Hyperpigmentation

DDx

  • Pigmented nevi
  • Ephelides (juvenile freckles)
  • Lentigines (senile freckles, liver spots)
  • Postinflammatory (eg, acne, atopic dermatitis)
  • Chronic venous insufficiency
  • Melasma (chloasma)
  • Neurofibromatosis (café au lait spots, axillary freckling)
  • Hemochromatosis
  • Addison's disease
  • Acanthosis nigricans
  • Hyperbilirubinemia (eg, primary biliary cirrhosis)
  • Ochronosis (alkaptonuria)
  • Pellagra (niacin deficiency)
  • Porphyria cutanea tarda
  • Wilson's disease
  • Whipple's disease
  • Scleroderma
  • Vitamin B12 deficiency
  • Folate deficiency
  • Medications: chloroquine, chlorpromazine, minocycline, amiodarone
  • Topicals: benzoyl peroxide, tretinoin, fluorouracil
  • Fixed drug eruption to laxatives (phenolphthalein), trimethoprim-sulfamethoxazole, NSAIDs, tetracyclines
  • Exogenous pigment exposure: carotenemia, argyria, gold, tattooing, arsenic
  • Berloque hyperpigmentation (phototoxicity from citrus or celery)
  • Visceral leishmaniasis (kala azar)
  • POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes)

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Last updated: December 1, 2014