OCHRONOSIS
--------------------------------------------------


A 46 y.o. African woman (visiting from the Congo) has been using a 
bleaching cream (available in Africa) for the past four or five years to 
lighten her complexion.  Even as her complexion darkened rather than 
lightened, she persisted in using the cream.  I saw her for the first time 
this week, and she has moderate erythema of her upper eyelids, eyebrows and 
cheeks, as well as mottled hyperpigmentation/hypopigmentation of the affected 
areas.  She seems to me a classic presentation of exogenous ochronosis.
Any therapeutic suggestions?  I told her to D/C the bleaching, and gave her 
some Aclovate to calm down the irritant dermatitis.  
Textbooks say that colloid degeneration and elastosis can be seen in 
biopsy specimens--does anybody think retinoids might help?  Thanks in advance.

Marty Okun
----------


Consider Kojic acid with Glycolic Acid or Tretinoin.
 Ref:  Garcia, A.&Fulton, JE:  The combination of Glycolic Acid and
Hydroquinone or Kojic Acid for the Treatment of Melasma and Related
Conditions, Dermatologic Surgery1196; 22:443-447.

Gene Sienkiewicz, M. D.
-----------------------