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

Former GP Dr Sarah Wollaston among latest MPs to join breakaway group

Former GP Dr Sarah Wollaston among latest MPs to join breakaway group

Health and social care committee chair and former GP Dr Sarah Wollaston has left...

Global sum to increase by just 92p in 2019/20

Global sum to increase by just 92p in 2019/20

Practices will receive just 92p more per weighted patient as their global sum in...

NHS must overhaul complaints system to better support staff, says HEE

NHS must overhaul complaints system to better support staff, says HEE

The NHS needs to undertake a 'root and branch' examination of how it handles complaints...

GP premises need 'urgent investment' says BMA as half are not fit for purpose

GP premises need 'urgent investment' says BMA as half are not fit for purpose

The BMA has called on the government to 'urgently invest' in general practice premises...

CQC to assess triage apps on GP inspections

CQC to assess triage apps on GP inspections

The CQC has said that it will assess the use of triage apps and systems in GP practices...

CQC urges patients to complain about GP services in bid to improve care

CQC urges patients to complain about GP services in bid to improve care

The CQC is encouraging members of the public to speak up about negative experiences...