Hemoglobin is a protein in red blood cells that carries oxygen throughout the body. Original magnification ×50. Dermatology Made Easy is a concise overview of the common dermatological conditions most likely to present in general medicine, and will help the reader diagnose, test and treat skin conditions quickly and accurately. I still have what looks like faint, almost lacy-looking bruising on my hips and darker coloration on my inner . All resurfacing procedures that cause peeling or exfoliation will lighten the skin to some extent. Found inside – Page 46Furthermore , patients with hyperpigmentation following trauma are likely to ... located unilaterally tation most likely reflects hemosiderin deposiover the ... This edition provides the comprehensive coverage of all aspects of sclerotherapy and surgical treatment of varicose and telangiectatic leg veins. Found inside – Page 98Hyperpigmentation. Induced. by. Chloroquine: A. Case. Report. † Sara Attuati1,*, Valeria Martini1, Riccardo Bonacina 1, Umberto Mariani 1 and Andrea ... The discoloration may be present on the upper, lower or both eyelids.1 It can be a significant cosmetic concern for patients, especially when they feel it makes themselves appear sad, tired, stressed or older than they are.2 But it also could be a warning sign of more serious medical problems, including disorders of the liver, heart, thyroid or kidneys; hereditary blood disorders; allergic reactions; nutrient deficiency, such as that of vitamin K; Addison’s disease; circulatory conditions resulting in fluid retention; or even sleep disturbance.2,3, Causes Patients develop cavities that may enlarge and result in necrosis. Stasis dermatitis is a common inflammatory skin disease that occurs on the lower extremities (see the image below). Hemosiderin staining is more than an eye sore. Melanin is carried by keratinocytes to the skin surface. 4. Although epidermal melanocytes appear normal, aberrant delivery of melanin to the surrounding keratinocytes results in deposition of pigment in dermal melanophages. - Perl's stain - Chemical iron concentration 2. It is a pigment, which is a result of hemoglobin's by-product. 3. Haemochromatosis is caused by genetic factors or by receiving multiple blood transfusions. D. Original magnification x 350. The body's immune system can slowly heal the hemosiderin staining, but it will take longer than two weeks. The presence of hemosiderin-laden alveolar macrophages in bronchoalveolar lavage (BAL) fluid is a useful diagnostic criterion for this entity. Its elimination from the area through phagocytosis may take years, if it ever occurs. Hemosiderin is a pigment that is a byproduct of hemoglobin. This helps the patient understand that the treated face skin will be lighter than the untreated neck skin. Untreated histoplasmosis may lead to progressive pulmonary fibrosis that leads to recurrent infections and respiratory and cardiac failure. Lymphedema swelling affects the entire limb and foot but is seldom symmetric. Lower Limb Assessment (Basic & Advanced) Documentation Guideliine . In contrast, bats can become infected, and they transmit histoplasmosis through their droppings. Found inside – Page 210The result is a gray-brown pigmentation of the skin known also as hyperpigmentation, skin pigmentation changes, or hemosiderin staining (Kimmel and Robin, ... Inhalation of fungal spores may lead to acute pulmonary histoplasmosis; however, approximately 90% of individuals with acute infection remain asymptomatic. Section stained with hematoxylin-eosin taken 6 months after injection with POL 0.75%. I really just hate this process, and am considering another gentle v-beam treatment if it still looks the same at 6 months. John C. Mavropoulos, Bernard A. Cohen, in Pediatric Dermatology (Fourth Edition), 2013. But it's not effective. Histoplasmosis is caused by Histoplasma capsulatum, a dimorphic fungus that remains in a mycelial form at ambient temperatures and grows as yeast at body temperature in mammals.1,2 The fungus can be found in temperate climates throughout the world, predominantly in river valleys in parts of the USA, the West Indies, Central and South America, Africa, India, East Asia and Australia. The use of topical antibiotics is generally indicated for the treatment of mild to moderate inflammatory (papular or pustular) lesions of acne vulgaris and rosacea. 