PMC9467848_01
Clinical features of the patient before and after treatment. (A-C). Clinical features of the patient before treatment. Diffuse, symmetric, and reticular gray brown hyperpigmentation on the face and neck. (D-F). Clinical features of the patient after treatment. The hyperpigmentation on the face and neck turn much lighter.
CCID-15-1809-g0001.jpg
PMC9467848_01_CCID-15-1809-g0001.jpg
f0001
Diffuse, symmetric, and reticular gray brown hyperpigmentation was observed all over the face and neck, especially the cheeks and the area around the mouth (Figure 1A-C). The hyperpigmentation has turned much lighter (Figures 1D-F and 2B).
Dermoscopic and reflectance confocal microscopy features before and after treatment. (A). Dermoscopic features of the patient before treatment. Diffuse black-pepper-like changes separated by hair follicles with sweat glands and telangiectasias can be seen. (B). Dermoscopic features of the patient after treatment.The hyperpigmentation turn much lighter. (C and D). Reflectance confocal microscopy features of basal layer and dermis before treatment. Abundant melanin in the epidermis and dermis, local liquefactive degeneration of basal layer cells, and the presence of melanophages in the dermis. (E). Reflectance confocal microscopy feature of basal layer after treatment. The melanin in the epidermis decrease significantly, the local liquefactive degeneration of basal layer cells show improvement, and the melanophages in dermis decrease in number.
CCID-15-1809-g0002.jpg
PMC9467848_01_CCID-15-1809-g0002.jpg
f0002
Under skin microscopy, diffuse black-pepper-like changes separated by hair follicles with sweat glands and telangiectasias were seen (Figure 2A). The reflectance confocal microscopy showed abundant melanin in the epidermis and dermis, local liquefactive degeneration of basal layer cells, and the presence of melanophages in the dermis (Figure 2C and D). The hyperpigmentation has turned much lighter (Figures 1D-F and 2B). Under reflectance confocal microscopy, the melanin in the epidermis was found to have decreased significantly, the local liquefactive degeneration of basal layer cells showed improvement, and the melanophages in dermis was found to have decreased in number (Figure 2E).
Histopathologic features. (A). Histopathology of neck lesions show punctiform epidermal atrophy, punctate liquefactive degeneration of basal layer cells, melanophages in the dermis, and a few lymphocytes infiltrating around the dermal adnexa (HE staining, x100, bar=200mum). (B). A large amount of melanin in the epidermis and dermis (Masson-Fontana silver staining, x100, bar=200 mum).
CCID-15-1809-g0003.jpg
PMC9467848_01_CCID-15-1809-g0003.jpg
f0003
Histopathology of neck lesions (HE staining) showed punctiform epidermal atrophy, punctate liquefactive degeneration of basal layer cells, melanophages in the dermis, and a few lymphocytes infiltrating around the dermal adnexa (Figure 3A). Masson-Fontana silver staining showed amounts of melanin in the epidermis and dermis (Figure 3B).