Differential diagnoses: Pigmentation

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




  • 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


  • 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


  • 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


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

Poikiloderma of Civatte

Poikiloderma of Civatte


  • 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


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

Naevus of Ota

Naevus of Ota


  • 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


  • Treatment not required

Dr Stollery is a GP in Leicestershire

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

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