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Aesthetics Practice Today

Treatment of Ochronosis

Published October 23, 2012 10:36 AM by Kimberly Cray

A patient presents with discrete patches of hyperpigmentation on the face, particularly involving the cheeks and upper lip. She denies recent sun exposure or use of oral contraception pills. She was diagnosed a year ago with melasma and given hydroquinone, which she used as directed in the evening for three months. She now presents with her condition worsening. Would you continue to treat this patient for melasma? What treatment would you recommend?

As providers in aesthetics when we are faced with hyperpigmentation, often our first instinct is to use a topical bleaching agent, such as hydroquinone. However, not every case of hyperpigmentation is melasma. We must remember to be extremely thorough with our exam and history taking. 

This patient actually needed treatment for ochronosis. Ochronosis is a syndrome caused by the accumulation of homogentisic acid in connective tissue. It can commonly occur after the use of phenol complexes, such as hydroquinone. The skin appears hyperpigmented and often bluish-gray in color. The offending agent must be stopped, as in this case, hydroquinone, for the patient to improve.   

Sun protection is key. Proper use of a physical block sun protectant is essential for the skin to recover. In addition, non-hydroquinone skin brighteners and bleaching agents as well as procedures may be utilized.  These include antioxidants and lasers, such as a Q-switched alexandrite (755 nm), specific for targeting pigmentation. Even in the treatment of "aesthetic" cases we must not overlook common medical causes for skin manifestations. Treat every case as unique and listen to what patients have tried in the past and not improved with before coming up with a treatment plan.

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    Occupation: Physician Assistant/Nurse Practitioner
    Setting: Miami & Upland, Calif.
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