You have been logged out of VisualDx or your session has expired.

Please reload this page and sign into VisualDx to continue.

  VisualDx Mobile   Select Language

Get VisualDx Mobile

There are VisualDx mobile apps available for iOS and Android devices.

You will need a VisualDx account to use the mobile apps.

Already have an account? Sign In or
sign up for a free trial.

Users with VisualDx accounts earn CME credits for using VisualDx.

Already have an account? Sign In or
sign up for a free trial.

Create a Personal Account

E-mail (username)
Verify Password
First Name
Last Name

Personal Account Created

Mobile Access

You can now download VisualDx for your iOS and Android devices. Launch the VisualDx app from your device and sign in using your VisualDx personal account username and password.

CME Certification

Sign in with your personal account to earn and claim CME credits through VisualDx. Credits can be earned by building a differential or looking up a diagnosis.

Version: 7.12.1433   (build 13ec73a)
Select Language

Select Region

Send us your feedback

This field is required

Oops! There was an issue during submission. Please try again. If the problem persists, email with your feedback.

Thank You!

We appreciate your feedback and you will be hearing from us soon.


Share This Page

Thank You!

We have sent an e-mail with a link to the current page.


E-mail This Patient Information Sheet

Thank You!

We have sent an e-mail with this patient information.


Image Contributors


  • Christine Ahn MD
    Carl Allen DDS, MSD
    Brandon Ayres MD
    Howard P. Baden MD
    Robert Baran MD
    Keira Barr MD
    Gregory J. Basura MD, Ph.D
    Donald Belsito MD
    Jeffrey D. Bernhard MD
    Jesse Berry MD
    Victor Blanco MD
    Benjamin R. Bohaty MD
    William Bonnez MD
    Sarah Brenner MD
    Robert A. Briggaman MD
    Robert Brodell MD
    Roman Bronfenbrener MD
    Walter Brooks MD
    William Buckley MD
    Philip Bulterys MD, PhD (candidate)
    Susan Burgin MD
    Sonya Burton MD
    Sean P. Bush MD, FACEP
    Jeffrey Callen MD
    Scott Camazine MD
    Michael Cardwell
    Shelley D. Cathcart MD
    Robert Chalmers MD, MRCP, FRCP
    Chia-Yu Chu MD, PhD
    Flavio Ciferri MD
    Maria Rosa Cordisco MD
    Noah Craft MD, PhD
    John T. Crissey MD
    Harold E. Cross MD, PhD
    Charles E. Crutchfield III MD
    Adriana Cruz MD
    Donna Culton MD, PhD
    Bart J. Currie MBBS, FRACP, DTM&H
    Chicky Dadlani MD
    Alexander Dane DO
    C. Ralph Daniel III MD
    Thomas Darling MD, PhD
    William Delaney MD
    Damian P. DiCostanzo MD
    Ncoza Dlova MD
    James Earls MD
    Libby Edwards MD
    Melissa K. Egge MD
    Charles N. Ellis MD
    Rachel Ellis MD
    David Elpern MD
    Nancy Esterly MD
    Stephen Estes MD
    E. Dale Everett MD
    Janet Fairley MD
    David Feingold MD
    Jennifer J. Findeis-Hosey MD
    Benjamin Fisher MD
    Henry Foong MBBS, FRCP
    David Foster MD, MPH
    Brian D. Foy PhD
    Michael Franzblau MD
    Vincent Fulginiti MD
    Sunir J. Garg MD, FACS
    Kevin J. Geary MD
    Lowell Goldsmith MD, MPH
    Sethuraman Gomathy MD
    Bernardo Gontijo MD, PhD
    Kenneth Greer MD
    Kenneth G. Gross MD
    Alan Gruber MD
    Nathan D. Gundacker MD
    Akshya Gupta MD
    Vidal Haddad MSC, PhD, MD
    Edward Halperin MD, MA
    Ronald Hansen MD
    John Harvey
    Rizwan Hassan MD
    Michael Hawke MD
    Jason E. Hawkes MD
    Peter W. Heald MD
    David G. Hicks MD
    Sarah Hocker DO
    Ryan J. Hoefen MD, PhD
    Li-Yang Hsu MD
    William Huang MD
    Sanjana Iyengar MD
    Alvin H. Jacobs MD
    Saagar Jadeja MD
    Shahbaz A. Janjua MD
    Joshua J. Jarvis MD
    Kit Johnson
    Zachary John Jones MD
    Robert Kalb MD
    A. Paul Kelly MD
    Henry Kempe MD
    Loren Ketai MD
    Sidney Klaus MD
    Ashwin Kosambia MD
    Jessica A. Kozel MD
    Carl Krucke
    Mario E. Lacouture MD
