SKIN PIGMENTATION AND OTHER PIGMENTARY CHANGES

To recall the causes of a diffuse pigmentation of the skin, one might simply visualize various organs of the body where a cause may originate. The adrenal gland brings to mind Addison disease, the liver suggests hemochromatosis, the thyroid suggests hyperthyroidism, the uterus suggests pregnancy (more likely to cause chloasma), and the ovaries suggest the chloasma of menopause. The liver is also the cause of jaundice . The skin itself is the site of melanotic carcinoma, which in occasional cases causes a deeply pigmented skin, and tinea versicolor, which produces a patchy yellow-brown pigmented area over the trunk. Any dermatitis that takes a long time to heal may cause a patchy pigmentation. Other causes of patchy pigmentation are the café au lait spots of neurofibromatosis, stasis dermatitis from chronic thrombophlebitis and varicose veins, the pigmentation of the dorsal surfaces of the hands and face in pellagra, carcinoid syndrome, porphyria, and Gaucher disease. Ochronosis produces a bluish black or bluish brown pigment of the sclera, ears, skin, and nails. Vitiligo (idiopathic type) suggests a patchy pigmentation but is really a depigmentation.

Approach to the Diagnosis

The workup for diffuse pigmentation involves ruling out hemochromatosis, hepatobiliary disease, and Addison disease with appropriate tests for these disorders (see Appendix A) and using the expertise of a dermatologist in the cases of patchy pigmentation.

Other Useful Tests

1. Wood’s lamp (tinea versicolor)
2. Serum electrolytes (Addison disease)
3. Serum cortisol (Addison disease)
4. Serum iron and iron binding capacity (hemochromatosis)
5. Urine porphyrins and porphobilinogen (porphyria)
6. Urine melanin (melanoma)
7. Urine for homogentisic acid (ochronosis)
8. Free thyroxine (FT₄) level (hyperthyroidism)
9. Serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels (menopause)
10. Skin biopsy

Pictures

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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