What causes dark circles under the eyes?

Dark circles under the eyes (DC) are defined as bilateral, round, homogeneous pigment macules on the infraorbital regions. Despite its significant prevalence, there are a few published studies about its pathogenesis. DC are caused by multiple etiologic factors that include dermal melanin deposition, postinflammatory hyperpigmentation secondary to atopic or allergic contact dermatitis, periorbital edema, superficial location of vasculature, and shadowing due to skin laxity. The purpose of this review is to discuss some of the available evidences about the anatomic features that could explain dark circles and the proposed treatments for this unpleasant condition.     

先天性角化不良

报告1例先天性角化不良.患者男,27岁.全身皮肤出现网状色素沉着20年,部分指、趾甲营养不良和唇、颊黏膜白斑17年.此外还并发牙龈增生,头发稀少、干枯,有龋齿,轻度智力低下.     

Diffuse Bier spots

A 34-year-old man presented with a 6-month history of hypopigmented macules that were interspersed with blanching erythematous macules on the trunk, upper extremities, and lower extremities. Bier spots are small, hypopigmented macules that are usually found on the arms and legs of young adults. The intervening skin may seem erythematous but blanches with pressure so that the hypopigmented macules disappear. This is a benign vascular anomaly.     

Elevated amount of human papillomavirus 31 DNA in a squamous cell carcinoma developed from bowenoid papulosis

A 50-year-old woman presented with asymptomatic, multiple black macules on the genitalia for 6 months. She presented multiple, round to irregularly shaped, black macules on her labia major and perineum. A keratotic reddish nodule was found on one of the macules. The results of laboratory investigations showed pancytopenia and a decreased CD4/CD8 ratio. A lymphocyte stimulation test showed a decreased response. The histological examination of a biopsy specimen led us to the diagnosis of bowenoid papulosis (BP) for the macules and squamous cell carcinoma (SCC) for the nodule. The macules and nodule were removed successfully. An elevated amount of HPV DNA was demonstrated in SCC compared with that of BP. The HPV DNA in SCC and BP was shown to be HPV-31. These observations indicated that the elevated amount of HPV-31 DNA could have led to the emergence of SCC from BP under the condition of decreased cellular immunity.     

Combination of microneedling and 10% trichloroacetic acid peels in the management of infraorbital dark circles

Background: Dark circles (DC), seen in the periorbital area, are defined as bilateral, round, homogeneous pigmented macules whose aetiology is thought to be multifactorial. Available treatments include bleaching creams, topical retinoic acid, chemical peels, lasers, autologous fat transplantation, injectable fillers and surgery (blepharoplasty). Objective: To evaluate the efficacy and safety of a combination of microneedling and 10% trichloroacetic acid (TCA) peels in the treatment of DC. Materials and methods: Thirteen female patients with mild to severe infraorbital DC were included in the study. The patients were aged between 21 and 61 years. They were treated with Automatic Microneedle Therapy System-Handhold and topical application of 10% TCA solution to each infraorbital area for five minutes. The effect was photo-documented and a Patient and Physician Global Assessment was evaluated. Safety was assessed by evaluating early and delayed adverse events. Results: Almost all patients showed significant aesthetic improvement. Both Physician and Patient Global Assessment rated a fair, good or excellent response in 92.3%. The procedure was well tolerated. Mild discomfort, transient erythema and oedema were quite common during or immediately after the procedure. The patients were followed up regularly every month for four months, and no recurrence was recorded. Conclusion: Microneedling and 10% TCA constitute an innovative combination treatment for DC with encouraging results and minor side effects.     

Bilateral type of nevus of Ota presenting as agminated lentigines

We report a 30-year-old female patient with a history of hyperpigmented macules of the face since the age of 7 years. The clinical appearance, brown macules in multiple segmental or grouped patterns, was suggested to be agminated lentigines. However, histologic examination of the pigmented macule revealed scattered melanocytes within the dermis. We diagnosed this lesion as a bilateral type of nevus of Ota presenting as agminated lentigines. The differential diagnosis from acquired bilateral nevus of Ota-like macules was made.     

Vitiligo following type II lepra reaction

A middle-aged male with lepromatous leprosy developed bouts of skin lesions of depigmented macules and patches of vitiligo, just following attacks of type II lepra reaction each time. In view of the present concept of autoimmunity playing a role in the pathogenesis of vitiligo as well as lepra reaction, their association in our patient appears to be more than fortuious. The depigmented macules persisted even after regression of skin lesions of leprosy following chemotherapy. The vitiligo macules responded partially to topical and systemic psoralen therapy.     

