Skip to main content
SpringerLink
Log in

Therapie von Pigmentstörungen in Zusammenhang mit systemischen Erkrankungen

Treatment of pigmentation disorders in association with systemic diseases

  • Leitthema
  • Published:
Der Hautarzt Aims and scope Submit manuscript

Zusammenfassung

Pigmentstörungen sind ein häufiges Hautproblem und umfassen ein breites Spektrum von Erkrankungen, deren Ursache in einer abnormen Melanin- oder auch Nichtmelaninpigmentierung der Haut liegt. Sowohl Hyper- als auch Hypomelanosen können erblich bedingt oder erworben sein. Der vorliegende Beitrag fasst die therapeutischen Ansätze zusammen, die bei der Mehrzahl der erworbenen Pigmentstörungen der Haut verfolgt werden. Folgende Hypermelanosen werden thematisiert: Lentiginose, Hyperpigmentierung auf dem Boden endokriner Störungen oder anderer systemischer Erkrankungen, medikamenteninduzierte Hyperpigmentierung. Die erworbenen Hypomelanosen umfassen postinflammatorische Hypomelanose, progressive makuläre Hypomelanose, chemische Depigmentierung, Hypomelanosis guttata idiopathica und punktiertes Leukoderma. Bezüglich der Nichtmelaninpigmentierung wird die exogene Pigmentierung durch Chemikalien, Metalle und Medikamentenexposition diskutiert. Die Therapie basiert primär darauf, die Ursache der Pigmentveränderungen zu finden. Auch das betroffene Areal, das Alter und die ethnische Herkunft sind wichtige Faktoren. Das Spektrum therapeutischer Optionen ist weit: topische Wirkstoffe, chemische Peelings, systemische Wirkstoffe, Laser und lichtbasierte Therapien. Da manche dieser Therapieverfahren Nebenwirkungen haben können, ist die Verfügbarkeit eines Protokolls wichtig, das Angaben zu Medikamentenkonzentration, Dosis, den Parametern der Lasertherapie und der Zahl der Sitzungen enthält. Für jede Störung wird die spezifische dermatologische Therapie dargestellt, auch wenn manche Pigmentveränderungen, die im Zusammenhang mit systemischen Erkrankungen auftreten, unter der Therapie dieser primären Erkrankung ausheilen. Die meisten Erkrankungen verschlimmern sich bei UV(Ultraviolett)-Exposition. Daher ist Sonnenschutz empfohlen, und auch eine kosmetische Abdeckung ist indiziert.

Abstract

Pigmentation disorders are a frequent skin problem and incorporate a broad spectrum of diseases, caused by an abnormal melanin pigmentation or also non-melanin pigmentation of the skin. Both hypermelanosis and hypomelanosis can be hereditary or acquired. This article summarizes the treatment approaches that are used in the majority of acquired pigmentation disorders of the skin. The following forms of hypermelanosis are addressed: lentiginosis, hyperpigmentation due to endocrine disorders or other systemic diseases, drug-induced hyperpigmentation. Acquired hypomelanoses include postinflammatory hypomelanosis, chemical depigmentation, idiopathic guttate hypomelanosis and punctate leucoderma. With reference to non-melanin pigmentation, the exogenous pigmentation due to chemicals, metals and drug exposure are discussed. The treatment is primarily based on finding the cause of the alterations to the pigment. The affected area, age and ethnic origin are also important factors. The spectrum of therapeutic options is broad: topical agents, chemical peeling, systemic agents, laser and light-based treatment. As some of these treatment procedures can have side effects, the availability of a protocol that contains information on the drug concentration, dose, parameters for laser treatment and the number of sessions is important. For every disorder the specific dermatological treatment is presented even when some pigmentation alterations that occur in association with systemic diseases, are cured by the treatment of the primary disease. Most diseases are exacerbated by exposure to UV light. Therefore, sun protection is recommended and a cosmetic coverage is indicated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Chun-Yin Chan J, Yee-nam Shek S, Kono T, Keung Yeung C, Hin-lee Chan H (2016) A retrospective analysis on the management of pigmented lesions using a picosecond 755-nm alexandrite laser in Asians. Lasers Surg Med 48(1):23–29

