Differential diagnoses: Pigment formation

Dr Nigel Stollery explains the differences between four common skin pigment conditions.

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, 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 affects forehead, cheeks and upper lip

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

Poikiloderma of Civatte: pigment presents at the sides of the neck

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Before commenting please read our rules for commenting on articles.

If you see a comment you find offensive, you can flag it as inappropriate. In the top right-hand corner of an individual comment, you will see 'flag as inappropriate'. Clicking this prompts us to review the comment. For further information see our rules for commenting on articles.

comments powered by Disqus