Histological evaluation of hyperpigmentation on female Filipino axillary skin

Int J Cosmet Sci. 2006 Aug;28(4):247-53. doi: 10.1111/j.1467-2494.2006.00328.x.


Females in South East Asia (Thailand, Indonesia and the Philippines) show concern about dark areas of skin which develop in their underarms, but little is known about the features differentiating pale and hyperpigmented axillary skin in the general population. To investigate this, a histology study was undertaken in the Philippines to define the aetiology of underarm darkening, which is postulated to be a mild form of postinflammatory hyperpigmentation (PIHP). Punch biopsies were taken from dark and light axillary skin sites of 20 female subjects, of whom seven had hyperpigmented underarms, based on an instrumental (Mexameter MX-18, Courage and Khazaka Electronic GmbH, Cologne, Germany) measure, and 13 had not. Histological and immunohistochemical analyses were undertaken using a range of stains and antibodies, including haematoxylin-eosin for general histopathology, Masson-Fontana for melanin, anti-CD68 for monocytes and macrophages, Van Gieson's technique for fibrosis, anti-proliferating cell nuclear antigen for cell mitosis, and the melanocyte-specific immunostains, anti-tyrosinase and anti-tyrosinase-related protein 1. In most cases, dark skin sites from hyperpigmented panelists had increased intensity of Masson-Fontana, anti-tyrosinase and/or anti-TRP1 staining, indicative of melanocyte stimulation and increased melanin production. Furthermore, hair plucking emerged as a key stimulus to increased pigmentation. The trauma of hair plucking slightly increased the number of infiltrating mononuclear cells and macrophages that ingested melanosomes leaking from the damaged epidermis, more so in the skin of hyperpigmented panelists; this, in turn, potentially increases pigmentation. However, cell infiltration was focal, mainly near the plucked follicles, and not indicative of diffuse inflammation. The results from this study support the hypothesis that axillary darkening is mild PIHP, characterized by increased epidermal melanin, following stimulation or mild irritation of skin, with hair plucking as a key factor in this process.