    Google Scholar 

  2. Alegre-Sanche A (2018) Treatment of flat and elevated pigmented disorders with a 755-nmalexandrite picosecond laser: clinical and histological evaluation. Lasers Med Sci 33(8):1827–1831

    Google Scholar 

  3. Kanchanapoomi Levin M, Ng E, Bae Y‑SC, Brauer JA, Geronemus RG (2016) Treatment of pigmentary disorders in patients with skin of color with a novel 755 nm picosecond, Q‑switched ruby, and Q‑switched Nd:YAG nanosecond lasers: a retrospective photographic review. Lasers Surg Med 48(2):181–187

    Google Scholar 

  4. Tanaka Y, Tsunemi Y, Kawashima M (2016) Objective assessment of intensive targeted treatment for solar lentigines using intense pulsed light with wavelengths between 500 and 635 nm. Lasers Surg Med 48(1):30–35

    PubMed  Google Scholar 

  5. Vachiramon V, Iamsumang W, Triyangkulsri K (2018) Q‑switched double frequency Nd:YAG 532-nm nanosecond laser vs. double frequency Nd:YAG 532-nm picosecond laser for the treatment of solar lentigines in Asians. Lasers Med Sci 33(9):1941–1947

    PubMed  Google Scholar 

  6. Vachiramon V, Panmanee W, Techapichetvanich T, Chanprapaph K (2016) Comparison of Q‑switched Nd: YAG laser and fractional carbon dioxide laser for the treatment of solar lentiginesin asians. Lasers Surg Med 48:354–359

    PubMed  Google Scholar 

  7. Negishi K, Akita H, Matsunaga Y (2018) Prospective study of removing solar lentigines in asiansusing a novel dual-wavelength and dual-pulse width picosecond laser. Lasers Surg Med 50(8):851–858

    PubMed  Google Scholar 

  8. Chan MWM, Yee-Nam Shek S, Keung Yeung C, Hin-Lee Chan H (2019) A prospective study in the treatment of lentigines in asian skin using 532 nm picosecond Nd:YAG laser. Lasers Surg Med 51(9):767–773

    PubMed  Google Scholar 

  9. Wu DC, Goldman MP, Wat H, Chan HHL (2020) A systematic review of picosecond laser in dermatology: evidence and recommendations. Lasers Surg Med. https://doi.org/10.1002/lsm.23244

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zouboulis CC, Rosenberger AD, Adler Y, Orfanos CE (1999) Treatment of solar lentigo with cryosurgery. Acta Derm Venereol 79:489–490

    CAS  PubMed  Google Scholar 

  11. Cotellessa C, Peris K, Fargnoli MC, Mordenti C, Giacomello RS, Chimenti S (2003) Microabrasion versus microabrasion followedby 15 % trichloroacetic acid for treatment of cutaneoushyperpigmentation in adult females. Dermatol Surg 29:352–356

    PubMed  Google Scholar 

  12. Lugo-Janer A, Lugo-Somolinos A, Sanchez JL (2003) Comparison of trichloroacetic acid solution and cryosurgery in the treatment of solar lentigines. Int J Dermatol 42:829–831

    PubMed  Google Scholar 

  13. Ortonne J‑P, Pandya AG, Lui H, Hexsel D (2006) Treatment of solar lentigines. J Am Acad Dermatol 54:262–271

    Google Scholar 

  14. Petit L, Pierard GE (2003) Analytic quantification of solar lentigineslightening by a 2 % hydroquinone-cyclodextrin formulation. J Eur Acad Dermatol Venereol 17:546–549

    CAS  PubMed  Google Scholar 

  15. Weinstein GD, Nigra TP, Pochi PE, Savin RC, Allan A, Benik K et al (1991) Topical tretinoin for treatment of photodamaged skin. A multicenter study. Arch Dermatol 127:659–665

    CAS  PubMed  Google Scholar 

  16. Kang S, Goldfarb MT, Weiss JS, Metz RD, Hamilton TA, Voorhees JJ et al (2003) Assessment of adapalene gel for thetreatment of actinic keratoses and lentigines: a randomizedtrial. J Am Acad Dermatol 49:83–90

