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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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There does not yet exist a specific treatment for IP. Treatment can only address the individual symptoms.
Melanism, meaning a mutation that results in completely dark skin, does not exist in humans. Melanin is the primary determinant of the degree of skin pigmentation and protects the body from harmful ultraviolet radiation. The same ultraviolet radiation is essential for the synthesis of vitamin D in skin, so lighter color of skin - less melanin - is an adaptation for the prehistoric movement of humans away from equatorial regions, as there is less exposure to sunlight at higher latitudes. People from parts of Africa have very dark skin, but this is not melanism.
Different therapeutic modalities have been attempted to repigment the lesions of nevus depigmentosus such as PUVA, excimer laser, and different grafting techniques. PUVA therapy has not been shown to be beneficial. Successful repigmentation was reported in a single case with 14 sessions of excimer laser treatment. Though the repigmentation of nevus depigmentosus is possible by grafting techniques, the results are inconsistent and recurrence is possible. In consideration of the experience of other authors and us, the quality and retention of pigment are unpredictable. These factors need to be considered while consulting and offering any treatment to the patient of nevus depigmentosus.
Treatment is predominantly preventive. Avoidance of topical phenols and diets low in tyrosine may help. Replacement and repair of damaged tissue is also possible.
As Becker's nevus is considered a benign lesion, treatment is generally not necessary except for cosmetic purposes. Shaving or trimming can be effective in removing unwanted hair, while electrology or laser hair removal may offer a longer-lasting solution. Different types of laser treatments may also be effective in elimination or reduction of hyperpigmentation, though the results of laser treatments for both hair and pigment reduction appear to be highly variable.
In most patients, the number and size of cherry angiomas increases with advancing age. They are harmless, having no relation to cancer at all.
The discoloration usually disappears spontaneously over a period of several months after giving birth or stopping the oral contraceptives or hormone replacement therapy.
Treatments are often ineffective as it comes back with continued exposure to the sun. Assessment by a dermatologist will help guide treatment. This may include use of a Woods lamp to determine depth of the melasma pigment. Treatments to hasten the fading of the discolored patches include:
- Topical depigmenting agents, such as hydroquinone (HQ) either in over-the-counter (2%) or prescription (4%) strength. HQ is a chemical that inhibits tyrosinase, an enzyme involved in the production of melanin.
- Tretinoin, an acid that increases skin cell (keratinocyte) turnover. This treatment cannot be used during pregnancy.
- Azelaic acid (20%), thought to decrease the activity of melanocytes.
- Tranexamic acid by mouth has shown to provide rapid and sustained lightening in melasma by decreasing melanogenesis in epidermal melanocytes.
- Cysteamine hydrochloride (5%) over-the-counter. Mechanism of action seems to involve inhibition of melanin synthesis pathway
- Flutamide (1%)
- Chemical peels
- Microdermabrasion to dermabrasion (light to deep)
- Galvanic or ultrasound facials with a combination of a topical crème/gel. Either in an aesthetician's office or as a home massager unit.
- Laser but not IPL (IPL can make the melasma darker)
Evidence-based reviews found that the most effective therapy for melasma includes a combination on topical agents.
In all of these treatments the effects are gradual and a strict avoidance of sunlight is required. The use of broad-spectrum sunscreens with physical blockers, such as titanium dioxide and zinc dioxide is preferred over that with only chemical blockers. This is because UV-A, UV-B and visible lights are all capable of stimulating pigment production.
Patients should avoid other precipitants including hormonal triggers.
Cosmetic camouflage can also be used to hide melasma.
The term "melanism" has been used on Usenet, internet forums and blogs to mean an African-American social movement holding that dark-skinned humans are the original people from which those of other skin colour originate. The term "melanism" has been used in this context as early as the mid-1990s and was promoted by some Afrocentrists, such as Frances Cress Welsing.
Depigmentation is the lightening of the skin, or loss of pigment. Depigmentation of the skin can be caused by a number of local and systemic conditions. The pigment loss can be partial (injury to the skin) or complete (caused by vitiligo). It can be temporary (from tinea versicolor) or permanent (from albinism).
Most commonly, depigmentation of the skin is linked to people born with vitiligo, which produces differing areas of light and dark skin. These individuals, if they so decided to use a lightning process to even out their skin tone, could apply a topical cream containing the organic compound monobenzone to lessen the remaining pigment. The brand drug incorporating 20% monobenzone is Benoquin, made by ICN.
