idiopathic guttate hypomelanosis natural treatment

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA Pityriasis versicolor presents as asymptomatic flaky patches on the trunk, neck, and/or arms, which persist for months or years. HHS Vulnerability Disclosure, Help Image of Darier disease from:Harb JN, Motaparthi K. Clinicopathologic findings of guttate leukoderma in Darier disease: a helpful diagnostic feature. The numbers in the parentheses are clickable links to research J Cutan Aesthet Surg. [Full Text]. 2010 Mar. The disorders can be genetic or acquired. J Am Acad Dermatol. WebIdiopathic guttate hypomelanosis is a focal violation of skin pigmentation of unclear (possibly polymorphic) genesis, presumably due to delayed recovery of melanin against the Idiopathic guttate hypomelanosis is a common benign acquired disorder characterized by small, well-defined, round white macules on the sun-exposed areas of the legs and forearms. Many other conditions resemble this dermatosis, and the more common ones are discussed briefly in the following section. Thank you for your feedback on this article. This often causes mental stress and anxiety, and sometimes even social stigma against the person having hypopigmented skin lesions. The etiology is poorly understood in black people. Beauty Skin Care. 116(6):664-8. Rambhia SH, Rambhia KD. Harb JN, Motaparthi K. Clinicopathologic findings of guttate leukoderma in Darier disease: a helpful diagnostic feature. The white patch itself is asymptomatic but there may be clinical features of the underlying condition. Singh A, Choudhary R, Ganguly S, Singh V. Indian Dermatol Online J. Blood sugar is high. I also have random white spots on my outer thighs. [19] Idiopathic guttate hypomelanosis (IGH) is an asymptomatic and benign dermatosis characterized by numerous, usually small, hypopig- mented and achromic spots on the extremities of mature individuals. [6]. Dr. Michael Tomeo answered Women are more commonly affected. Idiopathic guttate hypomelanosis is most common in countries with fair-skinned populations having a high degree of sun exposure. consent form, Website Privacy Idiopathic guttate hypomelanosis is a common condition characterised by the presence of numerous, small, white macules found predominantly on the shins and forearms. A Wood light examination could be helpful in revealing unsuspected involvement. Dermatoscopic examination may aid in diagnosis. The purpose of this study is to determine whether 5-FU infusion (Microinfusion of Medicine Percutaneously - MMP) is effective for Idiopathic Guttate Hypomelanosis (IGH) repigmentation compared to conventional Microneedling. Unable to load your collection due to an error, Unable to load your delegates due to an error. Pigmentation follows the pattern of the initial disease, making the diagnosis straightforward in most patients. Leukoderma is more apparent in skin of colour than in ethnic white skin, but prevalence rates are difficult to determine. Hypopigmentation may be localised or generalised. Women are more commonly affected. The patches are usually asymptomatic and can resemble vitiligo. For hypopigmentations resulting from infections care should be taken to avoid possible reinfection. Melasma is an acquired hypermelanosis seen predominantly on sun-exposed areas in women. Hands Examples of leukoderma sharing sensitive information, make sure youre on a federal 1109376 Lead Author - Dr Tim Cunliffe. Kreeshan FC, Madan V. Idiopathic Guttate Hypomelanosis Treated with 308-nm Excimer Light and Topical Bimatoprost. Acta Derm Venereol. J Eur Acad Dermatol Venereol. doi:10.1016/j.burns.2017.05.004. Dermatology. Ultrastructural study. If treatment is successful, repigmentation usually occurs within 3 to 4 months. It is not a sign of an internal problem. Copy edited by Gus Mitchell. Your age, race and family history will also be considered by your healthcare professional for an assessment of your skin condition. Disclaimer. Thus, the face, neck, hands and arms are most often affected. doi:10.1016/j.det.2016.11.006. Hamada T, Saito T, Sugai T, Morita Y. All rights reserved. WebClinical and morphologic studies were made of 20 cases of guttate hypomelanosis. For example the appearance of ash-leaf spots on the body are often the first indicators of tuberculosis sclerosis in infants which requires immediate medical attention. Yoshimura K, Sato K, Aiba-Kojima E, et