449-11), symmetrical hyperpigmented patches are seen on the lateral aspect of the forehead, upper part of the cheek, and mandibular area. As the iron deposits begin to accumulate under the skin, staining in the form of patches begins to develop. Produce new breakthroughs in anti-aging products Ocimum gratissimum contains bioactive molecules including thymol, eugenol, methyl chavicol, linalool, limonene, β-pinene, and α-terpineol which fight against acne.25,26 Orafidiya and colleagues reported that the Ocimum oil (2%) in cetomacrogol blend base was more efficient against acne compared to benzoyl peroxide 10% lotion (an organic compound used for curing acne). Fig. The code L81.8 is valid during the fiscal year 2021 from October 01, 2020 through September 30, 2021 for the submission of HIPAA-covered transactions. Areas of hyperpigmentation are more marked in darkly pigmented children. The exact pathophysiology is debated, but it involves a genetic predisposition, incompetent valves . venous edema. Hyperpigmentation due to hemosiderin deposition also occurs in instances of hemorrhagic disease, chronic venous insufficiency, and purpura. It is generally considered to be less potent but better tolerated than topical retinoids in the treatment of acne vulgaris. However, hemosiderin staining due to venous ulcers or lipodermatosclerosis is unlikely to go away, although sometimes the color may . Fortunately, there are several non-invasive lasers which can effectively treat these conditions including the q-switched ruby laser, . Answered by Vein Specialists. Hemosiderin staining vs hyperpigmentation keyword after analyzing the system lists the list of keywords related and the list of websites with related content, in addition you can see which keywords most interested customers on the this website EM typically resolves within 2 to 4 weeks. Venous stasis dermatitis is caused by chronic venous insufficiency. Found inside – Page 283... in a brownish discoloration of the skin referred to as hemosiderin staining. Over time, the induration and hyperpigmentation is associated with fibrosis ... The ICD-10-CM code L81.8 might also be used to specify conditions or terms . It shows no age or gender predilection. Contaminated soil can be potentially infectious for years. I will do this on patients that have had previous full face traditional laser within a year or two. Judiciously hiding the lower facial laser limit in the mandibular shadow also reduces the demarcation line. This is generally not true with younger patients or those who do not wear makeup on a daily basis, and is, in those cases, seen as a significant complication. Joe NiamtuIII, in Cosmetic Facial Surgery (Second Edition), 2018. The resulting venous hypertension causes an increase of leukocytes within the veins, which then migrate into surrounding tissue. Michelle DiBaise, in Essential Clinical Procedures (Second Edition), 2007. Author Information. Salicylic acid is found in many over-the-counter products, including lotions, creams, and pads. It is always prudent to laser a patient twice to attain a result as opposed to lasering once with overtreatment and melanocytic damage. These are often used as ocular hypotensive eye drops for patients with glaucoma or lash growth. 13.90). This happens when high pressure in our veins pushes blood into the skin tissue causing staining in the skin tissue. Sara obtained her Bachelor of Science degree from the University of Texas at Austin in 1994. Treatment for Hemosiderin Staining. Considerably, a low or moderate cytotoxicity in human dermal fibroblasts and HaCaT cells (spontaneously transformed aneuploid immortal keratinocyte cell line from human adult skin) has been reported from the ethanol extracts of Mollugo pentaphylla, Matteuccia orientalis, and Angelica anomala.17 Psoralea corylifolia (Fabaceae) and Magnoliae officinalis (Magnoliaceae) have also shown antimicrobial activities 2.8 and 2.5 times higher than salicylic acid, respectively, against Propionibacterium acne. Basically, it happens when some of the components of . https://doi.org/10.1007/s40257-016-0239-8, https://doi.org/10.4103/ijdpdd.ijdpdd_2_18, More Than a Cover-Up: Options for Patients with Periorbital Hyperpigmentation. viral warts ( B07.-) Disorders of pigmentation of the skin and other organs, including discoloration, hyperpigmentation and hypopigmentation. It can lead to a bronze discoloration of the skin, as well as to cirrhosis of the liver, diabetes, and arthritis, among other issues. Of note, benzoyl peroxide should not be applied at the same time as tretinoin because it may cause tretinoin to oxidize and become less effective. Different types of lasers and similar devices produce different results. Jage, M., & Mahajan, S. (2018). CSF analysis revealed a lymphocytic pleocytosis, which, despite the absence of direct pathogen detection, may have been a cerebral manifestation of histoplasmosis. As a 2% preparation, salicylic acid has been demonstrated to be more effective than 10% benzoyl peroxide for acne control, although this may be due to better patient compliance given the superior side effect profile of salicylic acid.3,66–68. Lasering a larger area can produce a mask-like difference between the lighter lasered skin and the non-lasered bordering skin (Fig. On treatment with liposomal amphotericin B the patient's clinical state and the laboratory findings improved dramatically. The most common causes of circumscribed hypermelanosis are tinea versicolor (which can present as both hypopigmentation and hyperpigmentation, hence its name), Azelaic acid may cause local skin irritation and changes in pigmentation. 