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Ashy dermatosis in Adult
Other Resources UpToDate PubMed

Ashy dermatosis in Adult

Contributors: Casey P. Schukow DO, Jeffrey M. Cohen MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Ashy dermatosis (AD), or dermatosis cenicienta, is an acquired condition of unknown etiology characterized by asymptomatic blue-gray or gray-brown "ashy" macules and/or patches, most commonly symmetrically distributed on the neck, trunk, and proximal extremities.

Many consider AD and erythema dyschromicum perstans (EDP) synonymous. However, some use the term EDP to refer to the subset of patients who present with annular erythematous / inflammatory borders around the ashy macules and patches, which is usually an early finding.

AD is most common among individuals with skin phototypes III-IV and may present in any age group without any sex predilection. Lesions are usually asymptomatic but may be pruritic. Macules often enlarge and coalesce into patches over multiple weeks. Overall, AD is slowly progressive and does not typically regress in adults, but it may spontaneously resolve in children.

Pathogenetically, a cell-mediated immune reaction to antigens located in basal and mid-epidermal keratinocytes is postulated. No definitive cause has been identified; however, AD has been associated with certain exposures, including ammonium nitrate, oral radiographic contrast media, cobalt, enteroviral infection, HIV seroconversion, chronic hepatitis C infection, and whipworm infection.

An AD-like eruption from osimertinib has been reported. See drug-induced hyperpigmentation for discussion of drugs that may cause an AD-like reaction.

Codes

ICD10CM:
L81.4 – Other melanin hyperpigmentation

SNOMEDCT:
58942006 – Erythema dyschromicum perstans

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Lichen planus (including the variant Lichen planus pigmentosus)
  • Lichenoid drug eruption
  • Pigmented contact dermatitis
  • Acquired dermal melanocytosis
  • Postinflammatory hyperpigmentation
  • Idiopathic eruptive macular pigmentation
  • Drug-induced pigmentation
  • Addison disease
  • Melasma
  • Fixed drug eruption – multiple
  • Macular amyloidosis
  • Late Pinta
  • Argyria
  • Secondary syphilis
  • Confluent and reticulated papillomatosis

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:01/10/2022
Last Updated:05/10/2023
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Patient Information for Ashy dermatosis in Adult
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Contributors: Aissa Do, Peterson Pierre MD
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Ashy dermatosis in Adult
A medical illustration showing key findings of Ashy dermatosis : Neck, Primarily truncal distribution, Trunk, Hyperpigmented macules, Hyperpigmented patches
Clinical image of Ashy dermatosis - imageId=613263. Click to open in gallery.  caption: 'Violaceous and dark gray macules and patches on the forehead.'
Violaceous and dark gray macules and patches on the forehead.
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