Volar melanotic macules in a Japanese man with histopathological postinflammatory pigmentation: the volar counterpart of mucosal melanotic macules

BACKGROUND: Volar melanotic macules are asymptomatic light-brown or tannish-grey macules usually found on the palms and/or soles of blacks, although they have also been reported on the volar surfaces of whites. Similar lesions have not been reported before in Japanese people. Since the cause is as yet unknown, it remains to be discussed whether they are a distinct entity. METHODS: In this report, a 52-year-old Japanese man with volar melanotic macules is reported with the clinical and histopathological findings. RESULTS: A 52-year-old Japanese man presented with many light-brown macules on his bilateral soles. He had a 20-year history of tinea pedis. Histopathological examination revealed melanophages and inflammatory infiltrates in the superficial dermis. There was a slight increase in melanin granules around the acrosyringium. Fontana-Masson stain revealed a slight increase in melanin granules in the basal layer including the acrosyringium and superficial dermis. These changes corresponded with postinflammatory pigmentation. CONCLUSIONS: This is the first report of volar melanotic macules in Japanese people. We suggest that volar melanotic macules is not an independent entity but a clinicopathological one that includes postinflammatory pigmentation, and that the condition is the volar counterpart of mucosal melanotic macules.     

Dyschromatosis Universalis Hereditaria: An Electron Microscopic Examination

We report electron microscopic findings from both hyperchromic and achromic macules of dyschromatosis universalis hereditaria (DUH). The keratinocytes of the hyperchromic macules contained numerous, fully melanized melanosomes; almost all of them were aggregated to form the melanosome complex. In contrast, the melanosomes were absent from both keratinocytes and melanocytes of achromic macules, even though intact melanocytes were found. Our results suggest that DUH may be a disorder of melanosome production and distribution in epidermal melanin units rather than a disorder of melanocyte number.     

Atypical pigmented penile macules

Two patients with pigmented lesions of the penis are described. The lesions consisted of asymptomatic, multifocal, irregular macules, with variegated pigmentation. The main differential diagnostic problem was with mucocutaneous melanoma. Histologic examination of the lesions showed basal layer hyperpigmentation. No cytologic atypia of melanocytes was detectable. The diagnosis in both cases was melanotic macules. Because of their atypical clinical appearance, genital melanotic macules are often misinterpreted as mucocutaneous melanoma. However histopathologic study solves the problem because genital melanotic macules show no melanocytic proliferation nor melanocytic atypia.     

Blue-red macules and pseudoatrophic macules in neurofibromatosis 1

INTRODUCTION: Blue-red macules are exception during neurofibromatosis 1. Between October 1988 and March 2000 in our cohort of patients, we systematically looked for these lesions. PATIENTS AND METHODS: Presence and number of blue-red macules were evaluated. Biopsies and photographs were proposed to patients. RESULTS: Forty-four patients out of 583 (39 y; range: 20-66 y) (7.5 p. 100; CI 95 p. 100: 5.5-9.8 p. 100) had blue-red macules mainly on the trunk. Histologically, blue-red macules corresponded to neurofibromatous tissue infiltrating capillary blood vessels and venules. CONCLUSION: Blue-red macules are a peculiar type of neurofibroma and can therefore be considered as a criterion for the diagnosis of neurofibromatosis 1.     

Registration of the number of macules in paucibacillary leprosy for evaluation of early diagnosis and individual prognosis

The number of macules is usually registered at diagnosis in the first clinical examination of leprosy patients. The question studied here is whether this practice is of any interest as an indicator of the precocity of detection of the prognosis. The study is based on the 26,996 paucibacillary patients detected from 1957 to 1982 in Polambakkam Leprosy Centre (South India) for whom the number of macules and disability status are assessed and registered. Several observations suggest that the proportion of single-macule patients among the newly detected cases is a more sensitive indicator than the proportion of new patients with disabilities for the evaluation of the delay between onset of the disease and detection. Its use could be especially helpful for programmes running for several years, when it becomes difficult to observe significant variations in the proportion of patients with disabilities. Regarding the prognosis value of the number of macules, inactivation and relapse probabilities were calculated. Regularity of treatment is found to be a better predictor of early inactivation than the number of macules, while relapse probabilities are more affected by the number of macules.     

A computed image analyzing system for quantitation of melanocyte morphology in café-au-lait macules of neurofibromatosis

Split-dopa preparation is a commonly used technique to visualize the epidermal melanocytes. It can characterize the number of melanocytes and their tyrosinase (dopa-oxidase) activities. There is not, however, any method to quantitate the morphologic changes of dopa-positive melanocytes in the split preparation. This study designed a computed image analyzing system and evaluated the structure of epidermal melanocytes in café-au-lait macules with comparison to normally pigmented skin in 5 patients with neurofibromatosis. By this method we were able to delineate the melanocyte structure with melanocyte population and coloration of the macules. We found that the population and structure of melanocytes differ greatly depending on the coloration of the café-au-lait macules. The light brown and brown macules showed the normal population of melanocytes with an increase in the area and perimeter of whole cell; the area, perimeter, and diameter of cytoplasm; and the area, length, and breadth of dendrites. In contrast, the dark brown macules revealed a significant increase of the epidermal melanocytes with a decrease in all of these parameters. Thus, the methodologic design presented here may enable a quantitative, two-dimensional analysis of melanocyte structure at the light microscopic level in the normal skin and in various pigmentary disorders.     