1987. It has been reported that Ocimum gratissimum oil with Aloe vera (Asphodelaceae) gel works against acne. Hemoglobin contains iron, which is engulfed by local white blood cells. It is usually the earliest cutaneous sequela of chronic venous insufficiency with venous hypertension and may be a precursor to more problematic conditions, such as venous leg ulceration and lipodermatosclerosis. MRI measurement hepatic or cardiac iron 3. Latanoprost, bimatoprost and other prostaglandin analogs can also cause periorbital hyperpigmentation. Hemosiderin is composed primarily of iron and will stain bright blue with Perls' Prussian blue. When RBC's leak into the tissue they break down and leave hemosiderin behind, which causes a characteristic brown pigmentation, commonly seen in patients with venous hypertension. However, it really isn't brown enough for me to think that it is pigment. CVI frequently causes Inflammatory skin disease (stasis dermatitis) on the lower extremities of patients with CVI, followed by development of reddish-brown skin discoloration and hyperpigmentation (hemosiderin stains). It has been 4 1/2 months since I had lipo of the stomach, flanks, bra line, and inner thighs. PCCA’s W06™ Anhydrous Topical Gel is a base that has a water activity below 0.6 (Aw < 0.6). Facial hyperpigmentation in skin of color: Special considerations and treatment. The granules stain positive for either melanin [15] or both melanin and hemosiderin [13, 16]. In the case of “pseudo” or “relative” hypopigmentation, avoiding aggressive resurfacing toward the mandibular border and feathering the lasered skin reduces the chance of significant hypopigmentation. diabetes. Hemosiderin staining or pigmentation or hemosiderosis is a medical condition in which one presents brown patches on the skin. They also take the time to explore some potential non-prescription and prescription options based on their research. No evidence of immunosuppression was found in the diagnostic work-up (HIV serology was negative, fasting blood sugar level was within normal range). I have personally performed periorbital subunit lasering thousands of times and have rarely experienced permanent pigmentation changes. The process wherein iron from the blood stains the skin is called hemosiderin staining or hemosiderin stain. Postsclerotherapy Hyperpigmentation. Create a free website or blog at WordPress.com. The duration of treatment depends on the severity of infection and the immune status of the patient. ), Essential Clinical Procedures (Second Edition), A 48-year-old Woman from Thailand with Fever and Disseminated Cutaneous Abscesses, Lymphadenopathy and Swelling of her Left Elbow, On follow-up the patient presented in a fair general condition. Hemosiderin staining or pigmentation of the skin is due to deposition of hemosiderin. Found inside – Page 53... hyperpigmentation ( from hemosiderin staining ) , dermatitis , and lipodermatosclerosis ; scarring from prior healed ulcers is also possible . DISCUSSION. This is the American ICD-10-CM version of L81.9 - other international versions of ICD-10 L81.9 may differ. As long as COVID-19 is spreading in communities, everyone is encouraged to practice social distancing and face-covering, regular and thorough hand hygiene, appropriate respiratory hygiene, and good disinfection habits. In melasma (Fig. This unique, reader-friendly compendium on all aspects of non-invasive facial rejuvenation shows the current approach to the issue. 3 Hemosiderin staining (iron staining) of the tissue is treated differently since it isn't related to excessive melanin. This condition is described to the patient preoperatively by showing them the color difference of the dorsal and ventral side of my forearm. The patient received imipenem, which led to a slight improvement of her skin manifestations but inflammation parameters remained grossly elevated. Found inside – Page 18613.11.2 Hyperpigmentation/ Hypopigmentation One form of hyperpigmentation is hemosiderin staining, resulting from the rupture of vessel walls and ... Found inside – Page 53... maceration, hyperpigmentation (from hemosiderin staining), dermatitis, and lipodermatosclerosis. Scarring from prior healed ulcers is also possible. Hemosiderin deposits can occur with chronic venous stasis, of course, but they can also occur with a