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Validation of a melasma quality of life questionnaire for the Brazilian-Portuguese language – the MELASQOL-BP study
P2607
P2609
Validation of a melasma quality of life questionnaire for the BrazilianPortuguese language e the MELASQOL-BP study Tania Cestari, MD, PhD, University of Rio Grande do SUL, Porto Alegre, Brazil; Doris Hexsel, MD, private clinic, Porto Alegre, Brazil; Maria de Lourdes Viegas, MD, Dermatology Clinic, Rio de Janeiro, Brazil; Luna Azulay, MD, Dermatology Center, Santa Casa de Miserico´rdia do Rio de Janeiro, Rio de Janeiro, Brazil Background: Pigmentation disorders, such as melasma, greatly influence quality of life (QoL) with patients usually choosing higher severity scores when compared to clinicians. Several instruments have been successfully developed to evaluate QoL. However, they must be adapted to the target population in terms of language and cultural diversity.
Intradermal tissue hemosiderosis presenting as slate-gray hyperpigmentation during treatment with imatinib mesylate Kevin T. Belasco, DO, MS, Nova Southeastern University, Sun Coast Hospital, Largo, FL, United States; Richard A. Miller, DO, Nova Southeastern University, Sun Coast Hospital, Largo, FL, United States
Purpose: Our purpose was to validate the Brazilian Portuguese version (MelasQoLBP) of the QoL evaluation questionnaire for patients with melasma and to assess the impact of treatment with a triple combination cream (hydroquinone, fluocinolone acetonide, and tretinoine) on the QoL of patients with moderate to severe melasma. Methods and Results: Three-hundred individuals from the 5 Brazilian geographic regions took part in this multicentric study. The following instruments were used to assess melasma severity and QoL at baseline: Melasma Area and Severity Index (MASI), MelasQoL-BP and WHOQoL., MelasQoL-BP was previously translated and culturally adapted from the original English questionnaire, according to the standards of the World Health Organization (WHO). From the original sample, we randomized 139 volunteers to treat melasma and repeat the evaluation in 8 weeks. The analysis of the MelasQoL-BP baseline answers demonstrated an important impact of the disease on skin appearance (65% of patients were bothered all the time or most of the time), frustration (55%), embarrassment (57%), and influence of the disease on interpersonal relationships (42%). Forty-three percent of patients felt unattractive due to their skin condition. MelasQoL-BP results showed significant internal consistency (Cronbach’s alpha coefficient 0.919; p \ 0.001) and good correlation with MASI scores. After treatment, the global assessment showed good or excellent results in 91.4% of the patients. The clinical outcome was not associated with the initial MASI score (p = 0.814; chi square), skin color (p = 0.449; probability ratio), or skin brightness (0.814; chi square). There was also a significant reduction on MelasQoL-BP scores (Wilcoxon test; p\0.001) after treatment, with the mean 6 standard deviation results shifting from 44.4 6 14.9 at baseline to 24.3 6 15.5 after treatment.
Imatinib mesylate is a novel tyrosine kinase inhibitor fusion protein currently approved for the treatment of chronic myelogenous leukemia (CML). We report the case of a 49-year-old female with CML, controlled with imatinib mesylate 400 mg daily, who presented to our clinic with a 3-year history of progressive, slate-gray hyperpigmentation of the face, arms, hands, and lower extremities. The patient related that the hyperpigmentation began approximately one year after starting the course of imatinib mesylate. The patient denied any previous exposure to silver or gold. She also denied any past or present use of minocycline, hydroquinone, or amiodarone, three known pharmacologic triggers of persistent cutaneous hyperpigmentation. Family history was negative for pigmentary disorders such as ochronosis. Histologic examination of 4 mm punch biopsies of the affected skin on the left posterior triceps revealed pigmented dermal macrophages with marked intradermal tissue hemosiderosis compatible with drug-induced hyperpigmentation. Prussian blue stain confirmed the presence of dermal iron deposition. Melanin stain failed to demonstrate intradermal melanin deposition. A wide array of cutaneous eruptions secondary to the use of imatinib mesylate are known to occur, but pigmentary alterations reported in the literature relate largely to hypopigmentation following the use of this medication. Management of cutaneous alterations attributed to imatinib mesylate is confounded by the need in many cases to continue treatment in spite of these changes to maintain clinical remission from CML leukemia. To our knowledge, this is the first report of extensive and persistent deep dermal hemosiderosis presenting as slate-gray hyperpigmentation induced by imatinib mesylate in a patient with chronic myelogenous leukemia. Commercial support: None identified.
