Exogenous ochronosis is an avoidable dermatitis that can be caused by the topical application of compounds such as hydroquinone or phenols. Melasma can become darker as exogenous ochronosis develops within it as a result of treatment with hydroquinone. Exogenous ochronosis following hydroquinone for melasma. Exogenous ochronosis is an uncommon dermatosis characterized as graybrown or blueblack macules localized to the sites of application of topical agents. Patch testing and histopathology in thai patients with. The topic endogenous ochronosis, you are seeking is a synonym, or alternative name, or is closely related to. Skin lightening products can be found widely throughout the world. Ochronosis is a disease characterized by the accumulation of homogentisic acid alcaptonuria is a specific genetic defect that causes ochronosis. In some patients, histopathologic study is required to reach a definite diagnosis. Being extremely difficult to treat, early identification is very important, with histopathology remaining the gold. Jul 31, 20 dermatopathology reference describes ochronosis histopathology including histologic features and provides links to additional medical references. It is a condition clinically and histopathologically similar to endogenous ochronosis, also known as alkaptonuria. A 55yearold woman with melasma develops biopsyproved exogenous ochronosis in the setting of prolonged topical hydroquinone use. Ochronosis causes, symptoms, diagnosis, treatment and pictures.
Jan 01, 2010 histopathology of the involved malar skin revealed exogenous ochronosis with brownish clumps in the papillary dermis. Exogenous ochronosis can be clinically mistaken for other disorders manifested by acquired localized hyperpigmented facial macules and, specifically, for melasma. Exogenous ochronosis following self medication of topical. Hydroquinone induced ochronosis shows melanophages in upper dermis associated with depigmentaion of the epidermal melanocytes in early lesions, collagen fibers appear basophilic and swollen before developing characterstic yellow ochronotic morphology with chronicity, large amorphous eosinophilic granules may develop resembling colloid milium. Ochronosis is the bluishblack or greyblue discoloration of the skin, especially the ear cartilage, the ocular eye tissue, and other body locations. The two types of ochronosis are endogenous and exogenous. The endogenous variety is an autosomalrecessive disease, known as alkaptonuria, that is caused by a lack of homogentisate oxidase enzyme.
We report two cases of exogenous ochronosis in two female patients of the subsaharan african population. Exogenous ochronosis also can occur, most commonly from the topical application of hydroquinone or other skinlightening compounds. Exogenous ochronosis eo is an entity that manifests as blackbluish or grayishbrown cutaneous hyperpigmentation, which is a consequence of the deposition of ochronotic pigment with characteristic bananalike morphology between the collagen fibers of the dermis. Sutantoyo cj 2015 endogenous ochronosis presenting as recalcitrant facial hyperpigmentation aggravated with prolonged use of topical hydroquinone 2% lob dermatol, 2015 doi. Exogenous ochronosis and striae atrophicae following the.
Ochronosis with subtle histological findings vallonthaiel ag. Our report was written in english, and was readily searchable on medline using the entry exogenous ochronosis. Exogenous ochronosis after prolonged use of topical. Exogenous ochronosis jain a, pai sb, shenoi sd indian j. Exogenous ochronosis eo is a rare disease, although well known for the adverse effects caused by topical therapy with hydroquinone hq. Exogenous ochronosis joseph f merola md, shane meehan md, ruth f walters md, lance brown md dermatology online journal 14 10. In 1976 findlay described exogenous ochronosis in patients that used topic clarifying agents containing hidroquinona. Histopathology is the key to differentiate the two conditions, when in doubt. If alkaptonuria is diagnosed early on in life it is reasonable for patients to have a lowprotein diet. Histopathology of the involved malar skin revealed exogenous ochronosis with brownish clumps in the papillary dermis. Histopathology in exogenous ochronosis shows pigment incontinence, solar elastosis, ochre pigment. Although it is widely regarded as an uncommon complication of treatment with hydroquinone containing skinlightening agents it may also be caused by topical substances such as phenol. Endogenous and exogenous ochronosis are indistinguishable on histology and the clinical history should be taken into account.