Increasingly, people who are not afflicted with the vitiligo experiment with lower concentrations of monobenzone creams in the hope of lightning their skin tone evenly. An alternate method of lightning is to use the chemical mequinol over an extended period of time. Both monobenzone and mequinol produce dramatic skin whitening, but react very differently. Mequinol leaves the skin looking extremely pale. However, tanning is still possible. It is important to notice that the skin will not go back to its original color after the none treatment of mequinol. Mequinol should not be used by people that are allergic to any ingredient in mequinol, if you are pregnant, if you have eczema, irritated or inflamed skin, an increased number of white blood cells or if you are sensitive to sunlight or must be outside for prolonged periods of time. Mequinol is used in Europe in concentrations ranging from 2-20% and is approved in many countries for the treatment of solar lentigines. Monobenzone applied topically completely removes pigment in the long term and vigorous sun-safety must to be adhered to for life to avoid severe sun burn and melanomas. People using monobenzone without previously having vitiligo do so because standard products containing hydroquinone or other lightning agents are not effective for their skin and due to price and active ingredient strength. However, monobenzone is not recommended for skin conditions other than vitiligo.
For stubborn pigmented lesions the Q-switched ruby laser, cryotherapy or TCA peels can be used to ensure the skin remains pigment-free.
Many treatments have been tried for port-wine stains including freezing, surgery, radiation, and tattooing; port-wine stains can also be covered with cosmetics.
Lasers may be able to destroy the capillaries without significant damage to the overlying skin. Lasers and other light sources may therefore be able to reduce the redness of stains, although there is not enough evidence to recommend one form over another.
For most people in trials of pulsed dye laser, more than 25% of the redness was reduced by laser after one to three treatments. Adverse effects were rare in these trials, although some people had changes to the color of the skin, especially Chinese people with darker skin. There can be pain, crusting, and blistering in the two weeks after treatment. The trials only followed people for six months, so long-term outcomes are not known. Up to 10 treatments may be necessary for improvement, but complete removal may not result.
The use of topical rapamycin as an adjunct to pulsed dye laser may improve results.
Treatment is generally given before one year of age. However, as it is recommended to be performed under anesthesia (15 minutes) on small children, it is not always possible to get frequent treatments. For example in Finland a child gets treated 2-3 times per year, resulting in a target of "being ready before school age" (7 years) "(needs citation)".
After the laser treatment the skin is filled with black marks, the size of a pen. This is due to the laser instrument's size; the black marks disappear within 1–3 weeks. The treated area can be sore and swollen for a couple of days.
Xanthochromism (also called xanthochroism or xanthism) is an unusually yellow pigmentation in an animal. It is often associated with the lack of usual red pigmentation and its replacement with yellow. The cause is usually genetic but may also be related to the animal's diet. A Cornell University survey of unusual-looking birds visiting feeders reported that 4% of such birds were described as xanthochromistic (compared with 76% albinistic). The opposite of xanthochromism, a deficiency in or complete absence of yellow pigment, is known as "axanthism".
Birds exhibiting genetic xanthochromism, especially deliberately bred mutations of several species of parrot in aviculture, are termed "lutinos". Wild birds in which xanthochromism has been recorded include yellow wagtail, wood warbler, Cape May warbler, rose-breasted grosbeak, evening grosbeak, red-bellied woodpecker, scarlet tanager, northern cardinal, great spotted woodpecker, common tailorbird, crimson-breasted shrike, kākāriki and kea.
Studies have recorded an incidence of about 3–5 cases per 1,000 newborn babies.
Amelanism (also known as amelanosis) is a pigmentation abnormality characterized by the lack of pigments called melanins, commonly associated with a genetic loss of tyrosinase function. Amelanism can affect fish, amphibians, reptiles, birds, and mammals including humans. The appearance of an amelanistic animal depends on the remaining non-melanin pigments. The opposite of amelanism is melanism, a higher percentage of melanin.
A similar condition, albinism, is a hereditary condition characterised in animals by the absence of pigment in the eyes, skin, hair, scales, feathers or cuticle. This results in an all white animal, usually with pink or red eyes.
These are localized white spots on skin which may affect any area of the body, but these white spots are quite stable lesions. In the majority of patients, the lesions are not completely achromic, but are hypopigmented and resemble splashed paint. The individual lesions are permanent and there are no effective therapies for re-pigmenting this nevus. If there is hair in an affected area, it is usually colourless or white.
These lesions generally do not require treatment. If they are cosmetically unappealing or are subject to bleeding angiomas may be removed by electrocautery, a process of destroying the tissue by use of a small probe with an electric current running through it. Removal may cause scarring. More recently pulsed dye laser or intense pulsed light (IPL) treatment has also been used.
Future treatment based on a locally acting inhibitor of MEK1 and Cyclin E1 could possibly be an option. A natural MEK1 inhibitor is myricetin
The exact cause of poikiloderma is unknown; however, extended sun exposure, namely the ultraviolet light emitted by the sun, is the primary factor.
