Dermoscopy negates the need for biopsy in cases of confetti-like leukoderma and exogenous ochronosis

Confetti-like leukoderma and exogenous ochronosis are two of the rarest side effects of a long-term use of hydroquinone (HQ). HQ is the first choice of topical bleaching agents used in the treatment of melasma. Confetti-like leukoderma is characterized as mottled depigmented spots, whereas exogenous ochronosis presents as gray-brown or blue-black hyperpigmentation. Both disorders are especially found in the area where HQ is applied. We report two cases of women with these two rare pigment disorders, who had a history of using HQ for more than 8 years. The dermoscopic examinations show dark-brown globular-like structures on a diffuse fine brown reticular patterns background, multiple guttate depigmented macules, and prominent telangiectasias which are characteristics for melasma, ochronosis, and confetti-like leukoderma. Both patients were advised to stop HQ and treated with sunscreen, 0.05% retinoic acid cream, 2% kojic acid cream, and 20%-35% glycolic acid chemical peel.