single lower blepharoplasty in a susceptible patient. I have seen too many patients from other offices that received isolated LSR to subunits and present with significant color and texture differences on the treated areas that stand out against the untreated facial skin. Hemosiderin Staining is the appearance of brownish patches above the ankles that usually occurs when red blood cells break down and begin to leak iron. True hypopigmentation is an infrequent complication that can occur immediately or several years after a deep resurfacing procedure. The brown pigment is lipofuscin in macrophages, not melanin She is a lifetime member of the University of Texas College of Pharmacy Alumni Association. This brown discoloration is caused by red blood cells leaking out of the veins and permanently staining the skin. It spreads into the tissue after an injury causing bruising and bleeding of the tissues. There are some commercial products available, including a combination product, but when those items don’t fit the specific needs of patients, we need to put on our thinking caps and start looking for other options for them. There are times when an isolated facial subunit can be lasered. Found insideDIFFERENTIAL DIAGNOSIS Pigmented purpuric dermatoses • Druginduced purpura • Contactdermatitis • Postinflammatory hyperpigmentation (hemosiderin staining) ... Found inside – Page 200The reported incidence of hyperpigmentation is variable and depends on many ... that this pigmentation is caused only by hemosiderin staining of the dermis, ... Birds cannot be infected by the fungus and do not transmit the disease; however, bird excretions contaminate the soil, thereby enriching the growth medium for the mycelium. Dermatofibromas (also known as fibrous histiocytomas) are a spectrum of benign dermal based lesions with fibroblastic and histiocytic differentiation. In children, older individuals and immunocompromised patients, dissemination of the infection may occur. Kara N. Shah, in Principles and Practice of Pediatric Infectious Diseases (Fifth Edition), 2018. Hemosiderin Hyperpigmentation Pigmentation resulting from deposits of hemosiderin occurs in purpura, hemochromatosis (see section later in chapter), hemorrhagic diseases, and stasis dermatitis. These marks look very much like laser burns. A fractional CO2 laser is an advanced laser that burns a smaller portion or fraction of the top skin layer or epidermis, unlike a traditional CO2 laser that burns the entire area. Most skin lightening will darken with time and sun exposure. eczema. Post Inflammatory Hyperpigmentation Vs. Hemosiderin Staining After Lipo, Which One is It? A range of hydroquinone concentrations can be compounded. Periorbital hyperpigmentation: A comprehensive review. Quantitative phlebotomy Golden brown hemosiderin pigment predominantly in hepatocytes Liver Bx, HFE hemochromatosis (H&E): Granules predominantly in hepatocytes Liver Bx, HFE hemochromatosis Joe Monroe practices at the Dawkins Dermatology Clinic, Oklahoma City, Oklahoma, and is the department editor for Dermatology Digest. Of note, it has been shown that whereas azelaic acid decreases the postinflammatory hyperpigmentation seen with acne, it does not alter skin tanning or hyperpigmentation that occurs with exposure to ultraviolet light.61,65, Salicylic acid occurs naturally as a phenolic phytohormone; its name comes from the Latin word salix, which means willow tree. This brown discoloration is caused by red blood cells leaking out of the veins and permanently staining the skin. The Journal of Clinical and Aesthetic Dermatology, 9(1), 49–55. In addition, not treating tanned skin and using proper pre- and post-laser skin conditioning with Retin-A and hydroquinone 4% can lighten the neck skin and make the difference less noticeable. https://doi.org/10.4103/ijdpdd.ijdpdd_2_18 PCCA Science has been researching published literature and would like to discuss what evidence is currently available regarding the questions revolving around hygiene, social distancing, and good disinfection habits. Rarely, disseminated infection can also occur in immunocompetent patients. While pigmentation itself isn't a problem, the conditions that cause the discoloration are often serious. Last Updated on Mon, 22 Feb 2021 | Varicose Veins. 