Conclusions: This study demonstrates that MelasQoL-BP is a valid instrument and can be used to evaluate melasma severity and response to treatment in Brazilian patients. The triple treatment produced significant results, regarding both clinical severity and quality of life. Galderma sponsored the expenses related to medication, transport, and translations.
P2608 Idiopathic macular hyperpigmentation in an adult female Arash Akhavan, MD, The Mount Sinai School of Medicine, New York, NY, United States; Donald Rudikoff, MD, The Mount Sinai School of Medicine, New York, NY, United States; Patrick Emanuel, MD, The Mount Sinai School of Medicine, New York, NY, United States A 53-year-old White female presented with a hyperpigmented longitudinal linear band on her right thumbnail, and dark spots on her lips, gums and fingers. The lesions on her lips began when she was 18 during her first pregnancy and the macules on her fingers developed when she was 39. The patient had a history of freckles on her face, chest, back, arms, legs, thighs, and buttocks since her teenage years. There was no family history of hyperpigmented spots or intestinal polyps. Colonoscopy and gastroduodenoscopy performed one year prior to her initial visit and barium study of her upper gastrointestinal tract at age 17 were negative for polyposis or tumor. Echocardiogram revealed only slightly thickened aortic and mitral valves, with mild mitral regurgitation. Her only other medication was omeprazole taken for gastro-intestinal reflux in the year prior to the visit. Clinical examination revealed brown macules on the palmar and lateral aspects of the fingers of both hands each approximately 2-3 mm in diameter, as well as dark brown macules on the lips measuring up to 1 cm in diameter. There was a long melanonychia on the right thumbnail. Hyperpigmented macules were also seen on the gingiva, labial mucosa, and perianal area. A hematoxylin-eosin-stained section of the lower lip showed acanthotic epithelium and increased melanin in the basal keratinocytes. A diagnosis of Laugier-Hunziker syndrome (LHS), a rare acquired disorder affecting patients in the second to ninth decades of life was made. Since first described in 1970 , the characterization of the disorder has evolved and it is now typically diagnosed by the presence of multiple pigmental macules on the buccal mucosa and lips (especially the lower lip), along with melanonychia striata of the fingernails. Dark macules may be present on the gingival, hard palate, tongue, hands, and anal mucosa, as well as on the perioral area, genitialia, perineum, and soles of feet. No systemic disease has been associated with the occurrence of LHS. Often asymptomatic progression of pigmentation occurs, but because of the invariably benign progression of LHS it is unnecessary to observe these patients for long periods of time. The patient’s labial hyperpigmentation was treated with a Q-switched ruby laser with excellent cosmetic results.
P2610
Commercial support: None identified.
Study and poster support were provided by Galderma Laboratories, L.P.
FEBRUARY 2007
Triple combination cream is an effective treatment for post-inflammatory hyperpigmentation Leslie Baumann, MD, University of Miami, Miami, FL, United States; Pearl Grimes, MD, Vitiligo and Pigmentation Institute of Southern California, Los Angeles, CA, United States; Amit G. Pandya, MD, University of Texas Southwestern Medical Center, Dallas, TX, United States; Marta Rendon, MD, The Dermatology and Aesthetic Center, Boca Raton, FL, United States Post-inflammatory hyperpigmentation appears as macular areas of darker skin color as a secondary response to inflammatory processes in the skin. Some of the most common inflammatory processes resulting in this hyperpigmentation include acne, eczema, or atopic dermatitis. Treatments for these conditions that result in skin irritation can often enhance the possibility of secondary hyperpigmentation. When the basal layer of the skin is involved, the duration of the hyperpigmentation can be prolonged. Treatment of post-inflammatory hyperpigmentation has been quite challenging with little or no success when using single-modality approaches. Triple combination cream (fluocinolone acetonide 0.01%, hydroquinone 4%, tretinoin 0.05%) is FDA-approved for another hyperpigmentation disorder, melasma, and its efficacy in treating post-inflammatory hyperpigmentation was studied. Two large randomized studies with identical protocols were conducted and the results were pooled. Triple combination cream was compared to each of its dyads and patients were evaluated by investigator global assessment of severity. Over an 8-week treatment period, the percentage of patients who were rated as clear from treatment with TC cream was higher than with any of the dyad comparators. Furthermore, trending graphs suggest that TC cream provides a more rapid response than the comparators and also suggests that a longer treatment period may provide even better results. Subgroup analyses found statistically significant differences based on baseline severity (P = .011) and ethnicity (P = .001) of patients.
