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The body may release cortisol that can reduce the number of circulating eosinophils by suppressing the release of proinflammatory cytokines like IL-5

Histologic Features Hyperpigmentation of the basal keratinocytes with prominence, but not increase of mostly dendritic melanocytes Subjacent mucosal melanophages and fibrosis Absence of melanocytic nests, cytologic atypia, pagetoid scatter Differential Diagnosis Post-inflammatory hyperpigmentation Lentiginous junctional melanocytic nevus Melanoma in situ Takeaway Essentials Clinical Relevant Pearls Can have variegated color and very irregular contours raising concern for melanoma Pathology Interpretation Pearls Hyperpigmentation of the basal keratinocytes can be subtle Comparing the hyperpigmented areas with the adjacent normal, non-hyperpigmented epidermis may provide the only clue Immunohistochemical/Molecular Findings In difficult cases immunohistochemistry for Mart-1 and/or MiTF-1 can be helpful in excluding melanoma in situ Post-inflammatory Hyperpigmentation Clinical Features Post-inflammatory hyperpigmentation, as the name implies, is pigmentation that occurs in the setting of a genital eruption that has an inflammatory component, particularly one that is directed at the epithelium [7, 35]

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Could the sharp pulse from Sermorelin activate certain intracellular pathways more effectively, while the sustained presence of Tesamorelin is better for others