Extracts from the Lectures of the 32nd Nordic Congress of Dermato-Venereology, Tampere, Finland
Hyperpigmentation is a common symptom but will not provide much valuable information to help diagnosing the skin
condition. Almost all skin diseases in dark skin can give hyperpigmentation at some point, especially if they have a chronic
or protracted course. A non-speci?c hyperchromia can darken
the elementary lesions of the underlying dermatosis, which
could mislead the physician when examining the patient.
Hyperpigmentation is the main cause of consultation of darkskinned patients but the list of causes of hyperpigmentation is
countless, thus topography and additional signs should help
the physician. Three conditions are of particular exception,
namely acne, lichen planus and prurigo lesions in HIV patients.
Hypopigmentation on the other hand is an important sign
for diagnosis and hypopigmentation also severely impairs the
quality of life of the patients. Causes of permanent achromia
include mainly vitiligo, post-traumatic achromia, idiopathic
hypomelanosis, chronic lupus of the discoid type, and burns.
Causes of mottled hypopigmentation include vitiligo, systemic
scleroderma and licheni?cation. Lastly, frequent causes of
hypopigmentation include eczema, seborrhoeic dermatitis,
pityriasis versicolor, vitiligo minor, injection or local treatment of corticosteroids, achromic hamartoma, lichen striatus
or verruca plana. Rare causes of hypopigmentation include
mycosis fungoides, sarcoidosis and leprosy.
Lastly, skin bleaching is a widespread practice especially among
sub-Saharan immigrants. Women mainly practice skin bleaching for various reasons: to obtain radiant skin, to get a better
social status including jobs and marital prospects or because
of social pressure such as westernised beauty ideals. Abuse of
depigmentating agents such as hydroquinone, potent or ultra
potent corticosteroids or other homemade concoctions leads
to a high prevalence of dis?guring dyschromia. Cutaneous
complications related to hydroquinone use are periorbital
pigmentation, exogenous ochronosis, vitiligo mottled-like
hypopigmentation, lupus-lichen lesions and even maybe
skin cancer. The abuse of corticosteroids leads to cutaneous
infections such as tinea, acne, stretch marks, skin atrophy and
Fig. 2. Prurigo nodularis in
an HIV patients. Typical
annular pigmented itchy
lesions with central depigmentation.
Fig. 3. Heterogenous depigmentation
induced by skin bleaching agents.
systemic complications. As users tend to hide the use of such
agents to the physician it is important to treat any underlying
skin dermatoses, disrupt bleaching agents, avoid any judgemental approach and educate about the risks of such practice.
NICOLAS KLUGER
Skin and Allergy Hospital, Helsinki
University
Central Hospital, Helsinki, Finland
E-mail: nicolaskluger@yahoo.fr
Health Economics and Dermatology
Fig. 1. Pityriasis rosea in a young girl. The rash appears grayish but the
topography and the aspects are still typical of pityriasis rosea. Note the
medalion in the left cheek that helped to make the diagnosis.
136
Nordic Dermato-Venereological Congress, Tampere
In recent years there have been major advances in dermatology. We have new biological drugs for treatment of psoriasis
and other in?ammatory condit ions. However, they are very
expensive, but we have been able to reduce the number of
beds due to dermatological research. Sweden is a very good
country for health economic studies as the budgetary system
is simple and includes all costs except sick-leave costs. Hence,
rent, salaries for staff, electricity, drugs for in- and out-patients
are included in the budget. Lindelöf et al. has demonstrated
that melanomas are best and cheapest treated by a dermatologist without previous referral from a general practitioner (GP).
However, still in many places people have to seek a GP ?rst.
When calculating cost, the whole process should be included,
not only different procedures. Priorities in health care must
be made to afford treatment of the most severe diseases. This
Forum for Nord Derm Ven 2013, Vol. 18, No. 4