Sign in with your personal account to earn and claim cme credits through visualdx. Another differential diagnosis of cmn is plexiform neurofibroma. Early ctcl often lacks the histologic criteria necessary for a definitive diagnosis. Nov 01, 2019 oral pigmentation is a relatively common condition that may involve any portion of the oral cavity. Nov 29, 2016 the journal of urgent care medicine jucm is the official journal of the urgent care association uca. Multiple causes are known, and they may range from simple iatrogenic mechanisms, such as implantation of dental amalgam, to complex medical disorders, such as peutzjeghers syndrome. Melasma chloasma melasma consists of dark brown, sharply marginated, roughly symmetric patches of hyperpigmentation on the face usually on the forehead, temples, cheeks, upper lip, or nose. Hyperpigmentation is present in 70 percent of affected patients at diagnosis. Rocky mountain spotted fever especially of wrist most often the rash begins as small, flat, pink, nonitchy spots macules on the wrists, forearms, and ankles. Postinflammatory hypopigmentation, in which there is a history of another inflammatory skin disorder.
Darkened tongue and hyperpigmented patches of skin symptom. Other diagnostic considerations other, less common annular skin conditions that should be considered in a differential diagnosis include 7. List of 32 causes for darkened tongue and hyperpigmented patches of skin, alternative diagnoses, rare causes, misdiagnoses, patient stories, and much more. Hyperpigmentation of the face and neck primary care. Mycosis fungoides mf, the most common primary cutaneous tcell lymphoma, is a neoplasic disease characterized by classical noninfiltrated lesions patches, plaques, tumors, and erythrodermic stages. A 47yearold man presents with a 1year history of a mildly pruritic eruption on the trunk and extremities. When evaluating a patient with hyperpigmented lesions, there is a broad differential, and the diagnosis of exogenous ochronosis may only be elicited with a good medication history for topical agents. Patches of erythema ab igne are characterized by erythematous andor hyperpigmented, reticular patterns. Conditions to include in the differential diagnosis in a child of this age include the following.
Axillary lentiginosis is usually localised to one axilla and is characterised by numerous. He denies any recent travel or close contact with persons or animals having a similar eruption. Macular hyperpigmentation usually involves palms and soles of healthy black people and is characterized by linear hyperpigmented macules. The most likely diagnosis is disseminated tinea corporis. Localised hyperpigmentation localised pigmentation may be due to melanin, haemosiderin or externallyderived pigment. Acanthosis nigricans is seen particularly as a sign of insulin resistance or as a paraneoplastic phenomenon. Avoid and treat dry skin, using nonsoap cleansers and thick simple emollients. Pigmentation disorders are often more troublesome in skin of colour. Jun 14, 2011 reticulate hyperpigmentation with onset in adolescents and adults. Atrophoderma of pasini and pierini differential diagnoses. May 20, 2018 cafe au lait spots, or cafe au lait cal macules calms, are hyperpigmented lesions that may vary in color from light brown to dark brown.
Hypopigmented patches on the skin dermatology jama jama. Darkened tongue and hyperpigmented patches of skin. Hyperpigmented patches on the trunk of a nigerian womanquiz. Causes of nodule and hyperpigmented patches of skin. Approach to reticulate hyperpigmentation vachiramon. Linear and whorled nevoid hypermelanosis has been associated with serious congenital defects, and a set of investigations, including brain magnetic resonance imaging, should be considered in this setting. Photo rounds, case study by journal of family practice. The melanocytes of darkskinned people produce more melanin than those of people with light skin. Dyschromia refers to skin discolouration or patches of uneven colour resulting in temporary or permanent hyperpigmentation increase in pigment production and or hypopigmentation decrease in pigment production. This chronic, harmless reaction to malassezia yeast, a cutaneous commensal organism, presents as scaly macules that can be hypopigmented or hyperpigmented. Use of folk remedies, such as lemon or lime juice for insect bites, should also be explored 5, 8, 9. Skin biopsy reveals an epidermis that is papillomatous and hyperpigmented, but lacks the antlerlike rete ridge pattern.
Itchy rash and hyperpigmented patches of skin right diagnosis. Pityriasis rosea, a selflimited papulosquamous skin eruption, is characterized by small, fawncolored lesions distributed along skin cleavage lines. Diagnosis of pigmented lesions of the oral cavity and perioral tissues is challenging. Disorders of oral pigmentation differential diagnoses. Approach to reticulate hyperpigmentation vachiramon 2011. He has no significant medical history and takes no medications. Hyperpigmented patches on the trunk of a nigerian woman diagnosis full text a 33yearold nigerian woman who immigrated to the united states 4 years previously presented with mildly itchy, dark, round, scaly patches, mostly on the trunk and proximal extremities, which appeared suddenly 3 months earlier. Oct 23, 2008 localised morphea or lichen sclerosus can also present as hypopigmented patches but the underlying skin will be firm in morphea. Melanin is carried by keratinocytes to the skin surface. The mongolian spot is a hyperpigmented macule or patch present at birth or shortly thereafter with a predilection for asian, black, and dark white skin types.