al: Repeated treatment protocols for melasma and acquired dermal melanocytosis. Normal skin color depends on melanin, hemoglobin (oxidized and reduced), and carotenoids. Idiopathic guttate hypomelanosis progresses with increasing sun exposure and, to a lesser degree, with age. [8, 9], Several light and electron microscopic studies have revealed a characteristic pathologic picture for idiopathic guttate hypomelanosis. Does Hypopigmentation Go Away On Its Own? 1. arrow-right-small-blue [QxMD MEDLINE Link]. Ulceration / necrosis (black non-viable skin) Skinkraft uses cookies or similar technologies to offer you a better experience and analyze insights into user behaviour. Helps normalize hormones, and progesterone especially is lacking, so these people get this condition if they are 35 years an [QxMD MEDLINE Link]. Avoiding direct sunlight and using high spf sunscreen can help protect from the detrimental effects of sunrays. You may have generalised hypopigmentation due to your genetic makeup or due to medical conditions such as albinism. If you would like to donate, please use this DermNet does not provide an online consultation service. The name is descriptive, referring to the cause and appearance of these spots: idiopathic means the cause is unknown, guttate refers to their teardrop shape and hypomelanosis, the lighter-colored skin. IGH spots appear gradually on the skin over time and tend to be small commonly between 26 mm. On the pathogenesis of idiopathic guttate hypomelanosis. the PI's rights to discuss or publish trial results after the trial is completed. For hypopigmentation resulting from rashes you have to make sure to treat the infections that have caused the rashes in the first place. Also, length of sessions about However you should discuss thoroughly with your doctor and understand the pros and cons of a certain treatment option before starting. Psoriasis 26. Dermatol Clin 2005;23:208-226. Vitiligo is an acquired disorder of melanocytes and is characterized by complete loss of pigment. TED'S ADVICE ON IDIOPATHIC GUTTATE HYPOMELANOSIS 1. National Library of Medicine The information on this website has not been evaluated by the FDA and is not intended to diagnose, treat, prevent, or cure any disease. It is not a sign of a cancer or any contagious skin problem. Do you have had any comments from people that something had helped by this condition? Buch J, Patil A, Kroumpouzos G, Kassir M, Galadari H, Gold MH, Goldman MP, Grabbe S, Goldust M. J Cosmet Laser Ther. Hypopigmentation is the decrease in the amount of melanin in the skin. given and further information. 1987 Jan. 16(1 Pt 1):35-44. Leukoderma is the visible result of loss of epidermal melanin. Flexures (body folds) "Hypomelanosis" more specifically refers to a reduction of epidermal melanin. [7]. GP Leeds, "I think it was one of the best courses for GPs I have attended Detailed Description: Split body design. Idiopathic Guttate Hypomelanosis Rafael Falabella, M.D. Nose However, there are several factors that are believed to be involved such as aging, ultraviolet exposure, trauma, genetic factors, autoimmunity, and local inhibition of melanogenesis. Epub 2018 Jul 20. training in dermatology. By accessing or using this website, you agree to abide by the Medical Disclaimer, Terms of Service, Privacy Policy, and Affiliate Disclosure. I just started to take MMS by Jim Humble and I was wondering if you think that this might help by this condition. Skin lesion algorithm - common benign 7. Limitations included a small sample size with minimal variation in Fitzpatrick skin type, an all-female pool, and lack of extended follow-up. Pityriasis versicolor CME. This includes areas like the arms and legs. Our studies have shown that significantly fewer dopa-positive melanocytes are in the white macules of idiopathic guttate hypomelanosis than in normal skin. My Mom also had the same white spots. Shin MK, Jeong KH, Oh IH, Choe BK, Lee MH. Pain / tenderness (sore to touch) The dermatologist had a book that was devoted to just IGH and she ran me a copy of 2 pages that explained more about it. Pityriasis alba (large patches on face and upper arms), Pityriasis rosea (short history and rapid onset), Topical/oral azoles including clotrimazole, miconazole, econazole and ketoconazole in various, Pityrosporum folliculitis (superficial acne-like. Would you like email updates of new search results? Environmental