Proceedings of the Fifth SKIN SPECTRUM SUMMIT

SSS-2019 02-10-20_Layout 1 2/12/2020 5:18 PM Page 32
When brown patches are not melasma
Dr. Andrew F. Alexis
MELANOMA,
SUN
PROTECTION
In a presentation titled “Diagnoses
Not to Miss” at Skin Spectrum
Summit in Toronto, Dr.
Andrew F. Alexis sorted through a
number of cases in which his patients
exhibited pigmentation
symptoms that could easily be
misinterpreted as more common
diseases at first glance due to
their fairly standard appearance.
In some cases, skin hyperpigmentation
can be brought on by unusual
skin-care regimens or
reactions to other therapies, he
said.
“When one is presented with symmetrical
brown patches on the face,
the diagnosis is usually melasma, but
not always.”
He outlined a number of cases in
which these brown patches turned
out to be something different than expected.
Dr. Alexis proceeded to discuss a
case involving a 53-year-old African-
American woman with brown patches
on her face, which he said is a very
common complaint. He described her
patches, which appeared on the
cheek and temple, as being brown
with a purplish-grey hue. She also had
a past medical history of hypertension,
for which she was prescribed diltiazem.
“What else can it be?” he asked
the audience.
It turns out that diltiazem triggered
a photodistributed lichenoid
drug eruption, he said.
“After identifying the causative
agent — diltiazem in this case — discontinuing
it and switching to a chemically
unrelated antihypertensive, she
got better,” he said.
He noted that this purplish-grey
photodistributed lichenoid drug eruption
could also be caused by therapies
such as antimalarials, thiazide diuretics,
furosemide, ethambutol and tetracycline.
“When you see dark patches on
the face that aren’t quite brown but
[are] more greyish blue or lichenoid
looking, consider photodistributed
lichenoid drug eruption,” he said.
He used other examples to give
an idea of the process he went
through to find the correct diagnosis.
One case involved a woman with
post-inflammatory hyperpigmentation
brought on by months of harsh scrubbing
of her facial area “in an effort to
even her skin tone,” said Dr. Alexis.
“She was trying to treat hyperpigmentation
but induced hyperpigmentation
from her very irritating skin-care
regimen,” he said.
A second case he noted was a patient
with lichen planus pigmentosus,
which tends to be in a photodistributed
area, he said. Characteristics include
bluish-grey pigmentation on the
face, head and neck.
He used these cases as a lesson
to the audience to be thorough in
their investigation of the causes of a
patient’s symptoms.
“When thinking about the common
things we see in patients of
colour, it is easy to get into a little bit of
a rut. Not every brown patch on the
face is melasma, and not every white
patch is vitiligo,” he said.
32 • Proceedings of 2019 SKIN SPECTRUM SUMMIT