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

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...

Two in five GPs cut sessions last year to improve work/life balance

Two in five GPs cut sessions last year to improve work/life balance

More than 40% of GPs reduced the number of sessions they work in frontline general...

Breath testing for cancer could be rolled out in GP practices within five years

Breath testing for cancer could be rolled out in GP practices within five years

Breath testing for some forms of cancer could revolutionise the accuracy of GP referrals...

No-deal Brexit could disrupt medicine supplies for 'at least' six months, DHSC admits

No-deal Brexit could disrupt medicine supplies for 'at least' six months, DHSC admits

'Critical' medicine supplies face a minimum of six months' disruption in the event...

Patient who attacked GP with crossbow jailed for 20 years

Patient who attacked GP with crossbow jailed for 20 years

A patient who blamed his GP for the death of his father and shot him with a crossbow...