    PubMed  Google Scholar 

  17. Yoshimura K, Harii K, Aoyama T, Iga T (2000) Experience with astrong bleaching treatment for skin hyperpigmentation in Orientals. Plast Reconstr Surg 105:1097–1108

    CAS  PubMed  Google Scholar 

  18. Fleischer AB Jr, Schwartzel EH, Colby SI, Altman DJ (2000) The combination of 2%4-hydroxyanisole (mequinol) and 0.01 % tretinoin is effective in improving the appearance of solar lentigines and related hyperpigmented lesions in two double-blind multicenter clinical studies. J Am Acad Dermatol 42:459–467

    PubMed  Google Scholar 

  19. Kheradmand M, Afshari M, Damiani G, Abediankenari S, Moosazadeh M (2019) Melasma and thyroid disorders: a systematic review and meta-analysis. Int J Dermatol 58(11):1231–1212

    CAS  PubMed  Google Scholar 

  20. Wright TS (2011) Cutaneous manifestations of malignancy. Curr Opin Pediatr 23:407–411

    PubMed  Google Scholar 

  21. van Geel N, Speeckaert R (2016) Acquired pigmentary disorders. In: Griffiths C, Barker J, Bleiker T, Chalmers R, Creamer D (Hrsg) Rook’s textbook of dermatology, S 196–198

    Google Scholar 

  22. Bell HK, Poston GJ, Vora J, Wilson NJ (2005) Cutaneous manifestations of the malignant carcinoid syndrome. Br J Dermatol 152:71

    CAS  PubMed  Google Scholar 

  23. van Geel N, Speeckaert R (2016) Acquired pigmentary disorders. In: Griffiths C, Barker J, Bleiker T, Chalmers R, Creamer D (Hrsg) Rook’s textbook of dermatology, S 200–201

    Google Scholar 

  24. van Geel N, Speeckaert R (2016) Acquired pigmentary disorders. In: Griffiths C, Barker J, Bleiker T, Chalmers R, Creamer D (Hrsg) Rook’s textbook of dermatology, S 236–237

    Google Scholar 

  25. Fields K, Milikowski C, Jewell T, Fields J (2014) Localized diffuse melanosis associated with melanoma successfully treated with imiquimod cream 5 %: a case report and review of the literature. Cutis 93(3):145–150

    PubMed  Google Scholar 

  26. Lu Y‑Y (2017) Hyperpigmentation as a peculiar presentation of mycosis fungoides. An Bras Dermatol 92(5):92–94

    PubMed  PubMed Central  Google Scholar 

  27. Erbil H, Sezer E, Koseoglu D, Filiz N, Kurumlu Z, Taştan HB, Demiriz M (2007) Hyperpigmented mycosis fungoides: a case report. J Eur Acad Dermatol Venereol 21(7):982–983

    CAS  PubMed  Google Scholar 

  28. Chuamanochan M, Haws AL, Pattanaprichaku P (2015) Reticulate hyperpigmentation in systemic sclerosis: a case report and review of the literature. J Med Case Rep 9:21

    Google Scholar 

  29. Dytoc M, Ting PT, Man J, Sawyer D, Fiorillo L (2005) First case series on the use of imiquimod for morphoea. Br J Dermatol 153(4):815–820

    CAS  PubMed  Google Scholar 

  30. Herath HMMTB (2018) Erythroderma and extensive poikiloderma—a rare initial presentation of dermatomyositis: a case report. J Med Case Rep 12:83

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Creadore A, Watchmaker J, Maymone MBC, Pappas L, Vashi NA, Lam C (2020) Cosmetic treatment in patients with autoimmune connective tissue diseases best practices for patients with lupus erythematosus. J Am Acad Dermatol 83(2):343–363

    PubMed  Google Scholar 

  32. Shafiee MA, Akbarian F, Memon KK, Aarabi M, Boroumand B (2015) Dermatologic manifestations in end-stage renal disease. Iran J Kidney Dis 9:339–353

