorder characterized by
circumscribed depigmented macules and
patches
Usually asymptomatic
Clinical variants include localized,
localized generalized
and universal
Association with immune disorders (especially
thyroid)
y
)
Wood’s lamp accentuates areas of vitiligo
www.seacourses.com
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Disorders of Pigmentation
Dr. Andrei Metelitsa
Clinical Pearls in Medicine
12 Night Italy & Dalmatian Coast Adriatic Sea CME Cruise
May 28 – June 09, 2015
Vitiligo Treatment

General measures
 Sun Protection, Makeup

Topical Steroids

Topical calcineurin inhibitors

Phototherapy

Laser

Depigmentation therapy
www.seacourses.com
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Disorders of Pigmentation
Dr. Andrei Metelitsa
Clinical Pearls in Medicine
12 Night Italy & Dalmatian Coast Adriatic Sea CME Cruise
May 28 – June 09, 2015
Tuberous Sclerosis
www.seacourses.com
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Disorders of Pigmentation
Dr. Andrei Metelitsa
Clinical Pearls in Medicine
12 Night Italy & Dalmatian Coast Adriatic Sea CME Cruise
May 28 – June 09, 2015
Pityriasis Alba




Low Grade Dermatosis
Mi
Minor
ffeature
t
off Atopic
At i Dermatitis
D
titi
More common among dark-skinned
children
Presents with ill-defined hypopigmented
patches
 Face most common site
 Initially can be more erythematous
 More apparent in summer
www.seacourses.com
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Disorders of Pigmentation
Dr. Andrei Metelitsa
Clinical Pearls in Medicine
12 Night Italy & Dalmatian Coast Adriatic Sea CME Cruise
May 28 – June 09, 2015
Pityriasis Alba - Treatment




May persist for months-years
Resolves spontaneously
Topical Steroids
Topical
p
Calcineurin Inhibitors
www.seacourses.com
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Disorders of Pigmentation
Dr. Andrei Metelitsa
Clinical Pearls in Medicine
12 Night Italy & Dalmatian Coast Adriatic Sea CME Cruise
May 28 – June 09, 2015
Tinea Versicolor
Etiology: Common superficial cutaneous fungal
eruption caused by Malassezia furfur
 History:

 Usually affects young adults
 Humid Environments

Physical:
 Oval macules and patches on the trunk
 Hyperpigmented and hypopigmented variants

Diagnosis:
 KOH – classic spaghetti and meatballs
(hyphae and spores)
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Disorders of Pigmentation
Dr. Andrei Metelitsa
Clinical Pearls in Medicine
12 Night Italy & Dalmatian Coast Adriatic Sea CME Cruise
May 28 – June 09, 2015
Tinea Versicolor

Treatment:
 Topical antifungals
▪ E.g. ketoconazole, terbinafine
 Systemic antifungals
▪ Itroconazole, ketoconazole, fluconazole
www.seacourses.com
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Disorders of Pigmentation
Dr. Andrei Metelitsa
Clinical Pearls in Medicine
12 Night Italy & Dalmatian Coast Adriatic Sea CME Cruise
May 28 – June 09, 2015
PEARLs


Sunprotection is critical
p
Increased pigmentation
 Brown vs. slate‐grey (medication induced)
g y(
)

Loss of pigmentation
 Depigmentation (vitiligo) vs. hypopigmentation
pg
(
g )
yp p g
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