1-4 It is an ill-defined entity that presents as bilateral round or semicircular homogenous . Hemosiderin often forms after bleeding (hemorrhage). Testing padding-left: 40px !important; This complication must be adequately addressed in the pre-laser informed consent process. Melasma is treated with daily broad-spectrum sunscreens and lightening agents such as hydroquinone (4% cream) and retinoic acid (0.025 to 0.10% cream) for 3 to 4 months; the creams are applied daily, but should be reduced to alternate days if irritation develops. Using around 2–8% concentration may stabilize the melanocytes and decrease pigmentation locally, Cases caused by vascularity are often treated by targeting the vessel walls to stabilize them, and the use of, Ascorbic acid can effectively lighten pigmentation, possibly due to an increase in dermal thickness that reduces dark discoloration from underlying congested blood, Retinoids are vitamin A derivatives, like tretinoin, that decrease the appearance of hyperpigmentation through multiple pathways. From: Decision Making in Medicine (Third Edition), 2010, Ravi Ubriani, ... Michael E. Ming, in Dermatopathology, 2010. Found inside – Page 39Staining – Hyperpigmentation of tissues; “Hemosiderin staining” • Location • Ulcer characteristics – size, depth, wound base, exudate, etc • Temperature of ... Cutaneous hyperpigmentation is present in 70 percent of patients due to two different mechanisms: (1) hemosiderin deposition resulting in diffuse, slate-gray darkening and (2) increased production . They promote collagen synthesis and reorganization. 13.85). The discoloration might look like a brownish or purplish bruise or cloudy area just beneath the skin surface. Melanin is normally found in the skin, eye, and substantia nigra. (A) artemetin, (B) carnosic acid, (C) curcumin, (D) epicatechin, (E) hydroquinone, (F) hypericin, (G) isaindigotone, (H) isorhamnetin, (I) lupeol, (J) masticadienonic acid, (K) trioxsalen, (L) usnic acid. Due to the fact that the entire facial skin has already been lightened and retextured, subunit lasering has much less effect than on a patient who has never been lasered (Fig. 7-9), but can be gray or have a blue or red tinge. Therefore, it is recommended that a diagnosis of "pigment" (as opposed to diagnosing the type of pigment, e.g., hemosiderin or lipofuscin) is most appropriate. The melanocytes of dark-skinned people produce more melanin than those of people with light skin. MONROE, JOE R. PA-C, MPAS. Hyperpigmentation was localized on the anterior side of the legs in all patients, on the arms in 5, and on the palate in 1. This process is much more common in darker-pigmented individuals. Varicose veins are twisted, dilated veins most commonly located on the lower extremities. I am not sure that there is any guaranteed means of preventing hypopigmentation, as some patients appear to be more predisposed to its development and if one performs a high volume of LSR, it will occasionally occur. Physical examination will often show hepatosplenomegaly and lymphadenopathy, and in some patients mucous membrane ulcerations as well as skin ulcers, nodules, or molluscum-like papules may be seen. The topical antimicrobial benzoyl peroxide is unique in that it serves to reduce rather than to increase the antibiotic resistance of P. acnes. In addition to her expertise in hormone replacement therapy, Sara possesses a vast knowledge of homeopathics as well as herbal and vitamin supplements. It spreads into the tissue after an injury causing bruising and bleeding of the tissues. We use cookies to help provide and enhance our service and tailor content and ads. Tretinoin, 0.01% to 0.1%, is applied once nightly or every other night if it is not well tolerated. even with a battery of special stains. Hemosiderin staining is the development of patches of brownish to yellow deposits just under the skin. This alteration in normal pigmentation follows many inflammatory processes in the skin, such as a diaper dermatitis, insect bites, drug reactions, and traumatic injury. Hemosiderin is composed of iron oxide . Cutaneous hyperpigmentation is present in 70 percent of patients due to two different mechanisms: (1) hemosiderin deposition resulting in diffuse, slate-gray darkening and (2) increased production . }, By Sara Hover, RPh, FAARM, PCCA Clinical Compounding Pharmacist, Periorbital hyperpigmentation is a skin disorder that appears in those with darker skin pigmentation. Whereas no topical retinoids are recommended in pregnancy, tazarotene must be avoided as it is classified as pregnancy category X. Found inside – Page 280Purpura from local trauma heals with hyperpigmentation due to hemosiderin ... Schamberg purpura Brownish hemosiderin staining of the lower legs and ankles ... This can happen when we have high pressure in the veins in the legs. . Hemosiderin staining doesn't happen to everyone after a bruise, but if you have a medium skin type (Asian, Hispanic or light African-American) or if you've had sclerotherapy injections for spider veins or dermal filler injections you may be at a higher risk of developing this problem. Creams and gels: Creams and gels applied topically can help lighten hemosiderin stains and improve their cosmetic appearance. A common consequence of a