    PubMed  Google Scholar 

  33. Karadag AS, Simsek GG (2010) Familial amyloidosis cutis dyschromica. Turk J Med Sci 40:151–154

    Google Scholar 

  34. Qiao J, Fang H, Hongtian Y (2012) Amyloidosis cutis dyschromica. Orphanet J Rare Dis 7:95

    PubMed  PubMed Central  Google Scholar 

  35. Hermawan M, Rihatmadja R, Sirait SP (2014) Familial amyloidosis cutis dyschromica in three siblings: report from Indonesia. Dermatol Reports 6:5375

    PubMed  PubMed Central  Google Scholar 

  36. Garg T, Marak A, Ahmed R, Chander R, Jain M (2017) An unusual presentation of primary cutaneous amyloidosis. Dermatol Online J 23(8):13030/qt38f676n9

    PubMed  Google Scholar 

  37. Dispenzieri A (2017) POEMS syndrome: 2017 update on diagnosis, risk stratification, and management. Am J Hematol 92(8):814–829

    PubMed  Google Scholar 

  38. Miest RYN, Comfere NI, Dispenzier A (2013) Cutaneous manifestations in patients with POEMS syndrome. Int J Dermatol 52(11):1349–1356

    PubMed  Google Scholar 

  39. Bagheri S, Eisen D (2011) Long-pulse neodymium-doped yttrium aluminum garnet laser treatment improves amiodarone-induced hyperpigmentation. Dermatol Surg 37(10):1539–1541

    CAS  PubMed  Google Scholar 

  40. Atkin DH, Fitzpatrick RE (2000) Laser treatment of imipramine-induced hyperpigmentation. J Am Acad Dermatol 43:77–80

    CAS  PubMed  Google Scholar 

  41. Rodrigues M, Bekhor P (2015) Treatment of minocycline induced cutaneous pigmentation with the picosecond alexandrite (755-nm) laser. Dermatol Surg 41(10):1179–1182

    CAS  PubMed  Google Scholar 

  42. Nisar M, Iyer K, Brodell R et al (2013) Minocycline-induced hyperpigmentation: a comparison of 3 Q‑switched lasers to reverse its effects. Clin Cosmet Investig Dermatol 6:159–162

    CAS  PubMed  PubMed Central  Google Scholar 

  43. John AM, Handler MZ, Schwartz RA (2020) Fixed drug eruptions: an update, emphasizing the potentially lethal generalized bullous fixed drug eruption. Am J Clin Dermatol 21(3):393–399

    PubMed  Google Scholar 

  44. Lacz NL, Vafaie J, Kihiczak NI, Schwartz RA (2004) Postinflammatory hyperpigmentation: a common but troubling condition. Int J Dermatol 43(5):362–365

    PubMed  Google Scholar 

  45. Chaowattanapanit S, Silpa-Archa N, Kohli I, Lim HW, Hamzav I (2017) Postinflammatory hyperpigmentation: a comprehensive overview: treatment options and prevention. J Am Acad Dermatol 77(4):607–621

    PubMed  Google Scholar 

  46. Davis EC, Callender VD (2010) Postinflammatory hyperpigmentation - a review of the epidemiology, clinical features, and treatment options in skin of color. J Clin Aesthet Dermatol 3(7):20–31

    PubMed  PubMed Central  Google Scholar 

  47. Zaynoun S, Rubeiz N, Kibbi A‑G (2008) Ashy dermatoses: a critical review of the literature and a proposed simplified clinical classification. Int J Dermatol 47:542–544

    PubMed  Google Scholar 

  48. Schwartz RA (2004) Erythema dyschromicum perstans: the continuing enigma of Cinderella or ashy dermatosis. Int J Dermatol 43(3):230–232

    PubMed  Google Scholar 

  49. Nguyen K, Khachemoune A (2019) Ashy dermatosis: a review. Dermatol Online J 25(5):13030/qt44f462s8

    PubMed  Google Scholar 

  50. Mahajan VK, Chauhan PS, Mehta KS, Sharma AL (2015) Erythema dyschromicum perstans: response to topical tacrolimus. Indian J Dermatol 60(5):525

    PubMed  PubMed Central  Google Scholar 

  51. Diaz A, Gillihan R, Motaparthi K, Rees A (2020) Combination therapy with prednisone and isotretinoin in early erythema dyschromicum perstans: a retrospective series. JAAD Case Rep 6(3):207–213

