CLINICAL DIAGNOSTIC MANUAL
Skin hyperpigmentation is a condition characterised by the darkening of specific areas of the skin due to increased melanin production. It can be caused by various factors, including sun exposure, inflammation, hormonal disorders, medications, and systemic diseases. Hyperpigmentation can affect patients’ self-esteem and, in some cases, indicate a more serious underlying medical condition.
Pathology | Suspected Diagnosis | Confirmatory Diagnosis |
|---|---|---|
Freckles | Small light brown spots that increase with sun exposure. | Physical examination. |
Lentigines | Dark brown spots, usually on sun-exposed areas. | Physical examination, dermatoscopy. |
Drug and medication-induced | Hyperpigmentation after taking certain medications. | Clinical history, medication review. |
Addison’s disease | Diffuse hyperpigmentation, fatigue, weight loss, hypotension. | Cortisol and ACTH levels, ACTH stimulation test. |
Cushing’s disease | Purple striae, hyperpigmentation, central obesity, moon face. | Cortisol levels, dexamethasone suppression test. |
Biliary cirrhosis | Hyperpigmentation, pruritus, jaundice. | Liver function tests, antimitochondrial antibodies (AMA). |
Pemphigoid | Tense, itchy blisters, post-inflammatory hyperpigmentation. | Skin biopsy with direct immunofluorescence. |
Pellagra | Photosensitive dermatitis, diarrhoea, dementia, niacin deficiency. | Clinical history, niacin levels. |
Carotenemia | Yellowish skin pigmentation, especially on palms and soles, excessive carotenoid intake. | Dietary history, blood carotenoid levels. |
Lichen planus | Purple papules with residual hyperpigmentation, itching. | Skin biopsy, physical examination. |
Acanthosis nigricans | Brown, velvety plaques in skin folds, associated with obesity or insulin resistance. | Physical examination, insulin resistance tests. |
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