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Exogenous Ochronosis

An Update on Clinical Features, Causative Agents and Treatment Options

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American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Exogenous ochronosis is clinically and histologically similar to its endogenous counterpart; however, it exhibits no systemic effects and is not an inherited disorder. It is characterized by an asymptomatic hyperpigmentation of the face, sides and back of the neck, back, and extensor surfaces of the extremities. The associated ochronotic discoloration most commonly results from use of products containing hydroquinone. It also occurs following use of antimalarials and products containing resorcinol, phenol, mercury or picric acid. The etiology of hydroquinone-induced hyperpigmentation in exogenous ochronosis remains speculative.

The majority of patients with this condition are Black, but it has been reported to occur in Hispanics and Caucasians. Exogenous ochronosis is prevalent among South African Blacks, but is believed relatively uncommon within the US. The reasons for this phenomenon are not clear, but it could be a result of the use of skin care products containing resorcinol in combination with hydroquinone or the use of hydroquinone in a hydroalcoholic lotion.

Treatment of this condition is difficult. The offending agent must be avoided, but improvement occurs only slowly. A number of topical agents have been studied as have dermabrasion and the use of lasers. Controlled studies in larger numbers of patients are require to determine the true efficacy of newer treatments.

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References

  1. Albers S, Brozena S., Glass L., et al. Alkaptonuria and ochronosis: case report and review. J Am Acad Dematol 1992; 27: 609–614

    Article  CAS  Google Scholar 

  2. Offel J.V., DeClerck L., Francx L., et al. The clinical manifestations of ochronosis: a review. Acta Clin Belg 1995; 50: 358–362

    PubMed  Google Scholar 

  3. Dom K., Pittevils T. Onchronotic arthropathy: the black hip. Case report and review of the literature. Acta Orthop Belg 1997; 63: 122–125

    PubMed  CAS  Google Scholar 

  4. Hardwick N., Gelder L.V., Merwe C.V.D., et al. Exogenous ochronosis: an epidemiological study. Br J Dermatol 1989; 120: 229–238

    Article  PubMed  CAS  Google Scholar 

  5. Bruce S., Tschen J., Chow D. Exogenous ochronosis resulting from quinine injections. J Am Acad Dematol 1986; 15: 357–361

    Article  CAS  Google Scholar 

  6. Touart D., Sau P. Cutaneous deposition diseases. Part II. J Am Acad Dermatol 1998; 39: 527–544

    Article  PubMed  CAS  Google Scholar 

  7. Kramer K., Lopez A., Stefanato C., et al. Exogenous ochronosis. J Am Acad Dermatol 2000; 42: 869–871

    Article  PubMed  CAS  Google Scholar 

  8. Lawrence N. Exogenous ochronosis in the United States. J Am Acad Dermatol 1988; 18: 1207–1211

    Article  PubMed  CAS  Google Scholar 

  9. Conner T., Braunstein B. Hyperpigmentation following the use of bleaching creams. Arch Dermatol 1987; 123: 105

    Article  Google Scholar 

  10. Cullison D., Abele D., O’Quinn J. Localized exogenous ochronosis: report of a case and review of the literature. J Am Acad Dermatol 1983; 8: 882–889

    Article  PubMed  CAS  Google Scholar 

  11. Hoshaw R., Zimmerman K., Menter A. Ochronosis-like pigmentation from hydroquinone bleaching creams in American blacks. Arch Dermatol 1985; 121: 105–108

    Article  PubMed  CAS  Google Scholar 

  12. Pennys N. Ochronosis-like pigmentation from hydroquinone bleaching creams [letter]. Arch Dermatol 1985; 121: 1239–1240

    Google Scholar 

  13. Fisher A.A. Tetracycline treatment for sarcoid-like ochronosis due to hydroquinone. Cutis 1988; 42: 19–20

    PubMed  CAS  Google Scholar 

  14. Carey A.B., Park H.K., Burke W.A., et al. Bleaching cream associated exogenous ochronosis. Presented at the 26th Annual Meeting of the American Society of Dermatopathology, Washington (DC): USA. J Cutan Pathol 1988; 15: 299

    Google Scholar 

  15. Howard K., Furner B. Exogenous ochronosis in a mexican-american woman. Cutis 1990; 45: 180–182

    PubMed  CAS  Google Scholar 

  16. Diven D., Smith E., Pupo R., et al. Hydroquinone-induced localized exogenous ochronosis treated with dermabrasion and CO2 laser. J Dermatol Surg Oncol 1990; 16: 1018–1022

    PubMed  CAS  Google Scholar 

  17. Davis T.L., Trapp C.F., Grimwood R.E. Exogenous ochronosis occurring in a male Presented at the 28th Annual Meeting of the American Society of Dermatopathology, Atlanta, Georgia. J Cutan Pathol 1990; 17: 290

    Google Scholar 

  18. Jordaan H., Niekerk D.V. Transepidermal elimination in exogenous ochronosis. Am J Dermatopathol 1991; 13: 418–424

    Article  PubMed  CAS  Google Scholar 

  19. Martin R.F., Sanchez J.L., Gonzalez A., et al. Exogenous ochronosis. PR Health Sci J 1992; 11: 23–26

    Google Scholar 

  20. Snider R., Thiers B. Exogenous ochronosis. J Am Acad Dermatol 1993; 28: 662–664

    Article  PubMed  CAS  Google Scholar 

  21. Camarasa J.G., Serra-Baldrich E. Exogenous ochronosis with allergic contact dermatitis from hydroquinone. contact Derm 1994; 31: 57–58

