Case and Research Letters
Acquired Symmetric Facial Hyperpigmentation
Hiperpigmentación facial simétrica adquirida
M. González-Olivares
, L. Castillo-Fernández, B. Echeverría
Corresponding author
Servicio de Dermatología y Anatomía Patológica, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
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González-Olivares, L. Castillo-Fernández, B. Echeverría" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "González-Olivares" "email" => array:1 [ 0 => "mgonzalezo@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Castillo-Fernández" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "Echeverría" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología y Anatomía Patológica, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hiperpigmentación facial simétrica adquirida" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 686 "Ancho" => 1800 "Tamanyo" => 241140 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A and B, Multiple, confluent macules measuring a few millimeters in diameter, forming a poorly-defined, bluish-gray macule of mottled appearance on the forehead and extending into both parietal regions.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0050" class="elsevierStylePara elsevierViewall">Dermal melanocytoses are a broad group of congenital or acquired melanocytic lesions that share the histopathologic feature of dendritic melanocytes in the dermis, with variable degrees of pigmentation and with or without dermal melanophages.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> This group includes the mongolian spot, blue nevus, nevus of Ota, nevus of Ito, Hori nevus and other less frequent entities, known as atypical dermal melanocytoses.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 35-year-old Nigerian woman who consulted for progressive asymptomatic facial hyperpigmentation that had started to develop on her forehead 2 years earlier. The only finding in her past medical history was systemic hypertension, for which she was on treatment with amlodipine. She described no temporal relationship between taking amlodipine or other drugs and onset of the hyperpigmentation, and she denied taking other drugs or applying topical products to the area. No treatment had been performed.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient, with skin phototype <span class="elsevierStyleSmallCaps">V</span>, presented multiple confluent macules of a few millimeters in diameter on her forehead, also extending into both parietal regions, grouped so as to form a large, poorly defined, bluish-gray macule of mottled appearance. The macule was not infiltrated and no superficial desquamation was observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No lesions were observed in the conjunctiva or on the oral mucosa.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Biopsy revealed a proliferation of dendritic melanocytes in the mid dermis, with no atypia (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), confirmed with Masson-Fontana stain. No nonmelanic pigment deposits were observed. All the findings were compatible with Hori nevus.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Hori nevus, also known as ABNOM (acquired bilateral nevus of Ota-like macules), is one of the most common acquired facial dermal melanocytoses.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> It was first described by Hori et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> in 1984. It usually affects Asian women in the fourth or fifth decade of life. Familial cases have been reported.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a> Hori nevus presents as blue-gray-brown macules with a bilateral distribution on the forehead, frontoparietal regions, eyelids, cheeks, and nose. There is no associated ocular or mucosal involvement,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> although a case with mucosal involvement has recently been described. We consider that the clinical and pathologic findings of that case with mucosal involvement could correspond to a nevus of Ota.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The origin of this alteration is unknown. The etiology and pathogenesis of Hori nevus appear to require the presence of poorly melanized ectopic melanocytes in the dermis, by descent or migration from the epidermis or hair bulb (<span class="elsevierStyleItalic">dropping off</span>) or by disturbances of migration during embryologic development, and the activation of these cells by UV radiation, hormones, chronic inflammation, or other as yet undefined factors.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> Diagnosis is mainly clinical. Histopathology reveals melanocytes in the mid and upper dermis, with no fibrosis or alterations of normal dermal structure.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> Ultrastructurally, these melanocytes are fully developed, with stage <span class="elsevierStyleSmallCaps">II</span>, <span class="elsevierStyleSmallCaps">III</span> and <span class="elsevierStyleSmallCaps">IV</span> melanosomes, and are surrounded by an extracellular sheath whose thickness increases over time, leading to lesion stability.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The main differential diagnoses are nevus of Ota, Riehl melanosis, ochronosis, and melasma.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> Nevus of Ota is differentiated by an earlier age at onset, a unilateral presentation, and mucosal involvement. Riehl melanosis and exogenous ochronosis are associated with a history of application of topical products prior to appearance of the lesions. In endogenous ochronosis, nonmelanic pigment is observed in the dermis. Melasma shares certain clinical characteristics, such as a female predominance, involvement typically of the malar region, and a common pathogenesis with increased expression of the SCF/c-kit pathway,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a> but the bluish-gray color of Hori nevus is not observed,<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">3,7</span></a> and histopathologic findings are also different.