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

GMC defers revalidation for a further 9,000 doctors due to pandemic

GMC defers revalidation for a further 9,000 doctors due to pandemic

Around 9,000 doctors who are due to revalidate between March and July 2021 will have...

NHS England praises GPs after steep rise in general practice appointments

NHS England praises GPs after steep rise in general practice appointments

NHS England primary care medical director Dr Nikki Kanani has thanked GPs and their...

Half of GPs say patients harmed by delays to care during COVID-19 pandemic

Half of GPs say patients harmed by delays to care during COVID-19 pandemic

Nearly half of GPs say patients on their list have come to harm because of delays...

Viewpoint: Test and trace isn't working - could GPs do it better?

Viewpoint: Test and trace isn't working - could GPs do it better?

The outsourced test and trace system isn't working, says Dr Simon Hodes. It's time...

Doctors call for test and trace millions to be diverted to primary care and local NHS

Doctors call for test and trace millions to be diverted to primary care and local NHS

Doctors have urged the government to divert hundreds of millions of pounds from the...

Hundreds of GPs a month seek mental health support as COVID-19 pressure bites

Hundreds of GPs a month seek mental health support as COVID-19 pressure bites

More than 200 GPs a month are seeking mental health support as COVID-19 drives up...