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Unerwünschte und erwünschte Pigmentierung

Undesirable pigmentation

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Zusammenfassung

Hintergrund

Homogene Pigmentierung lässt sich durch Strukturverwandte des α-MSH erzielen. Zu den kosmetisch störenden Hyperpigmentierungen zählen vor allem die der Gesichtsregion.

Fragestellung

Während Afamelatonid als „orphan drug“ für die erythropoetische Protoporphyrie zugelassen ist, sind weitere Strukturverwandte über Internetquellen zur Bräunung zu beziehen. Präventiv und therapeutisch zu beeinflussen sind vor allem die postentzündliche Hyperpigmentierung, Melasma und Lentigines.

Methoden

Einzelfallberichte zur Aktivierung dysplastischer Nävi unter Melanotan I liegen vor. Das Woodlicht hilft, die Tiefe der Hyperpigmentierung einzuschätzen. Da keine Leitlinien vorliegen, wird die Lehrmeinung anhand von Studien dargestellt.

Ergebnisse

Melanotan führt zur Aktivierung dysplastischer Nävi. Der Goldstandard in der Behandlung von Hyperpigmentierungen ist die Dreierkombination aus Hydrochinon, Tretinoin und einem topischen Steroid, allerdings oft mit dem Nebeneffekt der Irritation und gelegentlich Ochronose. Tyrosinaseinhibitoren, schälende Substanzen und Pflanzeninhaltsstoffe konnten diese Wirkungsstärke nicht erreichen, werden jedoch besser toleriert.

Schlussfolgerungen

Melanotan und Bleichcremes, die evtl. Quecksilber enthalten, aus dem Internet sind gesundheitsschädlich. Hyperpigmentierungen erfordern Kombinationstherapien aus Hemmung der Aktivität der Melanozyten und der Melaninsynthese, Entfernen des Melanins, Zerstörung der Melaningranula und Lichtschutz. Besonders bei Fitzpatrick-Hauttyp IV–VI können Kryotherapie und Laseranwendungen zu posttherapeutischer erneuter Hyperpigmentierung führen.

Abstract

Background

Homogenous pigmentation can be induced by α-melanocyte-stimulating hormone (MSH) homologues. Cosmetically inacceptable pigmentation is mostly located on the face.

Objectives

Although afamelatonide is a prescription drug for the orphan disease erthropoetic protoporphyria, structurally related α-MSH derivatives are available via the internet. Preventive and therapeutical options are necessary for postinflammatory hyperpigmentation, melasma, and lentigines.

Methods

Case reports address activation of dysplastic naevi by melanotan I. Wood's lamp is of some use in analyzing the level of hyperpigmentation. However, no guidelines have been established; thus, a summary of current studies is presented.

Results

Melanotan I leads to the activation of dysplastic nevi. The gold standard for hyperpigmentation is triple therapy with hydrochinon, tretinoin, and steroids, which can cause irritation and lead to ochronosis in some individuals. Tyrosinase inhibitors, substances that increase the cell turnover, and plant derivatives are less efficient but more tolerable.

Conclusions

Melanotan I and bleaching creams, which may possibly contain mercury, are dangerous. Hyperpigmentation is best treated using a combination therapy that inhibits melanocyte activity and melanin synthesis, removes melanin, destroys melanin granules, and includes UV protection. Especially in Fitzpatrick skin types IV–VI, cryotherapy and laser are not the first line treatment options due to renewed posttreatment hyperpigmentation.

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Bayerl, C. Unerwünschte und erwünschte Pigmentierung. Hautarzt 66, 757–763 (2015). https://doi.org/10.1007/s00105-015-3671-4

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