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">8,9</span></a> Histopathologic studies with healthy controls, the reported findings characteristic of melasma are increased melanin deposits in the epidermis, with normal or increased presence of epidermal melanocytes, which can appear larger than usual, with prominent dendrites, sometimes associated with an increase in the number of melanophages.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">8,9</span></a> Based on these findings, although melasma has been subclassified into epidermal and dermal, it is likely that the purely dermal forms are actually Hori nevus.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">With regard to treatment, some authors report improvement with various Q-switched (QS) lasers (QS yttrium-aluminium-garnet laser [1064<span class="elsevierStyleHsp" style=""></span>nm], QS alexandrite laser [755<span class="elsevierStyleHsp" style=""></span>nm], and QS ruby laser [694<span class="elsevierStyleHsp" style=""></span>nm]), though results are variable and a transitory residual hyperpigmentation is the norm.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">1,10–13</span></a> To reduce this residual hyperpigmentation combined treatments with QS laser and bleaching agents, dermabrasion, or carbon dioxide laser have been used.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">1,12</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion, Hori nevus is a cause of acquired facial hyperpigmentation that should be considered in daily clinical practice.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: González-Olivares M. Hiperpigmentación facial simétrica adquirida. Actas Dermosifiliogr. 2016;107:355–357.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 686 "Ancho" => 1800 "Tamanyo" => 241140 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A and B, Multiple, confluent macules measuring a few millimeters in diameter, forming a poorly-defined, bluish-gray macule of mottled appearance on the forehead and extending into both parietal regions.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 726 "Ancho" => 1800 "Tamanyo" => 437804 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Proliferation of dendritic melanocytes in the mid dermis, with no atypia: A, Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>20. B, Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>200.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0070" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired bilateral nevus of Ota-like macules (Hori nevus): Etiologic and therapeutic considerations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.M. Park" 1 => "H. Tsao" 2 => "S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 10 | 21 |
| 2024 October | 68 | 51 | 119 |
| 2024 September | 81 | 44 | 125 |
| 2024 August | 103 | 69 | 172 |
| 2024 July | 67 | 35 | 102 |
| 2024 June | 85 | 37 | 122 |
| 2024 May | 63 | 35 | 98 |
| 2024 April | 68 | 37 | 105 |
| 2024 March | 72 | 32 | 104 |
| 2024 February | 60 | 33 | 93 |
| 2024 January | 52 | 31 | 83 |
| 2023 December | 70 | 17 | 87 |
| 2023 November | 69 | 37 | 106 |
| 2023 October | 76 | 30 | 106 |
| 2023 September | 80 | 33 | 113 |
| 2023 August | 28 | 12 | 40 |
| 2023 July | 45 | 33 | 78 |
| 2023 June | 56 | 31 | 87 |
| 2023 May | 41 | 27 | 68 |
| 2023 April | 68 | 29 | 97 |
| 2023 March | 42 | 26 | 68 |
| 2023 February | 51 | 29 | 80 |
| 2023 January | 33 | 30 | 63 |
| 2022 December | 47 | 32 | 79 |
| 2022 November | 26 | 31 | 57 |
| 2022 October | 33 | 23 | 56 |
| 2022 September | 28 | 44 | 72 |
| 2022 August | 25 | 56 | 81 |
| 2022 July | 18 | 55 | 73 |
| 2022 June | 19 | 36 | 55 |
| 2022 May | 37 | 31 | 68 |
| 2022 April | 50 | 27 | 77 |
| 2022 March | 67 | 38 | 105 |
| 2022 February | 46 | 31 | 77 |
| 2022 January | 48 | 50 | 98 |
| 2021 December | 48 | 26 | 74 |
| 2021 November | 63 | 36 | 99 |
| 2021 October | 51 | 48 | 99 |
| 2021 September | 53 | 39 | 92 |
| 2021 August | 43 | 38 | 81 |
| 2021 July | 38 | 42 | 80 |
| 2021 June | 64 | 34 | 98 |
| 2021 May | 36 | 35 | 71 |
| 2021 April | 70 | 51 | 121 |
| 2021 March | 59 | 28 | 87 |
| 2021 February | 79 | 17 | 96 |
| 2021 January | 50 | 18 | 68 |
| 2020 December | 28 | 8 | 36 |
| 2020 November | 31 | 16 | 47 |
| 2020 October | 35 | 10 | 45 |
| 2020 September | 40 | 9 | 49 |
| 2020 August | 25 | 9 | 34 |
| 2020 July | 32 | 16 | 48 |
| 2020 June | 41 | 24 | 65 |
| 2020 May | 29 | 11 | 40 |
| 2020 April | 28 | 22 | 50 |
| 2020 March | 25 | 17 | 42 |
| 2020 February | 4 | 2 | 6 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 4 | 0 | 4 |
| 2019 November | 4 | 0 | 4 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 7 | 5 | 12 |
| 2019 April | 2 | 1 | 3 |
| 2019 March | 2 | 4 | 6 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 4 | 0 | 4 |
| 2018 November | 1 | 0 | 1 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 2 | 0 | 2 |
| 2018 February | 39 | 1 | 40 |
| 2018 January | 42 | 4 | 46 |
| 2017 December | 61 | 4 | 65 |
| 2017 November | 19 | 5 | 24 |
| 2017 October | 26 | 5 | 31 |
| 2017 September | 26 | 2 | 28 |
| 2017 August | 23 | 5 | 28 |
| 2017 July | 24 | 8 | 32 |
| 2017 June | 53 | 6 | 59 |
| 2017 May | 29 | 5 | 34 |
| 2017 April | 18 | 3 | 21 |
| 2017 March | 16 | 7 | 23 |
| 2017 February | 17 | 5 | 22 |
| 2017 January | 16 | 7 | 23 |
| 2016 December | 18 | 15 | 33 |
| 2016 November | 21 | 16 | 37 |
| 2016 October | 19 | 19 | 38 |
| 2016 May | 0 | 1 | 1 |
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