Acquired, Idiopathic, Patterned Facial Pigmentation

Idiopathic, acquired and mottled facial pigmentation are probably physiological (non-inflammatory) pigmentations that are mainly found in dark-skinned people (Fulk CS 1984; Gellin GA 1981; Jimbow M et al. 1989). They are accentuated by the sun and become more pronounced in the 3rd and 4th decades of life.

Solar stress, but also medication, hormonal causes, pregnancy and breastfeeding were mentioned as possible triggering and aggravating factors. Most authors assessed facial hyperpigmentation as: constitutional, idiopathic, familial or genetic (Sarma N et al. 2014).

It is assumed that these facial, non-inflammatory spot formations are constitutional pigmentation patterns. An association with the Blaschko lines is postulated. Mosaicism due to a late post-zygotic genetic aberration is conceivable (Sarma N et al. 2014). This hypothesis could only be confirmed by cytogenetic analysis. Interestingly, it has been postulated that the pattern of AIPFP is consistent with what used to be called "pigmentary demarcation line type F" (PDL-F) (Malakar S et al. 2000; Malakar S et al. 2007). Matzumoto was the first to describe the PDL (Matzumoto SH 1913).

Acquired, idiopathic, non-nevoid facial pigmentation is frequently found in dark-skinned people. Periorbital pigmentation is the best known entity in this group. It is particularly common in many dark-skinned people, also in India (Fulk CS 1984; Gellin GA 1981; Jimbow M et al. 1989). According to a larger cross-sectional study (n=187), the average age at medical consultation was 33.37 ± 16.7 years. The mean age at presentation of isolated periorbital pigmentation was 17.7 ± 12.37 years, for the perioral pigmentation pattern 21.86 ± 8.11 years and thus significantly lower than the overall average of 33.37 years.

m:w= 1:1.37. There were usually no anamnestic indications of a clear familial occurrence (same or different patterns of idiopathic pigmentation), with the exception of perioral involvement, which frequently occurs in families (36% positive anamnesis).

There are diffuse, light to dark gray, also slate gray, moderately sharply defined, mostly bizarrely configured hyperpigmentations. A certain pattern is detectable.

The pigmentation patterns were anatomically divided into:

• periorbital (81.3 %)
• zygomatic (73.3 %)
• malar
• perioral
• upper nasal and
• mandibular pigmentation

were categorized. Periorbital hyperpigmentation was the most frequently observed pattern. The infraorbital part was generally limited in the lower part by the bony orbital rim. Sometimes it also extended over the cheek . The medial infraorbital area was often pigmented earlier and more intensely than the lateral area. The second most common pattern was zygomatic hyperpigmentation/zygomatic hyperpigmentation (73.3%). The size of zygomatic pigmentation varied, with some being very small and others having a large and complete form.

Acquired hyperpigmentation of the face can occur in a variety of diseases: melasma, melnaocytic nevi, cutaneous amyloidosis, erythema dyschromicum perstans, contact dermatitis, seborrhoeic melanosis, actinic lichen planus and lichen planus pigmentosus. Halo pigmentation can also develop periorbital in atopic dermatitis.

Symptomatic, UV-protective. Skin bleaching agents (e.g. ^Pigmanorm® ) can be used under strict medical supervision. The side effects of depigmenting agents (mostly containing hydroquinone) must be taken into account.

The pigmentation is benign. Gradual progressive darkening was observed in almost all cases. Some areas developed a relatively higher intensity than other areas. Certain parts of the spots were often not fully visible at first, and UV rays appear to play a certain aggravating role.

Acquired, idiopathic, non-nevoid facial pigmentation is frequently found in dark-skinned people. Periorbital pigmentation is the best known entity in this group. It is particularly common in many dark-skinned people, also in India (Fulk CS 1984; Gellin GA 1981; Jimbow M et al. 1989).

1. Fulk CS (1984) Primary disorders of hyprpigmentation. J Am Acad Dermatol 10:1-16.
2. Gellin GA (1981) Dark circles around eye. J Am Med Assoc 245:1165.
3. Jimbow M et al (1989) Pigmentary disorders in oriental skin. Clin Dermatol 7:11-27.
4. Malakar S et al. (2000) Pigmentary demarcation lines over the face. Dermatology 200:85-86.
5. Malakar S et al. (2007) Periorbital melanosis is an extension of pigmentary demarcation line-F on face. Indian J Dermatol Venereol Leprol 73:323-325
6. Matzumoto SH (1913) On a proper pigment distribution at the Voiget's lines. Arch Dermatol Syphil 118:157-64.
7. Sarma N et al. (2014) Acquired, Idiopathic, Patterned Facial Pigmentation (AIPFP) Including Periorbital Pigmentation and Pigmentary Demarcation Lines on Face Follows the Lines of Blaschko on Face. Indian J Dermatol 59:41-48.