Pigmentary changes treatment

Deposits in the lens or cornea probably result from melanin-drug complex deposition and are best detected by slit-lamp examination. These deposits are probably dose-and time-related, since they generally occur only after years of treatment. Fortunately, they are in large part reversible, but if undetected they may progress to interfere with vision. They are most often reported with chlor-promazine or thioridazine and can occur in association with pigmentary changes in the skin. 

Tyrosinase inhibitors should be used in post-peel treatment as well as in pre-peel preparation (1 month before the peel when there is a risk of pigmentary change, i.e. when TCA-SAS or AHA peels are used). 

The natural skin color allows treatment without the risk of pigmentary changes. 

Prevention of pigmentary changes Blending Bleaching cream and Melablock HSP 50 or 25 should be applied until the following treatment or for at least 6 weeks. 

A few areas of mild erythema, which changes color with the cold, alcohol or emotion, can very occasionally last for several weeks. Erythema after a resorcinol peel is usually reversible without treatment, but requires preventive treatment against pigmentary changes, especially in high-risk patients (see the preceding paragraph and Chapter 37). 

Not counting the importance of skin preparation, the adjuvants used, technical errors and preventive postpeel care and treatment, the risk of pigmentary changes can be quantified diagrammatically as follows ... 

The capacity to develop PIH is largely dependent on genetic factors. Patients who suffer from pigmentary changes after a peel often develop hyperpigmentation from insect bites or small operative scars, and it is worth questioning patients before starting treatment. 

It takes several months to achieve an acceptable clinical result when hydroquinone is used as monotherapy, but abnormal epidermal and dermal pigmentation can eventually be reduced. There are reports in the literature that hydroquinone has been prescribed in high doses (up to 10-15%) to counter dramatic pigmentary changes at these doses, it must not be applied for more than 8 days and a more conventional concentration of 3-5% should be used for the rest of the treatment. The effect is dose-dependent, and it might be concluded that a high concentration is always required to get a rapid and clinically satisfactory result. However, it is important to bear in mind the problems that have been associated with the use of this agent ... 

Deep peels routinely produce pigmentary changes (Fig. 15.25). 1 routinely feather the edge of deep peels with 25% to 30% TCA, particularly at the angle of the jaw and on the neck (Fig. 15.26) It is also worthwhile to peel earlobes when carrying out deep peels. Sun avoidance is the best treatment for patients who are prone to... 

Imiquimod is an immune response modifier shown to be effective in the topical treatment of external genital and perianal warts (ie, condyloma acuminatum see Chapter 61). The 5% cream is applied three times weekly and washed off 6-10 hours after each application. Recurrences appear to be less common than after ablative therapies. Imiquimod is also effective against actinic keratoses, and possibly, molluscum contagiosum. Local skin reactions are the most common side effect these tend to resolve within weeks after therapy. However, pigmentary skin changes may persist. Systemic adverse effects such as fatigue and influenza-like syndrome have occasionally been reported. 

Thioridazine can cause significant retinal toxicity, leading to reduced visual acuity, changes in color vision, and disturbances of dark adaptation.These symptoms typically occur 30 to 90 days after initiation of treatment. The fundus often appears normal during the early stages of symptoms, but within several weeks or months a pigmentary... 

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