Hyperpigmentation

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Overview

In dermatology, hyperpigmentation is the darkening of an area of skin or nails caused by increased melanin.

Causes

Common Causes

Causes by Organ System

Cardiovascular	Cardiofaciocutaneous syndrome, Cutaneomeningospinal angiomatosis, Thrombophlebitis , Varicose veins, Vascular malformations
Chemical/Poisoning	Arsenic trioxide, Arsenicals, Carbon monoxide toxicity, Chemical poisoning, Cigarette smoke, Gold salts, Silver poisoning, Smoker’s melanosis
Dental	No underlying causes
Dermatologic	Acne, Atopic dermatitis, Atrophoderma of pasini and pierini, Birthmark, Blue nevus, Carotenemia, Chloasma, Cutaneous t-cell lymphoma, Dermatitis herpetiformis, Dermatofibroma, Dermatopathia pigmentosa reticularis, Dermatosis papulosa nigra, Dowling-degos syndrome, Dyschromatosis universalis hereditaria, Dyskeratosis congenita, autosomal dominant, Dyskeratosis congenita, x-linked, Eczema, Elevated melanin synthesis, Epidermal nevus, Erythema dyschromicum perstans, Erythrokeratoderma variabilis, Erythromelanosis follicularis faciei et colli, Excessive acth production, Excessive exposure to sunlight, Freckles, Hypercarotinemia, Hypomelanosis , Incontinentia pigmenti , Jaundice, Kwashiorkor, Laugier-hunziker syndrome, Lichen planus, Lichen simplex chronicus, Linea nigra, Lupus, Macular amyloidosis, Malassezia furfur, Mastocytosis, Melanoderma, Melanoma, Melasma, Moles, Mongolian blue spots, Nevus flammeus, Nevus of ota, Nevus spilus, Photocontact dermatitis, Phytophotodermatitis, Pigmented hairy epidermal nevus, Pigmented naevus, Poikiloderma of civatte, Poikiloderma, Psoriasis, Reticulate acropigmentation , Riehl’s melanosis, Rothmund-thomson syndrome, Scleredema adultorum, Scleroderma , Skin tag, Smoker’s melanosis, Spitz nevus, Tattoo, Tinea nigra, Tinea versicolor, Urod-related porphyria cutanea tarda, Whyte murphy syndrome, Yemenite deaf-blind hypopigmentation syndrome
Drug Side Effect	Antimalarials, Bleomycin, Busulphan, Chemotherapy, Cisplatin, Combined oral contraceptive pill, Cyclophosphamide, Dexamethasone, Dihydroxyacetone, Doxycycline, Emtricitabine, Hydroxyurea , Indinavir, Melarsoprol, Minocycline, Peplomycin, Polidocanol, Prednisolone , Retigabine, Retinol, Salicylic acid, Selenium, Sertaconazole, Siltuximab, Sunitinib malate, Thiazides
Ear Nose Throat	No underlying causes
Endocrine	Addison’s disease, Adrenal insufficiency, Adrenocorticotrophic hormone, Carney myxoma-endocrine complex, Classic childhood adrenoleukodystrophy , Glucocorticoid deficiency, Haemochromatosis, Hereditary acth resistance, Hypothyroidism, Mccune-albright syndrome , Nelson’s syndrome, Poems syndrome
Environmental	No underlying causes
Gastroenterologic	Canada-cronkhite syndrome, Celiac disease, Cronkite-canada syndrome, Haemochromatosis, Jaundice, Peutz-jeghers syndrome, Primary biliary cirrhosis , Ringworm, Stomach cancer, Whipple’s disease
Genetic	Alkaptonuria, Autoimmune adrenalitis, Berardinelli-seip congenital lipodystrophy, type 1 , Berardinelli-seip congenital lipodystrophy, type 2 , Birthmark, Celiac disease, Chondrodysplasia punctata 2, x-linked dominant, Chromosome 14 trisomy syndrome, Chromosome 14q deletion syndrome, Congenital erythropoeitic porphyria, Congenital lipomatous overgrowth, Craniolenticulosutural dysplasia, Dermatosis papulosa nigra, Dowling-degos syndrome, Dyschromatosis universalis hereditaria, Dyskeratosis congenita, autosomal dominant, Dyskeratosis congenita, x-linked, Erythrokeratoderma variabilis, Erythromelanosis follicularis faciei et colli, Fanconi anaemia, Gaucher’s disease, Hay-wells syndrome , Hereditary sensory and autonomic neuropathy type 3, Hidrotic ectodermal dysplasia, Microcephalic osteodysplastic primordial dwarfism, type 2, Multiple lentigines syndrome, Naegeli-franceschetti-jadassohn syndrome, Neurocutaneous melanosis, Peutz-jeghers syndrome, Porphyria cutanea tarda type 1 , Porphyria cutanea tarda type 2 , Proteus syndrome, Rapadilino syndrome, Rothmund-thomson syndrome, Schimke immunoosseous dysplasia, Spondylohypoplasia arthrogryposis popliteal pterygium , Variegate porphyria, Vitreoretinochoroidopathy dominant , Wolcott-rallison syndrome, Yemenite deaf-blind hypopigmentation syndrome
Hematologic	Angioma , Fanconi anaemia, Haematoma, Haemochromatosis, Nevus flammeus, Nevus of ota, Nevus spilus
Iatrogenic	Chemotherapy, Laser surgery, Radiotherapy
Infectious Disease	Acanthosis nigricans, Cutaneomeningospinal angiomatosis, Linea nigra, Malassezia furfur, Onchocerciasis, Ringworm, Tinea nigra, Tinea versicolor, Visceral leishmaniasis, Whipple’s disease
Musculoskeletal/Orthopedic	Chondrodysplasia punctata 2, x-linked dominant, Humeroradioulnar synostosis, Lison syndrome, Microcephalic osteodysplastic primordial dwarfism, type 2, Rapadilino syndrome
Neurologic	Lison syndrome, Systemic sclerosis
Nutritional/Metabolic	Alkaptonuria, Berardinelli-seip congenital lipodystrophy, type 1 , Berardinelli-seip congenital lipodystrophy, type 2 , Insulin resistance, Kwashiorkor
Obstetric/Gynecologic	Polycystic ovary syndrome , Pregnancy
Oncologic	Angioma , Basal cell papilloma, Canada-cronkhite syndrome, Cronkite-canada syndrome, Cushing’s disease, Cutaneous t-cell lymphoma, Dermatofibroma, Haematoma, Mastocytosis, Melanoderma, Melanoma, Nelson’s syndrome, Stomach cancer
Ophthalmologic	Vitreoretinochoroidopathy dominant ,
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	Chronic renal failure
Rheumatology/Immunology/Allergy	Autoimmune adrenalitis, Dermatitis herpetiformis, Lupus, Macular amyloidosis, Parry-romberg syndrome, Primary biliary cirrhosis , Psoriasis, Systemic sclerosis
Sexual	No underlying causes
Trauma	Tattoo
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

Treatment

Treatment of hyperpigmentation may include hydroquinone, kojic acid, azelaic acid, ascorbic acid, tretinoin (Retinol), topical glucocorticoids, and licorice extract. Note that all treatments will fail if the affected area is exposed to the sun and if there is not adequate UVA/UVB protection.

Physical examination for hyperpigmentation due to Amiodarone

Hyperpigmentation Due To Amiodarone.
With permission of Dermatology Atlas
Hyperpigmentation Due To Amiodarone.
With permission of Dermatology Atlas
Hyperpigmentation Due To Amiodarone.
With permission of Dermatology Atlas

References

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