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

Government stripped of power to suspend pensions for doctors facing unproven charges

Government stripped of power to suspend pensions for doctors facing unproven charges

Controversial powers allowing the government to suspend pension payments for doctors...

RCGP pulls plug on oil and gas conference after protests

RCGP pulls plug on oil and gas conference after protests

The RCGP has cancelled an oil and gas exploration conference booked to take place...

BMA to hold special conference after GP leaders reject 2020 contract offer

BMA to hold special conference after GP leaders reject 2020 contract offer

GP leaders have voted to hold a special conference after rejecting a package of contract...

Promise of 6,000 more GPs 'a pipedream' without investment, NHS leaders warn

Promise of 6,000 more GPs 'a pipedream' without investment, NHS leaders warn

Government promises to deliver 6,000 more GPs and 50m appointments are no more than...

Flu tracker: How flu levels are affecting GP workload across the UK

Flu tracker: How flu levels are affecting GP workload across the UK

Flu levels have spiked early in the 2019/20 season. Keep track of how levels of the...

Pension tax plan 'will fail to solve NHS workforce crisis', BMA warns

Pension tax plan 'will fail to solve NHS workforce crisis', BMA warns

BMA leaders have warned that raising the income threshold at which tax on pensions...