resolved inflammatory process in the skin, the resultant postinflammatory pigmentation is usually in the shape of the resolved active lesion. Found inside – Page 59... hyperpigmentation ( from hemosiderin staining ) , dermatitis , and lipodermatosclerosis ; scarring from prior healed ulcers is also possible . It is chemically similar to the active component of aspirin and has a comedolytic effect by disrupting the pilosebaceous unit and causing desquamation. Pigmentation disorders are often more troublesome in skin of colour. Hemosiderin contains iron pigment. It is antibacterial as well as anticomedonal through its capacity for keratolysis.61 In two blinded, randomized controlled trials, the therapeutic effect of azelaic acid on acne severity was demonstrated to be significant and on par with that of topical benzoyl peroxide and clindamycin .62 In addition, azelaic acid is helpful in treating the hyperpigmentation that results from acne-associated inflammation.61,63 For patients with acne rosacea, azelaic acid has been shown to be comparable to topical metronidazole in the reduction of inflammatory lesions and erythema.64, Azelaic acid, 20% cream or 15% gel, is applied topically twice daily.61–64, Azelaic acid may cause local skin irritation and changes in pigmentation. Lipofuscin pigment may be confirmed with Schmorl's stain, oil red O, or Sudan black B. Lipofuscin granules are typically periodic acid-Schiff positive and produce a discrete Hemosiderin or haemosiderin is an abnormal microscopic pigment found in the human body. The physical examination of the lower legs reveals patches of erythematous, eczematous and/or scaling, itching skin. Internally, hemosiderin staining of the liver can be a sign of haemochromatosis, or an iron surplus in the body. Hydroquinone and ascorbic acid are not new to this clinical area, but having a base that can stabilize them is. Assuming that there is no recurrence of the primary process, the postinflammatory pigmentation will resolve eventually over time, but it can take months or even years to completely fade. The information gathered is based on the best scientific evidence currently available regarding potential treatments. Various cultures from skin and lymph node biopsies remained sterile and so a submandibular lymph node was extirpated. We’re excited that patients and physicians now have access to Azelastine Hydrochloride USP as an ingredient option in compounded medications. Found inside – Page 216The treatment of established hyperpigmentation is not very effective. ... Exfoliants such as trichloroacetic acid can reduce hemosiderin staining, ... Some of the former abscess sites showed, The Microbiology of Skin, Soft Tissue, Bone and Joint Infections, Acne typically affects skins with a higher number of oil glands and causes inflammation, papules, skin lesions, and, Principles and Practice of Pediatric Infectious Diseases (Fifth Edition), Infections, Hyper- and Hypopigmentation, Regional Dermatology, and Distinctive Lesions in Black Skin, Goldman's Cecil Medicine (Twenty Fourth Edition). Dr. Goldberg addresses Vascular Lasers; Laser Hair Removal; Pigmented Lesions, Tattoos, and Disorders of Hypopigmentation; Ablative Lasers and Devices and Non-Ablative Photorejuvenation and Skin Remodeling The text goes beyond the standard ... It has been reported in 11% to 80%1-3 of patients. Since hemosiderin is an indigestible residue of hemoglobin degradation, it may appear as aggregates up to 100 µm in diameter.10 Hemosiderin has a variable concentration of these aggregates. However, histologic examination has demonstrated that this pigmentation is caused only by hemosiderin staining of the dermis, irrespective of the type of sclerosing solution used, pigmentation of the patient, or length of time after injection7,8 (see Figure 15.2). Some of the former abscess sites showed postinflammatory hyperpigmentation, enlarged lymph nodes were no longer present and the osteolytic lesions were partly recalcificated. Randy Gordon, in A Comprehensive Guide to Geriatric Rehabilitation (Third Edition), 2014. The commonly used Fontana-Masson ("melanin stain") method relies upon the melanin granules to reduce ammoniacal silver nitrate (but argentaffin, chromaffin, and some lipochrome pigments also will stain black as well). .PCCABlogPost .PCCABlogBullets { It may also be obtained by prescription in concentrations between 2% and 10%. A version of this article originally appeared in PCCA’s members-only magazine, the Apothagram. PCCA members with Clinical Services access can view these formulas here, and if they have questions about compounding for patients with periorbital hyperpigmentation, they can contact our Clinical Services department at 800.331.2498.
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