    Article  PubMed  CAS  Google Scholar 

  22. Jacyk W. Annular granulomatous lesions in exogenous ochronosis are manifestation of sarcoidosis. Am J Dermatopathol 1995; 17: 18–22

    Article  PubMed  CAS  Google Scholar 

  23. Findlay G., Morrison J., Simson I. Exogenous ochronosis and pigmented colloid millium from hydroquinone bleaching creams. Br J Dermatol 1975; 93: 613–622

    Article  PubMed  CAS  Google Scholar 

  24. Schultz E., Summers B., Summers R. Inappropriate treatment of cosmetic ochronosis with hydroquinone. S Afr Med J 1988; 73: 59–60

    Google Scholar 

  25. Williams H. Skin lightening creams containing hydroquinone. BMJ 1992; 305: 903–904

    Article  PubMed  CAS  Google Scholar 

  26. Lang P. Probable coexisting exogenous ochronosis and mercurial pigmentation managed by dermabrasion. J Am Acad Dermatol 1988; 19: 942–946

    Article  PubMed  Google Scholar 

  27. Dogliotti M., Leibowitz M. Granulomatous ochronosis: a cosmetic-induced skin disorder in blacks. S Afr Med J 1979; 56: 757–760

    PubMed  CAS  Google Scholar 

  28. Philips J., Isaacson C., Carman N. Ochronosis in black South Africans who used skin lighteners. Am J Dermatopathol 1986; 8: 14–21

    Article  Google Scholar 

  29. Tidman M., Horton J., MacDonald D. Hydroquinone-induced ochronosis — light and electron microscopic features. Clin Exp Dermatol 1986; 11: 224–228

    Article  PubMed  CAS  Google Scholar 

  30. Burke P., Maibach H. Exogenous ochronosis: an overview. J Dermatol Treatmnt 1997; 8: 21–26

    Article  Google Scholar 

  31. Findlay G., Beer H.D. Chronic hydroquinone poisoning of the skin from sun lightening cosmetics. S Afr Med J 1980; 57: 187–190

    PubMed  CAS  Google Scholar 

  32. O’Donoghue M, Lynfield Y., Derbes V.. Ochronosis due to hydroquinone. J Am Acad Dermatol 1983; 8: 123

    Article  PubMed  Google Scholar 

  33. Engasser P., Maibach H. Cosmetics and dermatology: bleaching creams. J Am Acad Dermatol 1981; 5: 143–147

    Article  PubMed  CAS  Google Scholar 

  34. Thomas A., Gisburn M. Exogenous ochronosis and myxoedema from resorcinol. Br J Dermatol 1961; 73: 378–381

    Article  PubMed  CAS  Google Scholar 

  35. Kelly A., editor. Forum on hydroquinone induced ochronosis; 9 August 1987; Los Angeles (CA): USA [unpublished summary letter]

    Google Scholar 

  36. Bucks D., McMaster J., Guy R., et al. Percutaneous absorption of hydroquinone in humans: effect of 1-dodecylazacycloheptan-2-one (azone) and the 2-ethylhexyl ester of 4-(dimethylamino)benzoic acid (Escalol 507). J Toxicol Environ Health 1988; 24: 279–289

    Article  PubMed  CAS  Google Scholar 

  37. Chen Y., Chavin W. Hydroquinone activation and inhibition of skin tyrosinase, In: Riley V., editor. Proceedings of the 9th International Pigment Cell Conference; 1975 Jan 13–17; Houston (TX). New York: Karger Publishers, 1976: 105–112

    Google Scholar 

  38. Engasser P. Ochronosis caused by bleaching creams. J Am Acad Dermatol 1984; 10: 1072–1073

    Article  PubMed  CAS  Google Scholar 

  39. Hull P., Procter P. The melanocyte: an essential link in hydroquinone-induced ochronosis. J Am Acad Dermatol 1990; 22: 529–531

    Article  PubMed  CAS  Google Scholar 

  40. Shepartz B. Inhibition and activation of homogentisic acid. J Biol Chem 1953; 205: 185–192

    Google Scholar 

  41. Olumide Y., Odunowo B., Odiase A. Regional dermatoses in the African. Part I. Facial hypermelanosis. Int J Dermatol 1991; 30: 186–189

    Article  PubMed  CAS  Google Scholar 

  42. Briviba K., Devasagayam T.P., Sies H., et al. Selective para hydroxylation of phenol and aniline by singlet molecular oxygen. chem Res Toxicol 1993; 6 (4): 548–553

    Article  PubMed  CAS  Google Scholar 

  43. Kaufmann B., Wegmann W. Exogenous ochronosis after L-Dopa treatment. Pathologe 1992; 13: 164–166

    PubMed  CAS  Google Scholar 

  44. Shultz E., Sher M. Rescinding of legislation to ban hydroquinone-containing bleaching creams. S Afr Med J 1990; 77: 372

    Google Scholar 

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Acknowledgements

We would like to thank Dr Eugene Gans who kindly critically reviewed this manuscript.

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Authors and Affiliations

  1. Department of Dermatology, UCSF Medical Center, 90 Medical Center Way Room #110, San Francisco, California, 94143-0989, USA

    Cheryl Y. Levin &  Howard Maibach

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  1. Cheryl Y. Levin
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  2. Howard Maibach
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Correspondence to Howard Maibach.

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Levin, C.Y., Maibach, H. Exogenous Ochronosis. Am J Clin Dermatol 2, 213–217 (2001). https://doi.org/10.2165/00128071-200102040-00002

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