Exogenous ochronosis and melasma are two different disorders, although both conditions may present as pigmentation on the face. Currently i am treating it with lemon juice, meladerm because it has no hydroquonine in it and flaxeed oil. Exogenous ochronosis eo, although rare, is a wellknown pigmentary disorder. Oral vitamins including b complex, vitamin c and folic acid along with ginkgo biloba are sometimes helpful in repigmentation skin. This reduces the intake of amino acids phenylalanine and tyrosine, which in turn reduces the amount of homogentisic acid produced. The most common cause of exogenous ochronosis is application of topical hydroquinone as part of the formulation. Other than the skin discoloration, there are no other health.
Dermatoscopic findings of ochronosis are unique and point towards a clue for its diagnosis. It occurs as the result of exposure to malarial drugs, skin lightening creams and overexposure the the sun. Diagnostic utility of dermatoscopy in hydroquinone. Bellew sg, alster ts 2004 treatment of exogenous ochronosis with a qswitched. Exogenous ochronosis is an increasingly recognized condition that typically presents with blueblack hyperpigmentation of skin. Aug 01, 2011 hydroquinone induced ochronosis shows melanophages in upper dermis associated with depigmentaion of the epidermal melanocytes in early lesions, collagen fibers appear basophilic and swollen before developing characterstic yellow ochronotic morphology with chronicity, large amorphous eosinophilic granules may develop resembling colloid milium. Autosomal recessive disorder of increased urinary excretion of homogentisic acid alkaptonuria, with deposition of ochre colored yellow pigment in collagen rich regions. Ochronosis genetic and rare diseases information center.
The major cause of ochronosis is a condition called alkaptonuria. Exogenous ochronosis genetic and rare diseases information. Exogenous ochronosis can be secondary to the topical application of hydroquinone, phenol, 68 resorcinol, 2,9 or oral administration of antimalarials. Histopathology revealed many ochre pigments in the dermis. A 66yearold woman presented with periocular and lateral neck bluegray p. Apr 29, 2019 ochronosis is the bluishblack or greyblue discoloration of the skin, especially the ear cartilage, the ocular eye tissue, and other body locations. Ochronosis differential diagnoses medscape reference. We report a case of exogenous ochronosis in a 50yearold indian woman. Endogenous ochronosis presenting as recalcitrant facial. Pdf exogenous ochronosis is a rare, cosmetically disfiguring condition, resulting from. However localized vitiligo is best treated with phototherapy such as narrow band uvb. Ochronosis is a pathological condition of the skin and mucosa in which there is a discoloration of the skin and mucosa which is normally bluishblack in color.
Exogenous ochronosis was first related in 1906 by pick. Exogenous ochronosis eo can be an unintended psychologically troubling condition for patients who are already being treated for longerterm hyperpigmentation disorders such as melasma. It is characterized histologically by bananashaped ochrecolored deposits in the dermis. Histopathology in exogenous ochronosis shows pigment incontinence, solar elastosis, ochre pigment, bananashaped fibers in papillary dermis, and eventually degeneration of the collagen. Home treatment for ochronosis answers on healthtap. The most common cause of exogenous ochronosis is application of topical hydroquinone as part of the formulation in a variety of skin bleaching creams. Histopathology showed yellowbrown ochronotic pigment, deposited within collagen bundles. In indian population, dle can present as macular hyperpigmentation.
Histopathology, although invasive, remains a gold standard in the diagnosis of eo, and confirms it. Limited studies have revealed only about 22 reported cases of exogenous ochranosis in more than 50 years of use in the us, so it is not reported very commonly. I am 100% sure i have exogenous ochronosis on my face from the use of hydroquonine. Early diagnosis is key in order that the offending agent can be stopped to prevent further disfiguring discoloration. Alkaptonuria is a rare genetic disease that is characterised by passing urine that becomes black when left standing.
Answers from specialists on home treatment for ochronosis. Eo can be diagnosed in the right clinical setting with the aid of dermatoscopy, which can. Endogenous ochronosis or alkaptonuria is an autosomal recessive disease. Eo can be diagnosed in the right clinical setting with.
