Postinflammatory hyperpigmentation
Presentation
- Occurs anywhere on the body.
- More commonly seen in darker-skinned patients.
- Develops after inflammatory skin conditions such as eczema or acne.
Management
- Treatment usually not required.
- Treating the underlying condition will reduce further pigment formation.
- Topical retinoids can be helpful.
- Avoiding UV exposure will reduce the degree of pigmentation.
- Sunblocks should be used, even in darker-skinned patients.
Freckles
Presentation
- Well-demarcated 1-5mm orange-brown macules.
- Occur on sun-exposed sites, such as face, hands and forearms.
- Usually much reduced in the winter months.
- More common in those with type I skin (red hair, pale skin).
- Histologically, normal numbers of melanocytes, but increased pigment.
Management
- No treatment necessary.
- Sunblock use can help to reduce pigment.
Chloasma
Presentation
- Symmetrical distribution, occurring mainly in women.
- Affects forehead, cheeks and upper lip.
- Occurs most commonly in association with pregnancy and use of the combined oral contraceptive pill (COC).
Management
- Usually fades after pregnancy or with cessation of the COC.
- Pigment more pronounced with UV light exposure.
- Sunblock can be helpful in lightening pigment.
- 4% hydroquinone alone or in combination with a retinoid can be helpful.
Poikiloderma of Civatte
Presentation
- Occurs in middle-aged and older patients.
- Pigment presents at the sides of the neck, with sparing under the chin.
- Associated with telangiectasia and atrophy.
- Mottled red-brown colour.
Management
- No reliable treatment available.
- Exacerbated by UV light, so sunblock can be helpful.
- Possibly associated with photosensitisers, such as perfumes.
- Lasers can be helpful in reducing pigment.
Dr Stollery is a GP in Kibworth, Leicestershire, and clinical assistant in dermatology at Leicester Royal Infirmary.
