September 24, 2017
Hyperpigmentation of the Skin Minimize

Hyperpigmentation of the skin

Hyperpigmentation in endocrine disorders

Generalised increased skin pigmentation is most intense on light exposed areas, in flexures, at sites of friction and pressure, in the creases of the palms and soles, and on all mucous membranes. The pattern is not specific and the possibility of Addison’s disease should be considered in any case of increased pigmentation. In autoimmune Addisons disease, patches of nonpigmented skin ie vitiligo may also be present.

  1. adrenal failure
  2. acromegaly
  3. Cushing’s syndrome
  4. hyperthyroidism
  5. phaeochromocytoma
  6. carcinoid syndrome
  7. high dose ACTH therapy

Chloasma or melasma

This is a blotchy pigmentation of the cheeks and pigmentation of the nipples and linea alba. It is almost invariable in pregnancy and is particularly noticeable in dark haired women.

  1. pregnancy
  2. menstruation
  3. oral contraceptive use

Hyperpigmentation in malignant disease

  1. diffuse pigmentation in cachexia
  2. diffuse slaty-blue colour due to melanoma
  3. acanthosis nigricans (localised to the flexures). mild cases are frequently seen in subjects with insulin resistance eg polycystic ovary syndrome, acromegaly and unexplained cases.

Hyperpigmentation in general medical disorders

  1. chronic infections and/or malnutrition (since they frequently co-exist) eg TB, Whipples
  2. scleroderma
  3. chronic renal failure
  4. anaemia due to vitamin B12 deficiency (in contrast to vitiligo seen in pernicious anaemia)
  5. cirrhosis of the liver
  6. haemochromatosis
  7. dermatomyositis

Pigmentation associated with nutritional deficiencies

  1. deficiencies of any of vitamins A, C, niacin, folate or B12
  2. malabsorption syndromes
  3. "Vagabonds" disease  ? post-inflammatory pigmentation

Pigmentation associated with drugs

  1. anti malarials
  2. arsenic
  3. chlorpomazine and related phenothiazines
  4. phenytoin (appears like chloasma)
  

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