Updated: 8/22/2020

Hyperpigmentation Disorders

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Overview
Freckle
  • Caused by normal number of melanocytes but increased melanin within basal keratinocytes
  • Darkens with sun exposure
 

Lentigo
  • Pigmented macule caused by melanocyte hyperplasia
  • Does not darken with sun exposure
 
Common mole
  • A benign tumor derived from melanocytes
 

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Blue nevus
  • Form of common mole, a benign tumor derived from melanocytes
  • Black and blue nodule usually present at birth
  • Often mistaken for melanoma
 

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Spitz nevus
  • Form of common mole, a benign tumor derived from melanocytes
  • Red-pink nodule
  • Often seen in children
  • Confused with hemangioma
 

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Dysplastic nevus
  • Atypical, irregularly pigmented lesion
  • Increased risk of transformation into malignant melanoma
 

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Dysplastic nevus synrome
  • Autosomal dominant inherited disease
 

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Melasma
  • Mask-like hyperpigmentation seen in pregnancy on the face
  • Sunlight accentuates, so avoid sunlight
  • Treat with hydroquinone cream
  • Usually fades postpartum
 

Xanthoma
  • Yellowish papules
  • Often accumulations of histiocytes
  • Can be idiopathic or associated with hyperlipidemia
  • Called xanthelasma when on eyelids
  • Treat by decreasing lipidemia
  • Surgically excise as needed
 

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Acanthosis nigricans
  • Black, velvety plaques on flexor surfaces
  • Seen in obesity and endocrine disorders, namely insulin resistance 
  • Can mark underlying malignancy 
 

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Seborrheic keratosis
  • Black or brown benign plaques
  • Appear to be stuck on skin
  • "Coin lesions"
  • Commonly seen in the elderly
  • Runs in families
  • Can be mistaken for melanoma
  • Liquid nitrogen freezing, if not too many
 

 

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Questions (2)

(M2.DM.15.4691) A 32-year-old obese man visits your dermatology clinic after his barber saw a darkened area on the back of his neck. He has not seen his primary care physician in many years and does not know if he has diabetes. A rapid blood glucose test showed a normal glucose level. Otherwise, he reports recent loss of appetite with slight weight loss. What could be causing this patient’s newly-discovered dermatologic change?

QID: 107645
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Diabetes insipidus

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Diabetes mellitus

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