Leucism (; or ) is a condition in which there is partial loss of pigmentation in an animal resulting in white, pale, or patchy coloration of the skin, hair, feathers, scales or cuticle, but not the eyes. Unlike albinism, it is caused by a reduction in multiple types of pigment, not just melanin.
Albeit difficult, treatment of poikiloderma involves the delivery of multiple wavelengths of intense pulsed light (IPL) to the affected area.
Types include:
- Poikiloderma vasculare atrophicans
- Poikiloderma of Civatte
- Hereditary sclerosing poikiloderma
Oral propranolol appears to be the most effective treatment for reducing the size of capillary hemangiomas in children and is more effective than placebo, observation without intervention, or oral corticosteroids.
A 1991 report documented the cases of nine patients with both Becker's nevus and malignant melanoma. Of the nine melanomas, five were in the same body area as the Becker's nevus, with only one occurring within the nevus itself. As this was apparently the first documented co-occurrence of the two diseases, there is so far no evidence of higher malignancy rates in Becker's nevi versus normal skin. Nonetheless, as with any abnormal skin growth, the nevus should be monitored regularly and any sudden changes in appearance brought to the attention of one's doctor.
Melasma is thought to be the stimulation of melanocytes (cells in the epidermal layer of skin that produce a pigment called melanin) by the female sex hormones estrogen and progesterone to produce more melanin pigments when the skin is exposed to sun. Women with a light brown skin type who are living in regions with intense sun exposure are particularly susceptible to developing this condition.
Genetic predisposition is also a major factor in determining whether someone will develop melasma.
The incidence of melasma also increases in patients with thyroid disease. It is thought that the overproduction of melanocyte-stimulating hormone (MSH) brought on by stress can cause outbreaks of this condition. Other rare causes of melasma include allergic reaction to medications and cosmetics.
Melasma Suprarenale "(Latin - above the kidneys)" is a symptom of Addison's disease, particularly when caused by pressure or minor injury to the skin, as discovered by Dr. FJJ Schmidt of Rotterdam in 1859.
Leucism (occasionally spelled "leukism") is a general term for the phenotype resulting from defects in pigment cell differentiation and/or migration from the neural crest to skin, hair, or feathers during development. This results in either the entire surface (if all pigment cells fail to develop) or patches of body surface (if only a subset are defective) having a lack of cells capable of making pigment.
Since all pigment cell-types differentiate from the same multipotent precursor cell-type, leucism can cause the reduction in all types of pigment. This is in contrast to albinism, for which leucism is often mistaken. Albinism results in the reduction of melanin production only, though the melanocyte (or melanophore) is still present. Thus in species that have other pigment cell-types, for example xanthophores, albinos are not entirely white, but instead display a pale yellow colour.
More common than a complete absence of pigment cells is localized or incomplete hypopigmentation, resulting in irregular patches of white on an animal that otherwise has normal colouring and patterning. This partial leucism is known as a "pied" or "piebald" effect; and the ratio of white to normal-coloured skin can vary considerably not only between generations, but between different offspring from the same parents, and even between members of the same litter. This is notable in horses, cows, cats, dogs, the urban crow and the ball python but is also found in many other species.
A further difference between albinism and leucism is in eye colour. Due to the lack of melanin production in both the retinal pigmented epithelium (RPE) and iris, those affected by albinism typically have red eyes due to the underlying blood vessels showing through. In contrast, most leucistic animals have normally coloured eyes. This is because the melanocytes of the RPE are not derived from the neural crest, instead an outpouching of the neural tube generates the optic cup which, in turn, forms the retina. As these cells are from an independent developmental origin, they are typically unaffected by the genetic cause of leucism.
Genes that, when mutated, can cause leucism include, "c-kit", "mitf" and "EDNRB.
Since the histopathology of nevus anemicus is normal, nevus anemicus is a pharmacologic nevus and not an anatomic one. In most people a nevus anemicus is on a covered area and so light in appearance that no treatment is needed.
As halo nevi are only of cosmetic significance, no treatment is required, and patients will be asymptomatic. Although halo nevi are harmless, it is important to monitor the lesion on regular basis. Watch out for any changes in appearance of existing or new halo nevi. If there is any change in appearance or is associated with pain, itch, and infection, a doctor should be consulted immediately to exclude the possibility of melanoma.
Most birthmarks are harmless and do not require treatment. Pigmented marks can resolve on their own over time in some cases. Vascular birthmarks may require reduction or removal for cosmetic reasons. Treatments include administering oral or injected steroids, dermatological lasers to reduce size and/or color, or dermatologic surgery.