    Joseph Lam MD
    Alfred T. Lane MD
    Edith Lederman MD
    Nahyoung Grace Lee MD
    Pedro Legua MD, PhD
    Robert Levin MD
    Bethany Lewis MD
    Sue Lewis-Jones FRCP, FRCPCH
    Taisheng Li MD
    Christine Liang MD
    Shari Lipner MD, PhD
    Adam Lipworth MD
    Jason Maguire MD
    Mark Malek MD, MPH
    Jere Mammino DO
    Ricardo Mandojana MD
    Lynne Margesson MD
    Thomas J. Marrie MD
    Maydel Martinez MD
    Ralph Massey MD
    Patrick McCleskey MD
    Karen McKoy MD
    Thomas McMeekin MD
    Josette McMichael MD
    Somchai Meesiri MD
    Joseph F. Merola MD
    Mary Gail Mercurio MD
    Anis Miladi MD
    Larry E. Millikan MD
    Dan Milner Jr. MD
    Zaw Min MD
    Stephanie Montero
    Alastair Moore MD
    Keith Morley MD
    Dean Morrell MD
    Samuel Moschella MD
    Taimor Nawaz MD
    Vic Newcomer MD
    John Nguyen MD
    Matilda Nicholas MD
    Thomas P. Nigra MD
    Steven Oberlender MD, PhD
    Maria Teresa Ochoa MD
    Art Papier MD
    Lawrence Parish MD
    Tanner Parrent MD
    Mukesh Patel MD
    Lauren Patty-Daskivich MD
    David Peng MD, MPH
    Robert Penne MD
    Nitipong Permpalung MD
    Miriam Pomeranz MD
    Doug Powell MD
    Harold S. Rabinovitz MD
    Christopher J. Rapuano MD
    Sireesha Reddy MD
    Angela Restrepo MD, PhD
    Bertrand Richert MD, PhD
    J. Martin Rodriguez, MD, FACP
    Theodore Rosen MD
    Misha Rosenbach MD
    Scott Schiffman MD
    Robert H. Schosser MD
    Glynis A. Scott MD
    Carlos Seas MD, MSc
    Deniz Seçkin MD
    Daniel Sexton MD
    Paul K. Shitabata MD
    Tor Shwayder MD, FAAP, FAAD
    Elaine Siegfried MD
    Gene Sienkiewicz MD
    Christye Sisson
    Philip I. Song MD
    Mary J. Spencer MD, FAAP
    Lawrence B. Stack MD
    Sarah Stein MD
    William Van Stoecker MD
    Frances J. Storrs MD
    Erik J. Stratman MD
    Lindsay C. Strowd MD
    Erika Summers MD
    Belinda Tan MD, PhD
    Robert Tomsick MD
    Hensin Tsao MD, PhD
    Richard P. Usatine MD
    Jenny Valverde MD
    Vishalakshi Viswanath MD
    Susan Voci MD
    Lisa Wallin ANP, FCCWS
    Douglas Walsh MD
    Ryan R. Walsh MD
    George Watt MD
    Clayton E. Wheeler MD
    Sally-Ann Whelan MS, NP, CWOCN
    Jan Willems MD, PhD
    James Henry Willig MD, MPH
    Karen Wiss MD
    Vivian Wong MD, PhD
    Sook-Bin Woo MS, DMD, MMSc
    Jamie Woodcock MD
    Stephen J. Xenias MD
    Nathaniel Yohannes
    Lisa Zaba MD
    Vijay Zawar MD
    Bonnnie Zhang MD
    Carolyn Ziemer MD
    Jeffrey P. Zwerner MD, PhD


  • Am. Journal of Trop. Med & Hygiene
  • Armed Forces Pest Management Board
  • Blackwell Publishing
  • Bugwood Network
  • Centers For Disease Control and Prevention
  • Centro Internacional de Entrenamiento e Investigaciones Mèdicas (CIDEIM)
  • Dermatology Online Journal
  • East Carolina University (ECU), Division of Dermatology
  • International Atomic Energy Agency
  • Massachusetts Medical Society
  • Oxford University Press
  • Radiological Society of North America
  • Washington Hospital Center
  • Wikipedia
  • World Health Organization
ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferencesView all Images (10)
Chemical leukoderma - Skin
Other Resources UpToDate PubMed

Chemical leukoderma - Skin

Print Images (10)
Contributors: Caroline M. West MS, Bethany K. H. Lewis MD, MPH, Martin Agyei MD, Jason E. Hawkes MD, Amanda Truong BS, Douglas L. Powell MD, Jamie L. Woodcock MD, Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH, Michael D. Tharp MD
Other Resources UpToDate PubMed


Chemical leukoderma is an acquired hypo- or depigmenting dermatosis caused by repeated or sometimes a single exposure to specific toxic substances. These substances compete with tyrosine for hydroxylation by tyrosinase, thereby impeding synthesis of melanin in melanocytes. Other names for chemical leukoderma include contact leukoderma and occupational leukoderma.

