char = H;code = 72 char = y;code = 121 char = d;code = 100 char = r;code = 114 char = o;code = 111 char = q;code = 113 char = u;code = 117 char = i;code = 105 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = e;code = 101 char = -;code = 45 char = i;code = 105 char = n;code = 110 char = d;code = 100 char = u;code = 117 char = c;code = 99 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = e;code = 101 char = x;code = 120 char = o;code = 111 char = g;code = 103 char = e;code = 101 char = n;code = 110 char = o;code = 111 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = o;code = 111 char = c;code = 99 char = h;code = 104 char = r;code = 114 char = o;code = 111 char = n;code = 110 char = o;code = 111 char = s;code = 115 char = i;code = 105 char = s;code = 115 char = :;code = 58 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = p;code = 112 char = o;code = 111 char = r;code = 114 char = t;code = 116 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = u;code = 117 char = r;code = 114 char = ;code = 32 char = c;code = 99 char = a;code = 97 char = s;code = 115 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = u;code = 117 char = s;code = 115 char = e;code = 101 char = f;code = 102 char = u;code = 117 char = l;code = 108 char = n;code = 110 char = e;code = 101 char = s;code = 115 char = s;code = 115 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = d;code = 100 char = e;code = 101 char = r;code = 114 char = m;code = 109 char = o;code = 111 char = s;code = 115 char = c;code = 99 char = o;code = 111 char = p;code = 112 char = y;code = 121 char = .;code = 46 result sql = Hydroquinone-induced exogenous ochronosis: a report of four cases and usefulness of dermoscopy.
Hydroquinone-induced exogenous ochronosis: a report of four cases and usefulness of dermoscopy.char = H;code = 72 char = y;code = 121 char = d;code = 100 char = r;code = 114 char = o;code = 111 char = q;code = 113 char = u;code = 117 char = i;code = 105 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = e;code = 101 char = ;code = 32 char = i;code = 105 char = s;code = 115 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = f;code = 102 char = i;code = 105 char = r;code = 114 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = c;code = 99 char = h;code = 104 char = o;code = 111 char = i;code = 105 char = c;code = 99 char = e;code = 101 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = p;code = 112 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = b;code = 98 char = l;code = 108 char 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= s;code = 115 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = t;code = 116 char = e;code = 101 char = n;code = 110 char = ;code = 32 char = u;code = 117 char = s;code = 115 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = b;code = 98 char = y;code = 121 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = o;code = 111 char = u;code = 117 char = t;code = 116 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = e;code = 101 char = s;code = 115 char = c;code = 99 char = r;code = 114 char = i;code = 105 char = p;code = 112 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = 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= 97 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = f;code = 102 char = e;code = 101 char = t;code = 116 char = t;code = 116 char = i;code = 105 char = -;code = 45 char = l;code = 108 char = i;code = 105 char = k;code = 107 char = e;code = 101 char = ;code = 32 char = d;code = 100 char = e;code = 101 char = p;code = 112 char = i;code = 105 char = g;code = 103 char = m;code = 109 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = e;code = 101 char = x;code = 120 char = o;code = 111 char = g;code = 103 char = e;code = 101 char = n;code = 110 char = o;code = 111 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = o;code = 111 char = c;code = 99 char = h;code = 104 char = r;code = 114 char = o;code = 111 char = n;code = 110 char = o;code = 111 char = s;code = 115 char = i;code = 105 char = s;code = 115 char = .;code = 46 char = ;code = 32 char = T;code = 84 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = m;code = 109 char = a;code = 97 char = n;code = 110 char = i;code = 105 char = f;code = 102 char = e;code = 101 char = s;code = 115 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = c;code = 99 char = l;code = 108 char = i;code = 105 char = n;code = 110 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = l;code = 108 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = g;code = 103 char = r;code = 114 char = a;code = 97 char = y;code = 121 char = -;code = 45 char = b;code = 98 char = r;code = 114 char = o;code = 111 char = w;code = 119 char = n;code = 110 char = ;code = 32 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = b;code = 98 char = l;code = 108 char = u;code = 117 char = e;code = 101 char = -;code = 45 char = b;code = 98 char = l;code = 108 char = a;code = 97 char = c;code = 99 char = k;code = 107 char = ;code = 32 char = h;code = 104 char = y;code = 121 char = p;code = 112 char = e;code = 101 char = r;code = 114 char = p;code = 112 char = i;code = 105 char = g;code = 103 char = m;code = 109 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ,;code = 44 char = ;code = 32 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = e;code = 101 char = l;code = 108 char = l;code = 108 char = ;code = 32 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = p;code = 112 char = i;code = 105 char = n;code = 110 char = p;code = 112 char = o;code = 111 char = i;code = 105 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = h;code = 104 char = y;code = 121 char = p;code = 112 char = e;code = 101 char = r;code = 114 char = c;code = 99 char = h;code = 104 char = r;code = 114 char = o;code = 111 char = m;code = 109 char = i;code = 105 char = c;code = 99 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = p;code = 112 char = u;code = 117 char = l;code = 108 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = a;code = 97 char = t;code = 116 char = ;code = 32 char = l;code = 108 char = o;code = 111 char = o;code = 111 char = k;code = 107 char = ;code = 32 char = l;code = 108 char = i;code = 105 char = k;code = 107 char = e;code = 101 char = ;code = 32 char = c;code = 99 char = a;code = 97 char = v;code = 118 char = i;code = 105 char = a;code = 97 char = r;code = 114 char = ,;code = 44 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = f;code = 102 char = o;code = 111 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = c;code = 99 char = a;code = 97 char = l;code = 108 char = l;code = 108 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = c;code = 99 char = a;code = 97 char = v;code = 118 char = i;code = 105 char = a;code = 97 char = r;code = 114 char = -;code = 45 char = l;code = 108 char = i;code = 105 char = k;code = 107 char = e;code = 101 char = .;code = 46 char = ;code = 32 char = O;code = 79 char = n;code = 110 char = ;code = 32 char = h;code = 104 char = i;code = 105 char = s;code = 115 char = t;code = 116 char = o;code = 111 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = h;code = 104 char = o;code = 111 char = l;code = 108 char = o;code = 111 char = g;code = 103 char = y;code = 121 char = 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f;code = 102 char = i;code = 105 char = b;code = 98 char = e;code = 101 char = r;code = 114 char = s;code = 115 char = ,;code = 44 char = ;code = 32 char = a;code = 97 char = p;code = 112 char = p;code = 112 char = e;code = 101 char = a;code = 97 char = r;code = 114 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = p;code = 112 char = i;code = 105 char = l;code = 108 char = l;code = 108 char = a;code = 97 char = r;code = 114 char = y;code = 121 char = ;code = 32 char = d;code = 100 char = e;code = 101 char = r;code = 114 char = m;code = 109 char = i;code = 105 char = s;code = 115 char = .;code = 46 char = ;code = 32 char = N;code = 78 char = o;code = 111 char = ;code = 32 char = d;code = 100 char = e;code = 101 char = s;code = 115 char = c;code = 99 char = r;code = 114 char = i;code = 105 char = p;code = 112 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = d;code = 100 char = e;code = 101 char = r;code = 114 char = m;code = 109 char = o;code = 111 char = s;code = 115 char = c;code = 99 char = o;code = 111 char = p;code = 112 char = y;code = 121 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = o;code = 111 char = c;code = 99 char = h;code = 104 char = r;code = 114 char = o;code = 111 char = n;code = 110 char = o;code = 111 char = s;code = 115 char = i;code = 105 char = s;code = 115 char = ;code = 32 char = i;code = 105 char = s;code = 115 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = u;code = 117 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = l;code = 108 char = i;code = 105 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = a;code = 97 char = t;code = 116 char = u;code = 117 char = r;code = 114 char = e;code = 101 char = .;code = 46 char = ;code = 32 char = W;code = 87 char = e;code = 101 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = p;code = 112 char = o;code = 111 char = r;code = 114 char = t;code = 116 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = u;code = 117 char = r;code = 114 char = ;code = 32 char = c;code = 99 char = a;code = 97 char = s;code = 115 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = h;code = 104 char = y;code = 121 char = d;code = 100 char = r;code = 114 char = o;code = 111 char = q;code = 113 char = u;code = 117 char = i;code = 105 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = e;code = 101 char = -;code = 45 char = i;code = 105 char = n;code = 110 char = d;code = 100 char = u;code = 117 char = c;code = 99 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = e;code = 101 char = x;code = 120 char = o;code = 111 char = g;code = 103 char = e;code = 101 char = n;code = 110 char = o;code = 111 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = o;code = 111 char = c;code = 99 char = h;code = 104 char = r;code = 114 char = o;code = 111 char = n;code = 110 char = o;code = 111 char = s;code = 115 char = i;code = 105 char = s;code = 115 char = .;code = 46 char = ;code = 32 char = D;code = 68 char = e;code = 101 char = r;code = 114 char = m;code = 109 char = o;code = 111 char = s;code = 115 char = c;code = 99 char = o;code = 111 char = p;code = 112 char = y;code = 121 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = p;code = 112 char = e;code = 101 char = r;code = 114 char = f;code = 102 char = o;code = 111 char = r;code = 114 char = m;code = 109 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = t;code = 116 char = w;code = 119 char = o;code = 111 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = r;code = 114 char = e;code = 101 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = o;code = 111 char = c;code = 99 char = h;code = 104 char = r;code = 114 char = o;code = 111 char = n;code = 110 char = o;code = 111 char = s;code = 115 char = i;code = 105 char = s;code = 115 char = ,;code = 44 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = d;code = 100 char = d;code = 100 char = i;code = 105 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = m;code = 109 char = e;code = 101 char = l;code = 108 char = a;code = 97 char = s;code = 115 char = m;code = 109 char = a;code = 97 char = ;code = 32 char = f;code = 102 char = i;code = 105 char = n;code = 110 char = d;code = 100 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = s;code = 115 char = ,;code = 44 char = ;code = 32 char = a;code = 97 char = m;code = 109 char = o;code = 111 char = r;code = 114 char = p;code = 112 char = h;code = 104 char = o;code = 111 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = d;code = 100 char = e;code = 101 char = n;code = 110 char = s;code = 115 char = e;code = 101 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = p;code = 112 char = i;code = 105 char = g;code = 103 char = m;code = 109 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = r;code = 114 char = u;code = 117 char = c;code = 99 char = t;code = 116 char = u;code = 117 char = r;code = 114 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = o;code = 111 char = b;code = 98 char = l;code = 108 char = i;code = 105 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = s;code = 115 char = o;code = 111 char = m;code = 109 char = e;code = 101 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = l;code = 108 char = l;code = 108 char = i;code = 105 char = c;code = 99 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = r;code = 114 char = ;code = 32 char = o;code = 111 char = p;code = 112 char = e;code = 101 char = n;code = 110 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = o;code = 111 char = b;code = 98 char = s;code = 115 char = e;code = 101 char = r;code = 114 char = v;code = 118 char = e;code = 101 char = d;code = 100 char = .;code = 46 char = ;code = 32 char = E;code = 69 char = x;code = 120 char = o;code = 111 char = g;code = 103 char = e;code = 101 char = n;code = 110 char = o;code = 111 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = o;code = 111 char = c;code = 99 char = h;code = 104 char = r;code = 114 char = o;code = 111 char = n;code = 110 char = o;code = 111 char = s;code = 115 char = i;code = 105 char = s;code = 115 char = ;code = 32 char = i;code = 105 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = v;code = 118 char = o;code = 111 char = i;code = 105 char = d;code = 100 char = a;code = 97 char = b;code = 98 char = l;code = 108 char = e;code = 101 char = ;code = 32 char = d;code = 100 char = e;code = 101 char = r;code = 114 char = m;code = 109 char = a;code = 97 char = t;code = 116 char = o;code = 111 char = s;code = 115 char = i;code = 105 char = s;code = 115 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = a;code = 97 char = t;code = 116 char = ;code = 32 char = i;code = 105 char = s;code = 115 char = ;code = 32 char = d;code = 100 char = i;code = 105 char = f;code = 102 char = f;code = 102 char = i;code = 105 char = c;code = 99 char = u;code = 117 char = l;code = 108 char = t;code = 116 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = t;code = 116 char = r;code = 114 char = e;code = 101 char = a;code = 97 char = t;code = 116 char = .;code = 46 char = ;code = 32 char = D;code = 68 char = e;code = 101 char = r;code = 114 char = m;code = 109 char = a;code = 97 char = t;code = 116 char = o;code = 111 char = l;code = 108 char = o;code = 111 char = g;code = 103 char = i;code = 105 char = s;code = 115 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = s;code = 115 char = h;code = 104 char = o;code = 111 char = u;code = 117 char = l;code = 108 char = d;code = 100 char = ;code = 32 char = b;code = 98 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = b;code = 98 char = l;code = 108 char = e;code = 101 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = d;code = 100 char = i;code = 105 char = f;code = 102 char = f;code = 102 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = ;code = 32 char = i;code = 105 char = t;code = 116 char = ;code = 32 char = f;code = 102 char = r;code = 114 char = o;code = 111 char = m;code = 109 char = ;code = 32 char = m;code = 109 char = e;code = 101 char = l;code = 108 char = a;code = 97 char = s;code = 115 char = m;code = 109 char = a;code = 97 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = i;code = 105 char = m;code = 109 char = m;code = 109 char = e;code = 101 char = d;code = 100 char = i;code = 105 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = d;code = 100 char = i;code = 105 char = s;code = 115 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = n;code = 110 char = u;code = 117 char = e;code = 101 char = ;code = 32 char = h;code = 104 char = y;code = 121 char = d;code = 100 char = r;code = 114 char = o;code = 111 char = q;code = 113 char = u;code = 117 char = i;code = 105 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = e;code = 101 char = .;code = 46 char = ;code = 32 char = D;code = 68 char = e;code = 101 char = r;code = 114 char = m;code = 109 char = o;code = 111 char = s;code = 115 char = c;code = 99 char = o;code = 111 char = p;code = 112 char = y;code = 121 char = ;code = 32 char = m;code = 109 char = i;code = 105 char = g;code = 103 char = h;code = 104 char = t;code = 116 char = ;code = 32 char = b;code = 98 char = e;code = 101 char = c;code = 99 char = o;code = 111 char = m;code = 109 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = v;code = 118 char = a;code = 97 char = l;code = 108 char = u;code = 117 char = a;code = 97 char = b;code = 98 char = l;code = 108 char = e;code = 101 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = s;code = 115 char = o;code = 111 char = u;code = 117 char = r;code = 114 char = c;code = 99 char = e;code = 101 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = p;code = 112 char = p;code = 112 char = r;code = 114 char = o;code = 111 char = a;code = 97 char = c;code = 99 char = h;code = 104 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = e;code = 101 char = x;code = 120 char = o;code = 111 char = g;code = 103 char = e;code = 101 char = n;code = 110 char = o;code = 111 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = o;code = 111 char = c;code = 99 char = h;code = 104 char = r;code = 114 char = o;code = 111 char = n;code = 110 char = o;code = 111 char = s;code = 115 char = i;code = 105 char = s;code = 115 char = .;code = 46 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 result sql = Hydroquinone is the first choice of topical bleaching agents used in treatment of melasma. In Brazil, hydroquinone is widely prescribed by physicians and often used by patients without a prescription. The principal adverse effects of its chronic use are confetti-like depigmentation and exogenous ochronosis. The latter manifests clinically with gray-brown or blue-black hyperpigmentation, as well as pinpoint hyperchromic papules that look like caviar, and therefore called caviar-like. On histopathology, curved ochre-colored structures, 'banana-shaped' fibers, appear in the papillary dermis. No description of dermoscopy in ochronosis is found in the literature. We report four cases of hydroquinone-induced exogenous ochronosis. Dermoscopy was performed in two patients on the areas with ochronosis, and in addition to the melasma findings, amorphous densely pigmented structures obliterating some follicular openings were observed. Exogenous ochronosis is an avoidable dermatosis that is difficult to treat. Dermatologists should be able to differentiate it from melasma and immediately discontinue hydroquinone. Dermoscopy might become a valuable resource in approaching exogenous ochronosis.
Publication: Int. J. Dermatol. 2008 Jan ;47(1)::19-23. :doi: 10.1111/j.1365-4632.2007.03351.x.
Publication Date: 2008 Jan
Study Author(s): Charlín, Raúl;Barcaui, Carlos B;Kac, Bernard Kawa;Soares, Deborah Brazuna;Rabello-Fonseca, Rosa;Azulay-Abulafia, Luna;
Institution: Instituto de Dermatologia Professor R. D. Azulay, Hospital Santa Casa da Misericórdia do Rio de Janeiro, Brazil.
[email protected]
Shortcut link to this study:
Hydroquinone is the first choice of topical bleaching agents used in treatment of melasma. In Brazil, hydroquinone is widely prescribed by physicians and often used by patients without a prescription. The principal adverse effects of its chronic use are confetti-like depigmentation and exogenous ochronosis. The latter manifests clinically with gray-brown or blue-black hyperpigmentation, as well as pinpoint hyperchromic papules that look like caviar, and therefore called caviar-like. On histopathology, curved ochre-colored structures, 'banana-shaped' fibers, appear in the papillary dermis. No description of dermoscopy in ochronosis is found in the literature. We report four cases of hydroquinone-induced exogenous ochronosis. Dermoscopy was performed in two patients on the areas with ochronosis, and in addition to the melasma findings, amorphous densely pigmented structures obliterating some follicular openings were observed. Exogenous ochronosis is an avoidable dermatosis that is difficult to treat. Dermatologists should be able to differentiate it from melasma and immediately discontinue hydroquinone. Dermoscopy might become a valuable resource in approaching exogenous ochronosis.
PMID: 18173595