Clinical characteristics of pigmented macules on palms and/or soles appearing after middle age in Japan

We have examined the clinical characteristics of pigmented macules on palms and/or soles. A total of 238 inpatients and 111 healthy persons over 40 years old in Japan were included in our analysis. We found: (a) that such pigmented macules may occur not only on healthy persons but also on patients who suffer from various internal disorders, (b) that, in both males and females, the incidence of pigmented macules is relatively high in malignancy patients in comparison with non-malignancy and control individuals, (c) that the incidence is higher in males than in females, (d) that, in both males and females, there was a tendency toward distribution on both palms and soles in malignancy patients in comparison with the non-malignancy and control individuals (p<0.01), and (e) that, among cases with pigmented macules, the number of pigmented macules is empirically greater in inpatients (the malignancy and non-malignancy groups) than in the controls.     

Congenital melanotic macules of the tongue

BACKGROUND: Congenital oral and labial melanotic macules are the leading causes of hyperpigmented lesions of the oral mucosa in adults. Although they usually appear in the second decade of life, there are rare reports of these phenomena in children. Congenital lingual melanotic macules have been recently identified as a peculiar and benign cause of hyperpigmentation of the tongue in newborn babies and infants. CASE REPORTS: We describe the cases of five infants presenting with smooth brown macules of the dorsum of the tongue, measuring several millimetres and detected either at birth or a few days after birth. No history of trauma, medication or similar lesions in relatives was found. Surgical excision of the lesions was performed in two cases. Clinical follow-up in the three other children showed no changes in the lesions in the first two and lightening of the brown macules in the third. DISCUSSION: Congenital lingual melanotic macules represent a clinically distinct and benign cause of hyperpigmentation of the oral mucosa. They may be more common than the literature suggests, especially among dark-skinned subjects.     

SPONTANEOUS REGRESSION OF HUMAN MALIGNANT MELANOMA

Cellular and subcellular changes and cell-mediated immunity of a patient (a 26-year-old man) with spontaneously regressed malignant melanoma are described. The patient developed black nodules on his left leg and foot several times over a period of 11 years. These nodules necrotized, regressed to form crusted nodules and disappeared leaving white macules. Many melanin-laden cells (so-called melanophages) were seen in the upper dermis of the melanotic macules, and no melanoma cells were observed in the upper dermis of the white macules which appeared at the site of regressed melanotic macules or nodules. In melanin-laden cells observed in melanotic macules, many melanosome complexes with hydrolytic enzyme activity and a small number of single melanosomes were recognized. We assumed that some or many of the melanin-laden, melanophage-like cells in the upper dermis of a regressing malignant melanoma might be effete melanoma cells. Cell-mediated immunity had been preserved while spontaneous regression of tumors was occurring. However, the patient died as a result of metastatic melanomas which involved the lymph nodes, liver, bones, brain, heart, kidney, lung and gastrointestinal tract.     

Photochemotherapy with topical khellin and sunlight in vitiligo.

In order to evaluate the efficacy of topical khellin the vitiligo macules of one side only were painted in 41 patients with a 2% solution of khellin in acetone and propylene glycol (90 and 10%, respectively) and exposed to sunlight for a period of 4 months with 3 weekly applications and with exposure times up to 90 min. The macules of the other side were treated in 36 of the 41 patients with acetone and propylene glycol only and sun-exposed with the same schedule, while in the remaining 5 patients they were neither treated with khellin or placebo nor sun-exposed. No significant difference was evidenced between the khellin and placebo-treated sides: no excellent result (repigmentation more than 75% of the affected area) was found, and good results (repigmentation more than 50%) were found in 24.9% of khellin- plus sunlight-treated macules and in 22.3% of placebo- plus sunlight-treated macules.     

A case of agminated lentiginosis with multiple café-au-lait macules

Agminated lentiginosis is an unusual pigmentary disorder, characterized by numerous lentigines grouped within an area of normal skin. The pigmented macules are often in a segmental distribution within a sharp demarcation at the midline. We encountered a 28-year-old woman with an unusual combination of multiple café-au-lait macules and diffuse numerous lentigines involving the right cheek and ipsilateral upper thorax with sharp demarcation at the midline. The multiple lentigines extended bilaterally over the back in a peppered distribution. There were 21 café-au-lait macules on both arms, and the trunk and buttocks; however, there were no Lisch nodules, neurofibromas, or any other clinical manifestations for neurofibromatosis. Histopathology of a macule revealed the features of lentigo.     

Amyloidosis cutis dyschromica: a rare pigmentary disorder

Amyloidosis cutis dyschromica represents a rare type of primary cutaneous amyloidosis with few reported cases worldwide. It is characterized by asymptomatic, generalized hyperpigmentation with intermingled hypopigmented macules without atrophy or telangiectasia. We report herein a 19-year-old female who developed this pigmentary abnormality at 4 years of age. Her aunt and great grandfather also had similar skin pigmentation. An unusual finding in our patient was the presence of papules in addition to characteristic macules. Amyloid deposits were shown histopathologically in both dyschromic macules and papules.