Ochronosis exogenous acquired E70.2

Pick, 19o6

Exogenously induced, bleach-induced, (cosmetic) ochronosis variant (exogenous dyschromia) that is particularly common in dark-skinned ethnic groups.

Rare finding in Europe. For South Africa, the prevalence is 28-35% in the dark-skinned population.

Not clearly proven! It is assumed that the hydroquinone contained in bleaching creams blocks the tissue-stable homogentisic acid oxidase. This leads to an accumulation and deposition of homogentisic acid polymers.

Risk factors for the manifestation of the disease are skin type V/VI, UV exposure and ethnic characteristics (long-term bleaching is a cultural phenomenon of certain ethnic groups for whom a lighter skin tone is a desirable beauty ideal).

The long-term use of bleaching substances in dark-skinned African women is reported to be 25-96%.

Face with emphasis on the zygomatic arches and areas particularly exposed to UV radiation.

Asymptomatic, flat, confluent, irregular, brown to slate grey hyperpigmentation, sometimes with underlying erythema. The changes are particularly prominent over bony prominences (forehead, nose, zygomatic bones).

Greyish-basophilic tinged fine feathery collagenous fibres grouped in the upper dermis. In the papillary body slightly clumped yellowish-brownish, banana-shaped, "ochronotic" fibres. Isolated macrophages.

The disease is to be distinguished from the extremely rare autosomal recessive endogenous ochronosis (alkaptonuria) with defect of the homogentisic acid oxidase.

Avoidance of bleaching agents containing hydroquinone. Consistent light protection.

Case reports on successful therapy approaches with tretinoin, trichloroacetic acid and cryotherapy are available.

Furthermore, the successful use of various bleaching agents has been reported. Laser systems CO2-, ruby, alexandrite-, Nd-YAG-laser reports possibly in combination with dermabrasion.

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4. Blumeyer A et al (2016) Progressive hyperpigmentation of the face. Dermatologist 67: 922-924
5. Haas N et al (1988) Ochronose-like pigmentation after hydroquinone-containing bleaching cream in a black African woman. Nude Dermatol 14: 173-176
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