J AM ACAD DERMATOL
AB171
P2609
Validation of a melasma quality of life questionnaire for the BrazilianPortuguese language e the MELASQOL-BP study Tania Cestari, MD, PhD, University of Rio Grande do SUL, Porto Alegre, Brazil; Doris Hexsel, MD, private clinic, Porto Alegre, Brazil; Maria de Lourdes Viegas, MD, Dermatology Clinic, Rio de Janeiro, Brazil; Luna Azulay, MD, Dermatology Center, Santa Casa de Miserico´rdia do Rio de Janeiro, Rio de Janeiro, Brazil Background: Pigmentation disorders, such as melasma, greatly influence quality of life (QoL) with patients usually choosing higher severity scores when compared to clinicians. Several instruments have been successfully developed to evaluate QoL. However, they must be adapted to the target population in terms of language and cultural diversity.
Intradermal tissue hemosiderosis presenting as slate-gray hyperpigmentation during treatment with imatinib mesylate Kevin T. Belasco, DO, MS, Nova Southeastern University, Sun Coast Hospital, Largo, FL, United States; Richard A. Miller, DO, Nova Southeastern University, Sun Coast Hospital, Largo, FL, United States
Purpose: Our purpose was to validate the Brazilian Portuguese version (MelasQoLBP) of the QoL evaluation questionnaire for patients with melasma and to assess the impact of treatment with a triple combination cream (hydroquinone, fluocinolone acetonide, and tretinoine) on the QoL of patients with moderate to severe melasma. Methods and Results: Three-hundred individuals from the 5 Brazilian geographic regions took part in this multicentric study. The following instruments were used to assess melasma severity and QoL at baseline: Melasma Area and Severity Index (MASI), MelasQoL-BP and WHOQoL., MelasQoL-BP was previously translated and culturally adapted from the original English questionnaire, according to the standards of the World Health Organization (WHO). From the original sample, we randomized 139 volunteers to treat melasma and repeat the evaluation in 8 weeks. The analysis of the MelasQoL-BP baseline answers demonstrated an important impact of the disease on skin appearance (65% of patients were bothered all the time or most of the time), frustration (55%), embarrassment (57%), and influence of the disease on interpersonal relationships (42%). Forty-three percent of patients felt unattractive due to their skin condition. MelasQoL-BP results showed significant internal consistency (Cronbach’s alpha coefficient 0.919; p \ 0.001) and good correlation with MASI scores. After treatment, the global assessment showed good or excellent results in 91.4% of the patients. The clinical outcome was not associated with the initial MASI score (p = 0.814; chi square), skin color (p = 0.449; probability ratio), or skin brightness (0.814; chi square). There was also a significant reduction on MelasQoL-BP scores (Wilcoxon test; p\0.001) after treatment, with the mean 6 standard deviation results shifting from 44.4 6 14.9 at baseline to 24.3 6 15.5 after treatment.
Imatinib mesylate is a novel tyrosine kinase inhibitor fusion protein currently approved for the treatment of chronic myelogenous leukemia (CML). We report the case of a 49-year-old female with CML, controlled with imatinib mesylate 400 mg daily, who presented to our clinic with a 3-year history of progressive, slate-gray hyperpigmentation of the face, arms, hands, and lower extremities. The patient related that the hyperpigmentation began approximately one year after starting the course of imatinib mesylate. The patient denied any previous exposure to silver or gold. She also denied any past or present use of minocycline, hydroquinone, or amiodarone, three known pharmacologic triggers of persistent cutaneous hyperpigmentation. Family history was negative for pigmentary disorders such as ochronosis. Histologic examination of 4 mm punch biopsies of the affected skin on the left posterior triceps revealed pigmented dermal macrophages with marked intradermal tissue hemosiderosis compatible with drug-induced hyperpigmentation. Prussian blue stain confirmed the presence of dermal iron deposition. Melanin stain failed to demonstrate intradermal melanin deposition. A wide array of cutaneous eruptions secondary to the use of imatinib mesylate are known to occur, but pigmentary alterations reported in the literature relate largely to hypopigmentation following the use of this medication. Management of cutaneous alterations attributed to imatinib mesylate is confounded by the need in many cases to continue treatment in spite of these changes to maintain clinical remission from CML leukemia. To our knowledge, this is the first report of extensive and persistent deep dermal hemosiderosis presenting as slate-gray hyperpigmentation induced by imatinib mesylate in a patient with chronic myelogenous leukemia. Commercial support: None identified.