She had earlier been treated for melasma with topical 4% hydroquinone cream. Mar 07, 2017 ochronosis is the bluish black discoloration of certain tissues, such as the ear cartilage and the ocular tissue, seen with alkaptonuria, a metabolic disorder additionally, ochronosis can occasionally occur from exposure to various substances such as phenol, trinitrophenol, resorcinol, mercury, picric acid, benzene, hydroquinone, and a. There are home units available by prescription form a dermatologist if multiple office. Dermatopathology reference describes ochronosis histopathology including histologic features and provides links to additional medical references. Based on clinical features and histopathology a diagnosis of exogenous ochronosis was made. Swollen and homogeneous collagen fibres were also noted. Exogenous ochronosis resulting from quinine injections. Exogenous ochronosis is an increasingly recognized condition that typically presents with blueblack. Dermal infiltration with lymphocytes was a common finding in all sections, with eosinophils in only 1 case with a diagnosis of lpp. Exogenous ochronosis bhattar pa, zawar vp, godse kv, patil sp. However, it is sometimes difficult to differentiate ochronosis from melasma clinically, especially when there is no history of topical hydroquinone use.
Endogenous ochronosis is a synonym for ochronosis, which is a rare skin condition marked by blue or black discoloration. Exogenous ochronosis is a cutaneous condition characterized by blue. Histopathology showed yellowbrown ochronotic pigment, deposited within collagen bundles causing. Ochronosis is a rare disease characterized by speckled and diffuse pigmentation symmetrically over the face, neck, and photoexposed areas. This discoloration takes place mostly on the parts of the skin that are commonly exposed to the sun. Ochronosis alkaptonuria is an autosomal recessive defect in homogentisic acid oxidase resulting in the accumulation of homogentisic acid in tissues, and pigmentation of cartilage e. The earliest sign of the condition is usually dark staining found in nappies or diapers of infants the most obvious sign in adults is a thickening and blueblack discolouration of the ear cartilage. It can occurs in individuals with alkaptonuria, an inherited metabolic disorder. Exogenous ochronosis eo is a cutaneous disorder characterized by blueblack pigmentation resulting as a complication of longterm application of skinlightening creams containing hydroquinone but may also occur due to topical contact with phenol or resorcinol in. Mar 08, 2018 ochronosis is a pathological condition of the skin and mucosa in which there is a discoloration of the skin and mucosa which is normally bluishblack in color. Exogenous ochronosis eo refers to the bluishblack discoloration of areas of the skin, especially the face, ear cartilage, the ocular eye tissue, and other body locations. Be sure to verify your new user account in the next 24 hours, by checking your email and clicking the verify. Ochronosis is an uncommon condition characterized by yellowbrown pigmented deposits in the dermis. Exogenous ochronosis europe pmc article europe pmc.
It also appears in studies that exogenous ochronosis was also linked with prolonged hydroquinone use longer than 6 months. Exogenous ochronosis is a paradoxical hyperpigmentation of the skin caused by the longterm use of hydroquinonecontaining bleaching creams. Exogenous ochronosis surgical and cosmetic dermatology. Exogenous ochronosis is the brownblack skin discoloration that occurs as a result of dermal accumulation of homogentisic acid. Exogenous ochronosis in asians, international journal of. All of the research that i have found says that its very difficult to treat, but that laser surgery has shown some significant improvements in treating it. Being extremely difficult to treat, early identification is very important, with histopathology remaining the gold standard in diagnosis. Apr 29, 2019 exogenous ochronosis eo refers to the bluishblack discoloration of areas of the skin, especially the face, ear cartilage, the ocular eye tissue, and other body locations. The histopathology of the lesion revealed bananashaped, brownish yellow ochronotic filaments in the papillary dermis, compatible with a. Exogenous ochronosis eo is a cutaneous disorder characterized by blueblack pigmentation resulting as a complication of longterm application of skinlightening creams containing hydroquinone but may also occur due to topical contact with phenol or resorcinol in darkskinned individuals. Exogenous ochronosis following hydroquinone for melasma exogenous ochronosis following hydroquinone for melasma zawar, v p.
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