but debilitating genetic disorder characterized by the chronic accumulation of iron in the body. Mercury poisoning—particularly cases of cutaneous exposure resulting from the topical application of mercurial ointments or skin-whitening creams. Aromatase deficiency Nelson's syndrome Graves' disease Schimke immunoosseous dysplasia (SOID). As a result of tinea cruris. Due to B12 deficiency. Atopic dermatitis as a result of inflammation. Hyperpigmentation can sometimes be induced by dermatological laser procedures. Diagnosis A physical examination including, Wood's lamp examination and a detailed history, usually sufficient for diagnosis. Skin examination. Viewing medical history. Treatment There are a wide range of depigmenting treatments used for hyperpigmentation conditions, and responses to most are variable. 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. Topical treatments Many topical treatments disrupt the synthesis of melanin by inhibiting the enzyme tyrosine hydroxylase. Several are prescription only in the US, especially in high doses, such as hydroquinone, azelaic acid, and kojic acid. Some are available without prescription, such as niacinamide, -ascorbic acid, retinoids such as tretinoin, or cysteamine hydrochloride. Hydroquinone was the most commonly prescribed hyperpigmentation treatment before the long-term safety concerns were raised, and the use of it became more regulated in several countries and discouraged in general by WHO. For the US, only 2% is at present sold over-the-counter, and 4% needs prescription. In the EU hydroquinone was banned from cosmetic applications. According to leading Celebrity Dermatologist Dr. Chytra Anand, active ingredients such as Licorice, Malic acid, Glycolic & Lactic acid, Niacinamide, Vitamin C & Turmeric in a daily skin care routine can also help reduce pigmentation. Oral Oral medication with procyanidin plus vitamins A, C, and E also shows promise as safe and effective for epidermal melasma. In an 8-week randomized, double-blind, placebo-controlled trial in 56 Filipino women, treatment was associated with significant improvements in the left and right malar regions, and was safe and well tolerated. Other treatments that do not involve topical agents are also available, including fraction lasers and dermabrasion. Laser treatments Laser toning using YAG lasers and intense pulsed light have been used to treat hyperpigmentation such as melasma and post-inflammatory hyperpigmentation. See also Hypopigmentation List of skin conditions Drug-induced pigmentation References External links Dermatologic terminology Medical signs