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Hyperpigmentation results from an increase in melanin synthesis, which is mostly brought on by sun exposure, dermatological disorders, hormones, aging, genetic factors, skin injuries or inflammation, and acne. Sun exposure, which greatly increases the synthesis of melanin, is the most common cause of hyperpigmentation.
The primary cause is a deficiency of uroporphyrinogen decarboxylase (UROD), a cytosolic enzyme that is a step in the enzymatic pathway that leads to the synthesis of heme. Behind the direct cause there are a number of genetic and environmental risk factors.
Postinflammatory hyperpigmentation (PIH) is a skin condition characterized by the darkening of the skin (hyperpigmentation) following an inflammatory injury, such as acne, dermatitis, infectious disease, or trauma. Less frequently, it may occur as a complication of a medical procedure performed on the skin. It is a common cause of skin ...
Chloroquine retinopathy is a form of toxic retinopathy (damage of the retina) caused by the drugs chloroquine or hydroxychloroquine, which are sometimes used in the treatment of autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus. This eye toxicity limits long-term use of the drugs. [3]
There are a wide range of depigmenting treatments used for hyperpigmentation conditions, and responses to most are variable. [11]Most often treatment of hyperpigmentation caused by melanin overproduction (such as melasma, acne scarring, liver spots) includes the use of topical depigmenting agents, which vary in their efficacy and safety, as well as in prescription rules.
Hydroxychloroquine, sold under the brand name Plaquenil among others, is a medication used to prevent and treat malaria in areas where malaria remains sensitive to chloroquine. Other uses include treatment of rheumatoid arthritis, lupus, and porphyria cutanea tarda. It is taken by mouth, often in the form of hydroxychloroquine sulfate. [3]
Drug-induced pigmentation of the skin may occur as a consequence of drug administration, and the mechanism may be postinflammatory hyperpigmentation in some cases, but frequently is related to actual deposition of the offending drug in the skin. [2]: 125–6 The incidence of this change varies, and depends on the type of medication involved.
A French study published in 2024 found that the use of hydroxychloroquine may have been associated with 17,000 deaths in Belgium, Turkey, France, Italy, Spain, and the United States. [61] [62] This study was ultimately retracted on August 22, 2024, after "the Editor-in-Chief found the conclusions of the article to be unreliable".