factors such as sunlight, other stresses to the skin. official website and that any information you provide is encrypted conditions, Other useful tools for patients and Thank you. WebA: Your condition has a long name with lots of syllables: idiopathic guttate hypomelanosis. Solve your problem quick & easy with online consultation. Berry J. CLINICAL PERSPECTIVE: The discrete, hypopigmented macules range in size from 2-6 mm and possess an irregular border. [QxMD MEDLINE Link]. Biopsy shows increased pigment in the epidermis and dermis. Leukoderma must be distinguished from hypopigmentation, which is pallor due to reduced pigmentation. Leukoderma is a clinical diagnosis confirmed on Wood lamp examination.. Dermoscopy can be helpful in the diagnosis of some forms of leukoderma. In very rare cases hypopigmentation may be associated with certain forms of cancers. Dermatol Clin. PABA Treatment of idiopathic guttate hypomelanosis with 5-fluorouracil tattooing using a handheld needle. Microscopy of malassezia If treatment is desired for cosmetic reasons, treatments such as cryotherapy, localized dermabrasion or microabrasion, small skin grafts, tretinoin cream, and topical steroids. The use of sunscreen (SPF 30 or greater) is essential to minimize further darkening. Nutritional deficiency of vitamin B12, copper or iron. papers from reputed academic organizations. doi:10.1111/pcmr.12161. Leukoderma, also called achromoderma, is a clinical sign describing a localised area of white depigmented skin due to total loss of epidermal melanin. Bethesda, MD 20894, Web Policies Idiopathic guttate hypomelanosis Progress in preventing idiopathic guttate hypomelanosis can be made by educating young women not to tan their legs. Now a leukoderma is simply a fancy term for a loss or lack of coloration in the Common disorders of pigmentation: when are more than cosmetic cover-ups required? and transmitted securely. Pityriasis versicolor 24. Shin J, Kim M, Park SH, Oh SH. [QxMD MEDLINE Link]. Principal Investigators are NOT employed by the organization sponsoring the study. link, declaration of Narrow-band ultraviolet B and PUVA (topical or systemic psoralens followed by ultraviolet [UV] A exposure) therapy twice weekly is effective treatment for extensive disease. If you have any concerns with your skin or its treatment, see a dermatologist for advice. Wallace ML, Grichnik JM, Prieto VG, Shea CR. Clinically, these lesions are found more commonly in the elderly on sun-exposed surfaces of the skin. Get your query answered 24*7 with Expert Advice and Tips from doctors for Idiopathic guttate hypomelanosis treatment | Practo Consult. [5]. Chemical-induced vitiligo. WebDEFINITION - Idiopathic Guttate Hypomelanosis, or Disseminate Lenticular Leucoderma, comprises small, white irregularly shaped macules occurring mostly on the anterior lower legs. Women of all ethnic groups are equally affected, but dark-skinned persons tend to be more affected. Skin lesion algorithm - common benign 4. 2022 Sep 5;13(5):657-659. doi: 10.4103/idoj.idoj_633_21. save the web address in the browser as one of your favourites then Most patients are reassured of the benign nature of the condition and no treatment is recommended. Download FREE Practo app. Idiopathic guttate hypomelanosis does not appear to be due to trauma or viral infection. One report describes successful treatment with pimecrolimus 1% [ 12] ; however, caution is warranted because the author has anecdotal experience possibly Associated with medical conditions It is also known as leucoderma or achromoderma. In extremely rare cases such patches may become permanent. The disease usually begins in childhood or early adulthood and is occasionally associated with autoimmune disorders, most often thyroid disease (30% of patients have Graves disease or hypothyroidism), and less so pernicious anemia, Addisons disease, diabetes mellitus, myasthenia gravis, and alopecia areata. Vitiligo often follows trauma, with disease common on extensor sites, such as the hands, elbows, and knees. Arms and legs Mixed topical combinations of hydroquinone, tretinoin, and a fluorinated corticosteroid are particularly effective as short-term treatment. 1990 Oct. 23(4 Pt 1):681-4. Idiopathic guttate hypomelanosis is a common acquired leukoderma characterized by multiple, discrete round or oval, porcelain-white macules on sun-exposed Falabella R, Escobar C, Giraldo N, Rovetto P, Gil J, Barona MI, Acosta F, Alzate A. J Am Acad Dermatol. Melanoma-associated leukoderma. 