Staining with elastic stain verhoeffvan gieson stain can also support the diagnosis of erythema ab igne. Reticulate hyperpigmentation with onset in adolescents and adults. Common causes of hyperpigmented patches of skin right diagnosis. The following list of conditions have hyperpigmented patches of skin or similar listed as a symptom in our database. Differential diagnosis of melasma in brown skin fig.
The differential diagnosis of the hyperpigmented stage of ip includes linear and whorled nevoid hypermelanosis, macular epidermal nevi and other disorders with blaschkoid pigmentation. Aug 20, 2017 differential diagnosis of melasma in brown skin fig. Hyperpigmented patches on the trunk of a nigerian womandiagnosis full text a 33yearold nigerian woman who immigrated to the united states 4 years previously presented with mildly itchy, dark, round, scaly patches, mostly on the trunk and proximal extremities, which appeared suddenly 3 months earlier. There are many patterns of distribution, including acral, flexural, truncal and facial. The lesions were asymptomatic in all three patients and were incidental skin findings in. Hyperpigmented patches on the trunk of a nigerian woman. Hyperpigmented patch on the leg mdedge dermatology.
Hyperpigmented macules and patches in a patient with gm1 type 1 gangliosidosis l. Disorders of hyperpigmentation and melanocytes clinical gate. An important consideration in the differential diagnosis of ppd is mycosis fungoides mf. However, a number of other lesions have a similar appearance but a different source, such as pigment deposits from silver and iron. Nodules, tumors, and hyperpigmented patches mdedge family. Acanthosis nigricans presents as diffuse velvety hyperpigmentation of both axillae. Racgp multiple hyperpigmented patches on a darkskinned. Vascular conditions such as livedo reticularis and vasculitis can present with lesions similar to erythema ab igne. See full list of possible disease causes of hyperpigmented patches of skin hyperpigmented patches of skin. Health, general skin diseases care and treatment case studies diagnosis risk factors.
Common pigmentation disorders american family physician. Lichenoid and hyperpigmented patches with a welldemarcated border on the abdomen, the chest and the arms. Phytophotodermatitis is a clinical diagnosis that is suggested by atypical, bizarre, sunburnlike reactions with hyperpigmentation. Hyperpigmentation generalised differential diagnosis in.
It is not directed at members of the public who should. It occurs primarily in pregnant women melasma gravidarum, or the mask of. Hyperpigmented patches on a womans sunexposed face. When the description is expanded to a red patch with scale in the groin, the differential diagnosis is limited somewhat, and when historical information eg, patients age, how the rash began, and what treatments were applied is added, the differential diagnosis becomes even more restricted. Hyperpigmented macules and patches in a patient with gm1 type. The herald patch may appear as an annular lesion with an erythematous raised border, fine scale. We report three cases of erythema ab igne from chronic heating pad use over a duration of six months to three years. While typically harmless, increased skin pigmentation can be caused by several things. Differential diagnosis includes postinflammatory hypopigmentation, piebaldism a rare autosomal dominant disorder in which depigmented patches surrounded by hyperpigmented show info start test. Large, hyperpigmented patches on an infant clinical advisor.
Nov 15, 2003 hyperpigmentation is present in 70 percent of affected patients at diagnosis. Diagnosis of some common and uncommon hyperpigmentation. They can be bilateral or unilateral, depending on the position of the heat source. The presence of a lilac ring around a hypopigmented round or oval patch with induration should suggest the diagnosis of morphea. Our patient was symptomatically treated with topical retinoid cream and a moisturizer for several months, with no subjective or objective improvement. Hyperpigmentation may be the sign of a benign or relatively easily treated condition, or it may indicate the presence of a lifethreatening condition such as melanoma. It is the leading cause of death from skin disease. One of the most important lesional characteristics to be noted is the color. Undertreated psoriasis or eczema of the trunk may also present as hypopigmented patches but some evidence of these conditions elsewhere should allow you to make the diagnosis. Initial biopsies of the skin lesions performed at an outside institution prior to current presentation were nondiagnostic. List of 82 causes for itchy rash and hyperpigmented patches of skin, alternative diagnoses, rare causes, misdiagnoses, patient stories, and much more.