Conclusions: This study demonstrates that MelasQoL-BP is a valid instrument and can be used to evaluate melasma severity and response to treatment in Brazilian patients. The triple treatment produced significant results, regarding both clinical severity and quality of life. Galderma sponsored the expenses related to medication, transport, and translations.
P2608 Idiopathic macular hyperpigmentation in an adult female Arash Akhavan, MD, The Mount Sinai School of Medicine, New York, NY, United States; Donald Rudikoff, MD, The Mount Sinai School of Medicine, New York, NY, United States; Patrick Emanuel, MD, The Mount Sinai School of Medicine, New York, NY, United States A 53-year-old White female presented with a hyperpigmented longitudinal linear band on her right thumbnail, and dark spots on her lips, gums and fingers. The lesions on her lips began when she was 18 during her first pregnancy and the macules on her fingers developed when she was 39. The patient had a history of freckles on her face, chest, back, arms, legs, thighs, and buttocks since her teenage years. There was no family history of hyperpigmented spots or intestinal polyps. Colonoscopy and gastroduodenoscopy performed one year prior to her initial visit and barium study of her upper gastrointestinal tract at age 17 were negative for polyposis or tumor. Echocardiogram revealed only slightly thickened aortic and mitral valves, with mild mitral regurgitation. Her only other medication was omeprazole taken for gastro-intestinal reflux in the year prior to the visit. Clinical examination revealed brown macules on the palmar and lateral aspects of the fingers of both hands each approximately 2-3 mm in diameter, as well as dark brown macules on the lips measuring up to 1 cm in diameter. There was a long melanonychia on the right thumbnail. Hyperpigmented macules were also seen on the gingiva, labial mucosa, and perianal area. A hematoxylin-eosin-stained section of the lower lip showed acanthotic epithelium and increased melanin in the basal keratinocytes. A diagnosis of Laugier-Hunziker syndrome (LHS), a rare acquired disorder affecting patients in the second to ninth decades of life was made. Since first described in 1970 , the characterization of the disorder has evolved and it is now typically diagnosed by the presence of multiple pigmental macules on the buccal mucosa and lips (especially the lower lip), along with melanonychia striata of the fingernails. Dark macules may be present on the gingival, hard palate, tongue, hands, and anal mucosa, as well as on the perioral area, genitialia, perineum, and soles of feet. No systemic disease has been associated with the occurrence of LHS. Often asymptomatic progression of pigmentation occurs, but because of the invariably benign progression of LHS it is unnecessary to observe these patients for long periods of time. The patient’s labial hyperpigmentation was treated with a Q-switched ruby laser with excellent cosmetic results.
P2610
Commercial support: None identified.
Study and poster support were provided by Galderma Laboratories, L.P.
FEBRUARY 2007
Triple combination cream is an effective treatment for post-inflammatory hyperpigmentation Leslie Baumann, MD, University of Miami, Miami, FL, United States; Pearl Grimes, MD, Vitiligo and Pigmentation Institute of Southern California, Los Angeles, CA, United States; Amit G. Pandya, MD, University of Texas Southwestern Medical Center, Dallas, TX, United States; Marta Rendon, MD, The Dermatology and Aesthetic Center, Boca Raton, FL, United States Post-inflammatory hyperpigmentation appears as macular areas of darker skin color as a secondary response to inflammatory processes in the skin. Some of the most common inflammatory processes resulting in this hyperpigmentation include acne, eczema, or atopic dermatitis. Treatments for these conditions that result in skin irritation can often enhance the possibility of secondary hyperpigmentation. When the basal layer of the skin is involved, the duration of the hyperpigmentation can be prolonged. Treatment of post-inflammatory hyperpigmentation has been quite challenging with little or no success when using single-modality approaches. Triple combination cream (fluocinolone acetonide 0.01%, hydroquinone 4%, tretinoin 0.05%) is FDA-approved for another hyperpigmentation disorder, melasma, and its efficacy in treating post-inflammatory hyperpigmentation was studied. Two large randomized studies with identical protocols were conducted and the results were pooled. Triple combination cream was compared to each of its dyads and patients were evaluated by investigator global assessment of severity. Over an 8-week treatment period, the percentage of patients who were rated as clear from treatment with TC cream was higher than with any of the dyad comparators. Furthermore, trending graphs suggest that TC cream provides a more rapid response than the comparators and also suggests that a longer treatment period may provide even better results. Subgroup analyses found statistically significant differences based on baseline severity (P = .011) and ethnicity (P = .001) of patients.
J AM ACAD DERMATOL
AB171