2013 Apr. Int J Dermatol 41: 744-747. Copyright 2000-2023 The Cleveland Clinic Foundation. De Schrijver S, Theate I, Vanhooteghem O. Halo nevi are not trivial: about 2 young patients of regressed primary melanoma that simulates halo nevi. Idiopathic guttate hypomelanosis should be diagnosed on clinical grounds. Boils and folliculitis (including hid 8. Usage of cosmetic products containing lead or bleaching agents. Pityriasis versicolor fluoresces blue-green on examination using a Wood lamp (long wavelength UVA1). It causes little white areas to appear on skin that is exposed to the sun. 2019;20(22):5731. doi:10.3390/ijms20225731. Lips Another pattern is orificial, with depigmented areas surrounding orifices (nares, mouth, vagina, urethra, and anus). WebIdiopathic guttate hypomelanosis is a common skin disorder of unknown cause. 1967 Dec. 96 (6):673-6. Oval (ash leaf) hypopigmented macules are the earliest cutaneous sign of tuberous sclerosis. Idiopathic guttate hypomelanosis is a benign condition. Usually, no treatment is required. Indian Dermatol Online J. Ravikiran SP, Sacchidanand S, Leelavathy B. The https:// ensures that you are connecting to the Books about skin diseasesBooks about the skin Eczema - gravitational (venous) 13. This might take upto a year to show any visible results. Chemical burn scar with leukoderma Bacterial or fungal infections as in macular acne or pityriasis versicolor respectively. Genetics Home Reference; Oculocutaneous Albinism; Accessed 5 th June 2020. [QxMD MEDLINE Link]. JAAD Case Rep. 2018;4(3):2626. Therapeutic wounding - 88% phenol in idiopathic guttate hypomelanosis. Cryotherapy and dermabrasion may have some benefit. Seborrhoeic eczema 29. Certain medications such as imatinib mesylate may result in hypopigmentation.[. version, Concise guidelines for common skin Idiopathic guttate hypomelanosis is most commonly a complaint of middle-aged, light-skinned women, but it is increasingly seen in both sexes and older dark-skinned people with a history of long-term sun exposure. Bleaching agents with hydroquinone (a hydroxyphenolic compound that inhibits the conversion of dopa to melanin), in concentrations of 2% to 4%, can help to minimize (lighten) the pigmentation. J Am Acad Dermatol. Leukoderma may recover slowly if the cause can be avoided, such as cessation of a drug or chemical exposure, or treated such as inflammatory dermatoses. Dermatology Made Easybook. Failla CM, Carbone ML, Fortes C, Pagnanelli G, D'Atri S. Melanoma and vitiligo: in good company. A few common causes of hypopigmentation include: This form of hypopigmentation is followed by a previous skin problem, such as the following: (i) Inflammatory skin diseases like atopic dermatitis, lichen striatus, etc. IGH is more common in people with light skin and may appear in women at younger ages than it does in men. Idiopathic guttate hypomelanosis (IGH) is a common benign acquired condition that presents as small irregularly-shaped, well-defined hypopigmented porcelain Arch Dermatol. WebA variety of therapies with variable success rates, including cryotherapy, superficial abrasion and topical retinoids are currently being used in Idiopathic guttate hypomelanosis. 2019 Mar;36(3):235-245. doi: 10.1007/s40266-018-00633-w. Br J Gen Pract. Rerknimitr P, Disphanurat W, Achariyakul M. Topical tacrolimus significantly promotes repigmentation in idiopathic guttate hypomelanosis: a double-blind, randomized, placebo-controlled study. Travel acquired / worldwide infections Berry J. [7] Another hypothesis is that microtrauma to the skin may contribute to the condition. JAMA 2005;293:730-735. Do this twice daily for best results. It is important for the PCDS to build its own image bank, as such we welcome original images from our [QxMD MEDLINE Link]. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTA2ODQyMi1vdmVydmlldw==. PO Box 789, Rickmansworth, WD3 0NU. Idiopathic guttate hypomelanosis is a common acquired leukoderma characterized by multiple, discrete round or oval, porcelain-white macules on sun-exposed Freckles and lentigines; multiple lentigines syndrome. It is not a diagnosis in itself and has many causes. FOIA William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine I shall book again and already shared with colleagues Our team of dermatologists and formulators strive to be objective, unbiased and honest. Reserved. One report describes successful treatment with pimecrolimus 1% [ 12] ; however, caution is warranted because the author has anecdotal experience possibly suggesting that topical calcineurin inhibitors may be linked to the development of idiopathic guttate hypomelanosis in immunosuppressed patients. Hypopigmentation is mostly harmless and most forms of skin discolorations go away by themselves over a certain period of time. [1], Because pigmentation of the skin is due to an integration of melanocyte and keratinocyte function, an acquired defect of the epidermal melanin unit results in the observed hypopigmentation in idiopathic guttate hypomelanosis patients. Fungal infections (tinea) 15. Leukoderma in patients with atopic dermatitis. Recommend washing affected areas with an anti-dandruff shampoo twice weekly to reduce the chance of relapse. Genetics play an important role in conditions such as vitiligo, which sometimes run in families. Listing a study does not mean it has been evaluated by the U.S. Federal Government. C. Skin grafting can be used in patients who have discoloration due to severe burns. [QxMD MEDLINE Link]. Idiopathic guttate hypomelanosis (IGH) is an acquired, benign leukoderma of unknown etiology. Brown patches Darker areas of skin 2021 Jan-Mar. American Association for Physician Leadership, American Society for Dermatologic Surgery, International Society for Dermatologic Surgery. Treatment is not necessary. A Woods light examination highlights the macules and helps to identify them in fair-skinned patients. Falabella R, Escobar C, Giraldo N, et al. Normally such patches appear within a few weeks of the treatment and may stay up to a few months. Epidermal grafting can help some patients with stable disease. Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological SocietyDisclosure: Nothing to disclose. 80 (2):141-4. Facial vitiligo is likely to have psychosocial effects Kubba A, Batrani M, Taneja A, Jain V. Tumor of follicular infundibulum: an unsuspected cause of macular hypopigmentation. Consent Forms: The PCDS always needs good You can get this form of hypopigmentation either by birth or you can acquire it during your lifetime. Significantly fewer dopa oxidase-positive, KIT+, and melanocytes are seen in the lesions. The exact pathogenesis remains controversial. This blog post is based on scientific evidence, written and fact checked by our doctors. Eczema - atopic (including facial ecz 12. Trunk (chest, abdomen, back) 43 (4):553-557. Pityriasis versicolor is more common in hot, humid climates or in those who sweat heavily, so it may recur each summer. Pruritis ani 25. Download, The ETIOLOGY - Actinic damage has been proposed as a cause of IGH in Caucasians. ALL RIGHT RESERVED. Low Platelets. Dermoscopy can be helpful in the diagnosis of some forms of leukoderma. Information provided by (Responsible Party): This pilot study included six patients with idiopathic guttate hypomelanosis on their lower extremities, which were recruited from an outpatient dermatology clinic. Protection Policy, The Leading Dermatological Society for GPs, It is thought to be an inevitable part of ageing, with a gradual reduction in melanocytes, Inherited factors may be relevant as lesions appear to be more common in family members, Idiopathic guttate hypomelanosis is seen far more frequently in women of a younger age than in men. Ortonne J-P, Passeron T: Melanin pigmentary disorders: Treatment update. This condition is the same for vitiligo and idiopathic guttate hypomelanosis in treatment because both are fungus. Some of these microbiologist knew about this (and dandruff) since the beginning of the last century (early 1900) f, but the information is lost (it is nowhere to be found today) they are also fungus too, but they are different species. Idiopathic guttate hypomelanosis is seen far more frequently in women, beginning around the age of 30 years. I have red a reaction of Ted that he thinks it is a fungus problem. Errichetti E, Stinco G. Dermoscopy of idiopathic guttate hypomelanosis. Warts 31. [4], There may be a genetic component to IGH, as families of IGH patients have a greater incidence of IGH when compared to controls. Treatment of your hypopigmentation will depend on the underlying cause therefore a correct diagnosis of your condition is essentially the first