Hypopigmented macules and patches clinical advisor. Causes of hypopigmented patches of skin that are rare the offical us government definition of a rare disease is one that affects 200,000 people or less. Differential diagnosis axillary freckling may be seen as a manifestation of neurofibromatosis. There is a wide range of differential diagnoses when patients present with hyperpigmentation of the skin, and clinicians can often make the correct diagnosis only after taking a history and performing a thorough physical examination. Mucocutaneous vulvar lesions can be classified using the morphologic definitions described in the table. Differential diagnosis of melasma in brown skin plastic. The lesions of addisons disease, lues, ephelides, nevi and melanoma form the base of differential diagnosis of palmar and plantar hyperpigmentation. Differential diagnosis in dermatology this website is for medical practitioners seeking a method to diagnose a skin rash. The hyperpigmentation is composed of homogeneous macules that coalesce into reticulated patches. Jan 15, 2009 although most hyperpigmented lesions are benign and the diagnosis is straightforward, it is important to exclude melanoma and its precursors and to identify skin manifestations of systemic disease. Maculopapular rash pictures, causes, diagnosis 2020. Hyperpigmentation is a feature of a multitude of clinical conditions, ranging from normal variations of skin color to acquired and inherited syndromes, and is one of the most common reasons for dermatologic consultation, particularly in patients with darker skin types. Initial biopsies of the skin lesions performed at an outside institution prior to.
Even though epidemiology may be of some help in orientating the clinician and even though some lesions may confidently be diagnosed on clinical grounds alone, the definitive diagnosis usually requires histopathologic evaluation. Maculopapular rash may be mistakenly called macule, papule, patch, nodule, plaque, vesicle, or pustule. A differential diagnosis is carotenaemia, in which the skin colour takes on a yelloworange hue due to ingestion of coloured vegetables. Erythema ab igne is an asymptomatic cutaneous disorder characterized by erythematous reticulated hyperpigmentation resulting from chronic exposure to infrared radiation in the form of heat. This lesion, pathognomonic for neurofibromatosis, is a proliferation of nerves that becomes apparent in early childhood. Physical examination revealed a widespread skin eruption consisting of welldemarcated, hyperpigmented, scaly patches and plaques distributed throughout the patients trunk and extremities. Hyperpigmented skin patches journal of urgent care medicine. In many cases, the patient general may reveal a lesion or eruption of which the patient may be unaware. When evaluating a patient with hyperpigmented lesions.
Some of the less common causes of hyperpigmented patches of skin may include. To differentiate these skin lesions from each other, here are the pictures of each. Differential diagnosis for acquired macular pigmentation of unknown etiology. It involves cells called melanocytes, which produce a skin pigment called melanin. Sep 30, 2019 hyperpigmentation is a condition that causes skin to darken. It occurs primarily in pregnant women melasma gravidarum, or the mask of pregnancy and in women taking oral contraceptives. Mf is an uncommon clinical variant of mf characterized by hypopigmented macules and papules without atrophy fig. The pigment cells or melanocytes are located at the base of the epidermis and produce the protein melanin. The following causes of hypopigmented patches of skin appear in the population at a rate of less than 200,000 people per year in the usa. After history, physical examination, and morphologic classification see tables, the information in this topic can be used to begin differential diagnosis of the lesion. Mycosis fungoides is a cutaneous tcell lymphoma that clinically presents as a single or multiple hypopigmented or hyperpigmented patches or as erythematous scaly lesions in the patch or plaque stage. Black dots can be observed on the left hemiabdomen white arrows question 1. Patients may occasionally provide selftaken digital images of skin lesions or eruptions.
Melanoma melanoma is the most dangerous type of skin cancer. Some of the common causes of hyperpigmented patches of skin may include. It is not directed at members of the public who should refrain from using it to diagnose their skin rash and instead seek a doctors opinion and treatment. Edp is characterized by hyperpigmented macules and patches of variable shape and size with an ashengray to brownblue color fig.
Causes of hyperpigmented patches of skin right diagnosis. When evaluating a patient with reticulated hyperpigmented erythema, the diagnosis of erythema ab igne should be considered if there is a history of chronic heat exposure with a corresponding distribution. Differential diagnosis of round or discoid lesions. As mentioned, the endogenous form of ochronosis associated.
Histologic examination of the biopsy specimen revealed a loss of epidermal ridge pattern, a decreased granular cell layer, hyperkeratosis, and increased pigmentation of basal keratinocytes, consistent with pr. Atopic dermatitis, characterised by very itchy symmetrical plaques that respond to topical steroids. A polymorphic eruption may also be seen, presenting as simultaneous hypo and hyperpigmented macules 14. Hyperpigmentation is a condition that causes skin to darken. Acanthosis nigricans presents as diffuse velvety hyperpigmentation of both axillae, rather than reticulate pigmentation. Avoid exposing the legs to direct heat or the hot air of the heater in a car. The diagnosis of erythema ab igne may be suspected based on the clinical appearance of the. Failure of complete melanocyte migration into the epidermis prior to birth with ensuing dermal nesting and melanin production produces characteristic blue patches.
Hyperpigmentation dermatologic disorders merck manuals. Nodules, tumors, and hyperpigmented patches mdedge. After treatment with 2% ketoconazole shampoo, the patient. What caused this hyperpigmented reticulated rash on this. These patches are marked by a slight depression of the skin with an abrupt edge, usually on the backs of adolescents or young adults. Hyperpigmented, reticulated rash in a 15yearold female.