    PubMed  PubMed Central  Google Scholar 

  52. Kroon MW, Wind BS, Meesters AA et al (2012) Non-ablative 1550 nm fractional laser therapy not effective for erythema dyschromicum perstans and postinflammatory hyperpigmentation: a pilot study. J Dermatolog Treat 23:339–344

    PubMed  Google Scholar 

  53. Wolfshohl JA, Geddes ERC, Stout AB, Friedman PM (2017) Improvement of erythema dyschromicum perstans using a combination of the 1,550-nm erbium-doped fractionated laser and topical tacrolimus ointment. Lasers Surg Med 49(1):60–62

    PubMed  Google Scholar 

  54. Madu PN, Syder N, Elbuluk N (2020) Postinflammatory hypopigmentation: a comprehensive review of treatments. J Dermatolog Treat 20:1–5

    Google Scholar 

  55. Relyveld GN, Kingswijk MM, Reitsma JB et al (2006) Benzoyl peroxide/clindamycin/ UVA is more effective than fluticasone/UVA in progressive macular hypomelanosis: a randomized study. J Am Acad Dermatol 55:836–843

    PubMed  Google Scholar 

  56. Cuesta Montero L, Belinchón I, Toledo F, Betlloch I (2011) Progressive macular hypomelanosis, excellent response with narrow-band ultraviolet B phototherapy. Photodermatol Photoimmunol Photomed 27(3):162–163

    Google Scholar 

  57. Gozali MV, Zhang J, Yi F, Zhou B, Luo D (2016) Chemical leukoderma induced by dimethyl sulfate. An Bras Dermatol 91(5):26–28

    PubMed  PubMed Central  Google Scholar 

  58. Bonamonte D, Vestita M, Romita P, Filoni A, Fot C, Angelini G (2016) Chemical leukoderma. Dermatitis 27(3):90–99

    CAS  PubMed  Google Scholar 

  59. Jung JY, Yeom KB, Eun HC (2010) Chemical leukoderma improved by low-dose steroid pulse therapy. Ann Dermatol 22:241–244

    PubMed  PubMed Central  Google Scholar 

  60. Shin J, Kim M, Park SH, Oh SH (2013) The effect of fractional carbon dioxide lasers on idiopathic guttate hypomelanosis: a preliminary study. J Eur Acad Dermatol Venereol 27:e243–6

    CAS  PubMed  Google Scholar 

  61. Rerknimitr P, Chitvanich S, Pongprutthipan M, Panchaprateep R, Asawanonda P (2015) Non-ablative fractional photothermolysis in treatment of idiopathic guttate hypomelanosis. J Eur Acad Dermatol Venereol 29(11):2238–2242

    CAS  PubMed  Google Scholar 

  62. Rerknimitr P, Disphanurat W, Achariyakul M (2013) Topical tacrolimus significantly promotes repigmentation in idiopathic guttate hypomelanosis: a double-blind, randomized, placebo-controlled study. J Eur Acad Dermatol Venereol 27:460–464

    CAS  PubMed  Google Scholar 

  63. Asawanonda P, Sutthipong T, Prejawai N (2010) Pimecrolimus for idiopathic guttate hypomelanosis. J Drugs Dermatol 9(3):238–239

    PubMed  Google Scholar 

  64. Kumarasinghe SP (2004) 3–5 second cryotherapy is effective in idiopathic guttate hypomelanosis. J Dermatol 31:437–439

    PubMed  Google Scholar 

  65. Falabella R, Escobar C, Giraldo N, Rovetto P, Gil J, Barona MI et al (1987) On the pathogenesis of idiopathic guttate hypomelanosis. J Am Acad Dermatol 16(1 Pt 1):35–44

    CAS  PubMed  Google Scholar 

  66. Pagnoni AK, Sadiq I, Stoudemayer T (1999) Hypopigmented macules of photodamaged skin and their treatment with topical tretinoin. Acta Derm Venereol 79:305–310