Chemicals in the phenol and catechol families are the most widely recognized causative agents in chemical leukoderma, including monobenzylether of hydroquinone found in some "acid-cured" rubber gloves, germicides such as para-tertiary butylphenol (PTBP), and pymethroid insecticides. Exposure to these types of agents typically occurs in an industrial setting. Additionally, phenols and catechols can be found in many common household materials, including wallets, decorative coloring agents for skin, footwear, watchstraps, hearing aids, deodorants, hair treatments, cosmetics, eyewear, and detergents. Other implicated toxins include mercurials, arsenics, sulfhydryls, and azelaic acid, as well as medications often used by primary care physicians and dermatologists, including corticosteroids and tretinoin.

Chemical leukoderma is common in developing countries where manufacture of consumer products is often not strictly regulated. In developed countries, exposure to causative agents more commonly takes place in industrial occupations. Pathologically, this condition is a result of apoptosis of melanocytes induced by oxidative stress after toxic exposure with an underlying genetic fragility of melanocytes.

Chemical leukoderma can affect any age group but is far more prevalent in adult patients, especially in the western world where occupational exposure is the likely etiology. Pediatric cases of chemical leukoderma have been reported in developing countries where children have repeated exposure to common household objects containing the chemical agent.

"Chemical leukoderma syndrome" describes the spectrum of disease and includes patients with continued development of hypopigmented lesions despite avoidance of the causative toxin for more than a year.


L81.9 – Disorder of pigmentation, unspecified

297951005 – Skin depigmented

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

  • Vitiligo, unlike chemical leukoderma, features trichome (area of intermediate pigment between hypopigmentation and normal-colored skin), leukotrichia (hypopigmentation of hair), and koebnerization (lesions favoring sites of trauma). Patients with vitiligo also lack a history of occupational exposure.
  • Pityriasis (tinea) versicolor presents as scaly hypo- / hyperpigmented macules and patches with fungal elements visible on KOH.
  • Pityriasis alba presents with hypopigmentation frequently located on the face with fine pityriasiform scaling.
  • Post-inflammatory dyschromia / hypopigmentation presents in a patient with history of preceding dermatitis or other inflammatory dermatosis.
  • Idiopathic guttate hypomelanosis presents as confetti-like macules on the extremities, particularly the forearm, calves, and shins.
  • Sarcoidosis generally presents as red-brown plaques with peripheral elevation and central hypopigmentation.
  • Tuberculoid leprosy presents with anesthetic hypopigmented macules and patches that are most prominent on the face and extremities.
  • Lepromatous leprosy can present with many widespread hypopigmented or slightly erythematous lesions. Lesions tend to be more prominent on the cooler parts of the body (eg, nose, earlobes, eyebrows, cheeks, ears, buttocks, and extensor and acral extremities).
  • Leishmaniasis (Old World, New World) lesions may heal without therapy, leaving a hypopigmented, atrophic scar. Active lesions usually develop central ulceration. Microscopy or biopsy should reveal parasite in most active cases.
  • Secondary syphilis presents as a papulosquamous, sometimes hypopigmented eruption involving the trunk and extremities, including palms and soles. History of primary chancre should raise concern for this diagnosis. Patients also usually present with systemic symptoms such as fever, headache, sore throat, and malaise.
  • Incontinentia pigmenti evolves from birth through childhood with hypopigmentation being the 4th (last) stage in the progression. Stages 1-3 present as vesicular stage, verrucous stage, and hyperpigmented stage.
  • Hypopigmented mycosis fungoides presents with hypopigmented patches and plaques with fine scale and with local sensitivity. Generally located on the trunk, pelvic girdle, and lower limbs. Often associated with pruritus, poikiloderma, and ulceration.
  • Tuberous sclerosis often has hypopigmented macules or differing configurations.

Best Tests

Subscription Required

Management Pearls

Subscription Required


Subscription Required

Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

Subscription Required


Subscription Required

Last Updated: 09/21/2015
Copyright © 2018 VisualDx®. All rights reserved.
Chemical leukoderma - Skin
Print 10 Images
View all Images (10)
(with subscription)
Chemical leukoderma
Clinical image of Chemical leukoderma
Copyright © 2018 VisualDx®. All rights reserved.