Latrogenic Dyschromia: A Preliminary Report on 6 Cases on The Clinical, Dermoscopy and Histopathology Findings

In the Philippines and other Asian countries, “bleaching creams” containing various concentrations and mixtures of hydroquinone, steroids and retinoids are often used without regulation. With immediate improvement, most patients lack follow-up and continue to self-medicate without knowing the complications of long- term use. Iatrogenic dyschromia refers to skin color alteration induced by medical treatment or inadvertently by physicians. To the best of our knowledge, the clinical and histopathologic characteristics have not been fully elucidated yet. We have identified 6 females with Fitzpatrick skin phototype IV with mottled pigmentation on the forehead, nose and cheeks initially diagnosed as exogenous ochronosis. Dermoscopy revealed intervening white and light brown areas, visible follicular openings and extensive network of vessels. Histopathology showed basal cell layer hyperpigmentation of the epidermis. The dermis revealed telangiectasias, solar elastosis and focal degeneration of collagen fibers. Masson’s trichrome revealed thinning of collagen bundles. Melan-A stain revealed melanocytopenia. The dermatologist should be able to recognize iatrogenic dyschromias as they differ from melasma and ochronosis in clinical, histopathologic and dermoscopy findings. Continuous application of skin lightening agents without sun protection is most likely the major predisposing factor in the development of this condition. A larger study is warranted to fully define this condition