Differential diagnoses: Pigmentation

The differential diagnosis of conditions presenting with pigmentation including melasma, postinflammatory hyperpigmentation, poikiloderma of Civatte and Naevus of Ota.

Melasma
Melasma

Melasma

Presentation

  • Symmetrical pigmentation
  • Occurs mainly in women, but can be rarely seen in men
  • Mainly affects the cheeks, forehead and upper lip
  • Often associated with pregnancy or oral contraceptive use
  • Pigmentation usually fades after pregnancy or stopping combined oral contraceptive pill, but in some cases, may be permanent

Management

  • UV protection will prevent darkening of areas on exposure
  • If required, laser treatment can be effective
  • Camouflage products are an effective alternative



Postinflammatory hyperpigmentation

Postinflammatory hyperpigmentation

Presentation

  • Macular melanin pigmentation
  • Follows any inflammatory condition of the epidermis, such as eczema or psoriasis
  • More common in darker skin types
  • Patients usually report a rash occurring before the pigment appears
  • May occur after a fixed drug eruption

Management

  • No treatment particularly effective
  • Pigment usually decreases with time
  • Sunblock/UV avoidance will help



Poikiloderma of Civatte

Poikiloderma of Civatte

Presentation

  • Combination of pigment, telangiectasia and atrophy
  • Skin has a mottled red/brown appearance
  • Usually occurs in middle to older age in both sexes
  • Usually affects sides of the neck, sparing the chin and ears
  • Thought to be a result of UV exposure and cosmetics acting as photosensitisers
  • Very common and treatment not usually sought

Management

  • Sunblock/UV avoidance will help
  • Laser can be useful if treatment required



Naevus of Ota

Naevus of Ota

Presentation

  • Grey/blue pigmentation around the eye and on the sclera
  • Usually affects only one side of the face
  • Type of blue naevus with melanocytes deep in the dermis
  • Most common among Japanese people
  • Usually present from birth or early childhood
  • Remains throughout life
  • Similar lesions (naevi of Ito) occur on the shoulder

Management

  • Treatment not required

Dr Stollery is a GP in Leicestershire

Take a test on this article and claim your certificate on MIMS Learning

This is an updated version of an article that was first published in October 2014.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

Vaccination tracker

UK COVID-19 vaccination programme tracker

GPs across the UK have led the largest-ever NHS vaccination programme in response...

RCGP chair Professor Martin Marshall

Hand PCNs control of primary care infrastructure funding, says RCGP

CCG funding for primary care infrastructure should be handed to PCNs when the bodies...

Professor Martin Marshall and Talking General Practice logo

Podcast: RCGP chair Professor Martin Marshall

Talking General Practice speaks to RCGP chair Professor Martin Marshall.

Dr Chaand Nagpaul

In-house review not enough to stop 'unjust' GMC referrals, warns BMA

Doctors' leaders have repeated calls for a full independent review of the GMC referral...

Coronavirus

How widespread is long COVID in the UK?

Millions of people in the UK are living with long COVID. GPonline looks at the data...

COVID-19 vaccination sign

GP contract for autumn COVID-19 booster campaign due shortly

GP practices in England will be invited shortly to sign up for the COVID-19 autumn...