    CAS  PubMed  Google Scholar 

  67. Ravikiran SP, Sacchidanand S, Leelavathy B (2014) Therapeutic wounding: 88 % phenol in idiopathic guttate hypomelanosis. Indian Dermatol Online J 5(1):14–18

    PubMed  PubMed Central  Google Scholar 

  68. Hexsel DM (1999) Treatment of idiopathic guttate hypomelanosis by localized superficial dermabrasion. Dermatol Surg 25(11):917–918

    CAS  PubMed  Google Scholar 

  69. Jung HM, Kim H, Lee JH, Gyong Moon K, Bae JM (2017) Treatment of laser therapy-induced punctate leukoderma using a 308-nm excimer laser. Ann Dermatol 29(5):630–632

    PubMed  PubMed Central  Google Scholar 

  70. Kim HS, Jung HD, Kim HO, Lee JY, Park YM (2012) Punctate leucoderma after low-fluence 1,064-nm quality-switched neodymium-doped yttrium aluminum garnet laser therapy successfully managed using a 308-nm excimer laser. Dermatol Surg 38:821–823

    CAS  PubMed  Google Scholar 

  71. Fong K, Goh BK (2019) Epidermal cellular grafting as a treatment for punctate leukoderma secondary to laser toning. J Eur Acad Dermatol Venereol 33(11):e396–e397

    CAS  PubMed  Google Scholar 

  72. Gottesman SP, Goldberg GN (2013) Immediate successful treatment of argyria with a single pass of multiple Q‑switched laser wavelengths. JAMA Dermatol 149(5):623–624

    PubMed  Google Scholar 

  73. Griffith RD, Simmons BJ, Bray FN, Falto-Aizpurua LA, Yazdani Abyaneh MA, Nouri K (2015) 1064 nm Q‑switched Nd:YAG laser for the treatment of argyria: a systematic review. J Eur Acad Dermatol Venereol 29(11):2100–2103

    CAS  PubMed  Google Scholar 

  74. Han TY, Chang HS, Lee HK, Son SJ (2011) Successful treatment of argyria using a low-fluence Q‑switched 1064-nm Nd:YAG laser. Int J Dermatol 50(6):751–753

    PubMed  Google Scholar 

  75. Friedmann DP, Buckley S, Mishra V (2017) Localized cutaneous argyria from a nasal piercing successfully treated with a picosecond 755-nm Q‑switched alexandrite laser. Dermatol Surg 43(8):1094–1095

    CAS  PubMed  Google Scholar 

  76. Hall AH (2002) Chronic arsenic poisoning. Toxicol Lett 128(1-3):69–72

    CAS  PubMed  Google Scholar 

  77. Wu JJ, Papajohn NG, Murase JE, Verkruysse W, Kelly KM (2009) Generalized chrysiasis improved with pulsed dye laser. Dermatol Surg 35(3):538–542

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Abteilung für Dermatologie, Universität Iuliu Hatieganu für Medizin und Pharmazie, Cluj, Rumänien

    Sorina Danescu

  2. Abteilung für pädiatrische Dermatologie, Krankenhaus „Colentina“, 19–21 Stefan cel Mare Av., Bukarest, Rumänien

    Carmen Salavastru

  3. Carol-Davila-Universität für Medizin und Pharmazie, Bukarest, Rumänien

    Carmen Salavastru, GS Tiplica & K. Fritz

  4. 2. Klinik für Dermatologie, Krankenhaus „Colentina“, Bukarest, Rumänien

    GS Tiplica

  5. Hautärzte und Laserzentrum, Landau, Deutschland

    K. Fritz

Authors
  1. Sorina Danescu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carmen Salavastru
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. GS Tiplica
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. Fritz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carmen Salavastru.

Ethics declarations

Interessenkonflikt

S. Danescu, C. Salavastru, G. Tiplica und K. Fritz geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Übersetzung aus dem Englischen

Ansgar Schlichting

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Danescu, S., Salavastru, C., Tiplica, G. et al. Therapie von Pigmentstörungen in Zusammenhang mit systemischen Erkrankungen. Hautarzt 71, 932–943 (2020). https://doi.org/10.1007/s00105-020-04715-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00105-020-04715-y

Schlüsselwörter

Keywords

Search

Navigation