Differential diagnoses: Skin pigmentation

Dr Nigel Stollery discusses the usual presenting features of four disorders

Naevus anaemicus

Presentation

  • Usually a single lesion is present
  • Can occur anywhere on the body
  • Localised pale areas not related to pigment
  • Over-reactive blood vessels reduce the colour of the skin
  • Pressure at the edge of the lesion will make it disappear as other vessels are compressed

Management

  • Treatment not required
  • Cosmetic camouflage can be very helpful

Vitiligo

Presentation

  • Very well-demarcated areas with total loss of pigment
  • Any areas can be affected
  • Can be associated with other autoimmune conditions
  • Affected areas have no scale and do not itch
  • May occur in scars (Koebner phenomenon)

Management

  • Treatment can be difficult
  • Potent topical steroids can help promote repigmentation
  • Cosmetic camouflage can help
  • In extensive disease, permanent depigmentation of remaining pigment can be undertaken with hydroquinone
  • Sun block use is important

Lichen sclerosus

Presentation

  • Usually affects the genitals, but extragenital lesions can occur
  • Areas are usually symptomatic
  • Affected areas are white, shiny and atrophic
  • Cause unknown, women more affected than men
  • May be associated with autoimmune conditions

Management

  • Trunk lesions tend to be unresponsive to treatment
  • Genital lesions respond to topical steroids, which may reduce the risk of scarring
  • Spontaneous remission can sometimes occur
  • Affected areas may rarely undergo malignant change

Pityriasis alba

Presentation

  • Occurs on children’s faces
  • Relatively common, especially in darker-skinned children
  • Usually multiple poorly defined pale areas with fine scale
  • Condition is usually asymptomatic, with no itch
  • More noticeable during the summer months

Management

  • Reassurance can be given that this is self-limiting
  • No treatment is required
  • Usually clears in teenagers
  • Sun block can help

Dr Stollery is a GP in Leicestershire

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

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

GPs demand power to close lists and drop home visits amid workload crisis

GPs demand power to close lists and drop home visits amid workload crisis

LMCs will set out major concerns over practice workload later this month, highlighting...

GP services disrupted as floods cause havoc

GP services disrupted as floods cause havoc

GPs have been left battling to get into work and deliver services, with some finding...

GMC warning for GPs working for online services

GMC warning for GPs working for online services

A set of principles aimed at helping GPs and other health professionals who practise...

Tories promise 50m more GP appointments a year and 6,000 extra GPs

Tories promise 50m more GP appointments a year and 6,000 extra GPs

The Conservatives have promised an extra 50m GP appointments a year and an extra...

Map: Diabetes spending per patient varies almost threefold between CCGs

Map: Diabetes spending per patient varies almost threefold between CCGs

Spending on diabetes treatment per patient with the condition varies almost threefold...

Hundreds sign petition to help UK doctors trained abroad find jobs

Hundreds sign petition to help UK doctors trained abroad find jobs

More than three hundred people have signed a petition calling on the government to...