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Exogenous Ochronosis: A Comprehensive Review of the Diagnosis, Epidemiology, Causes, and Treatments

Abstract

Exogenous ochronosis (EO) can be an unintended psychologically troubling condition for patients who are already being treated for longer-term hyperpigmentation disorders such as melasma. Early diagnosis is key in order that the offending agent can be stopped to prevent further disfiguring discoloration. EO can be diagnosed in the right clinical setting with the aid of dermatoscopy, which can assist in early diagnosis and may negate the need for a biopsy. Laser modalities using Q-switched lasers of longer wavelengths and combination laser dermabrasion treatments have shown the most significant results with minimal adverse events. However, further large-scale studies are needed to determine optimal treatment modalities. Although considered uncommon, the incidence of EO will likely continue to increase with the growth of immigrant populations and the use of skin-lightening agents above the FDA’s recommended over-the-counter concentrations, without the guidance of a dermatologist.

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Acknowledgments

Brian J. Simmons, Robert D. Griffith, Fleta N. Bray, Leyre A. Falto-Aizpurua, and Keyvan Nouri have no conflicts of interest to declare. No funding was used in the design and conduct of the study, collection, management, analysis and interpretation of data, preparation, review or approval of the manuscript, or in the decision to submit the manuscript for publication.

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Correspondence to Brian J. Simmons.

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Simmons, B.J., Griffith, R.D., Bray, F.N. et al. Exogenous Ochronosis: A Comprehensive Review of the Diagnosis, Epidemiology, Causes, and Treatments. Am J Clin Dermatol 16, 205–212 (2015). https://doi.org/10.1007/s40257-015-0126-8

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  • DOI: https://doi.org/10.1007/s40257-015-0126-8

Keywords

  • Hydroquinone
  • Yttrium Aluminium Garnet
  • Intense Pulse Light
  • Homogentisic Acid
  • Reflectance Confocal Microscopy