step towards its treatment. Boron. Oakley A. Idiopathic guttate hypomelanosis. Dermatol Surg. An African-American patient with idiopathic guttate hypomelanosis on her leg. So, today I visited a dermatologist who knew exactly what they were. 2014 Oct 10. Sun damage can lead to age spots, or dark spots, on our skin, as well as white spots known as idiopathic guttate hypomelanosis (IGH). But, the uneven skin coloration may be a reason for psychological stress in some people, who therefore opt for different treatment strategies to get a more even complexion. Microscopy of potassium hydroxide (KOH) preparations from pityriasis versicolor shows clusters of yeast cells and long hyphae. 1987 Jan;16(1 Pt 1):35-44. doi: 10.1016/s0190-9622(87)70003-6. Laosakul K, Juntongjin P. Efficacy of tip cryotherapy in the treatment of idiopathic guttate hypomelanosis (IGH): a randomized, controlled, evaluator-blinded study. WebAyurveda treatment for idiopathic guttate hypomelanosis A 19-year-old male asked: Idiopathic guttate hypomelanosis occur at age of 20years? However, with increasing age and sun exposure, it is found almost equally in elderly men and women. Normal aging leading to the movement of melanin to the upper layers of the skin. [QxMD MEDLINE Link]. Scalp Vitiligo affects approximately 1% of the population and both genders equally. Certain cosmetic treatments such as laser therapy may result in hypopigmentation patches especially in people with darker skin tones. Oakley A. Idiopathic guttate hypomelanosis. Please use the attached consent form when obtaining images, and download and Actinic (solar) keratosis 3. Leukoderma, Author: Vanessa Ngan, Staff Writer, 2003; Updated: Katrina Tan, Medical Student, Monash University, Melbourne, Australia; Dr Martin Keefe, Dermatologist, Christchurch, New Zealand. [2, 3] In 1967, Hamada and Saito found a 50% reduction in melanocytes. DIFFERENTIAL DIAGNOSIS - Unlike IGM, Vitiligo tends to be periorificial and not confined to the lower legs. Accessed 12 th February 2021. Accessibility A logical approach to the management of skin conditions including 2013;26(6):796804. It causes little white areas to appear on skin that is exposed to the sun. 2014 Mar-Apr. It has to be prescribed by a certified healthcare professional though. Avoiding direct exposure to sunlight will prevent worsening the skin condition. Certain forms of hypopigmentation such as vitiligo, albinism etc. Skin surface replicas and biopsies showed no evidence of post-traumatic or post-inflammatory scarring. Goldust M, Mohebbipour A, Mirmohammadi R. Treatment of idiopathic guttate hypomelanosis with fractional carbon dioxide lasers. Localised hypopigmentation: clarification of a diagnostic conundrum. Several other skin conditions are associated with proliferation of malassezia, especially with the predisposing factors of humidity, sweating and seborrhoea. [QxMD MEDLINE Link]. A. Laser treatment might be effective in removing hypopigmentation due to scars. A topical formulation with coal tar has been recorded to help vitiligo patients when used daily. Leukoderma in lichenified atopic dermatitis, Cryotherapy-induced leukoderma with recurrent BCC, Leukoderma in lichenified atopic dermatitis. WebIdiopathic guttate hypomelanosis is a common benign acquired disorder characterized by small, well-defined, round white macules on the sun-exposed areas of the legs and forearms. JAAD Int. Betaine HCl to increase your stomach acid to protect from increases in further fungus exposure 2. [QxMD MEDLINE Link]. Idiopathic guttate hypomelanosis (sun spots) Wearing sunscreen and avoiding excessive sun exposure is a good first step toward reducing further skin damage. ETIOLOGY - Actinic damage has been proposed as a cause of IGH in Caucasians. Treatment is not necessary. Treatment of choice for limited disease is mid- to high-potency topical corticosteroids, although topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, can also be very beneficial. J Eur Acad Dermatol Venereol. Available: om/articles/324228 70. This website also contains material copyrighted by 3rd parties. eczema, Other guidelines - The British Any inflammatory condition in the skin (e.g., eczema, psoriasis), especially in dark-skinned patients, can lead to postinflammatory hyperpigmentation, a common late sequela characterized by patches of brown skin.

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