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Post-inflammatory hypopigmentation - Skin in Child
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Post-inflammatory hypopigmentation - Skin in Child

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Contributors: Steven M. Nwe DO, Jeffrey D. Bernhard MD, Sarah Stein MD, Karen Wiss MD, Sheila Galbraith MD, Craig N. Burkhart MD, Dean Morrell MD, Lynn Garfunkel MD, Nancy Esterly MD
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Synopsis

Post-inflammatory hypopigmentation is an acquired pigmentary disorder in which there is a localized partial or total loss of pigmentation following a cutaneous inflammatory or traumatic process. Though often used synonymously with post-inflammatory hypomelanosis, post-inflammatory hypopigmentation refers to a decrease in pigmentation regardless of the origin, whereas hypomelanosis refers specifically to melanin-related decreases in pigmentation.

While it can occur in patients of all ages and skin types, it is more pronounced in those with darker skin. This is attributable to the greater color contrast between the lesions and the patient's normal skin. The incidence is comparable in males and females. Predisposition is believed to be based on an individual's genetically predetermined melanocyte response to cutaneous inflammation. It can be seen as a sequela of many inflammatory skin diseases (atopic dermatitis, psoriasis, lichen striatus, pityriasis lichenoides chronicus, lichen planus, sarcoidosis, discoid lupus erythematosus), infections (zoster, pityriasis versicolor, impetigo), procedures (chemical peels, laser, dermabrasion), and burns.

Histopathology may be nonspecific and will vary depending on the underlying etiology. It will generally show decreased epidermal melanin with melanophages present in the upper dermis and variable superficial lymphohistiocytic infiltration.

Resolution of lesions is dependent on the underlying cause and degree of involvement, ranging from a few weeks in minimally hypopigmented lesions to several years in depigmented lesions (eg, discoid lupus erythematosus and burns).

Codes

ICD10CM:
L81.9 – Disorder of pigmentation, unspecified

SNOMEDCT:
277787003 – Post-inflammatory hypopigmentation

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Differentials for hypopigmented lesions include:
  • Pityriasis alba – Scaly, oval, ill-defined macules and patches with mild hypopigmentation; more common in children.
  • Progressive macular hypomelanosis – Punctiform red fluorescence under Wood's lamp.
  • Pityriasis versicolor – Coppery/orange under Wood's lamp; KOH prep of scale shows a characteristic "spaghetti and meatballs" appearance.
  • Leprosy – Associated with hypoesthesia.
  • Mycosis fungoides – Early-stage variant involving hypopigmentation on the trunk and extremities that may be pruritic.
  • Scleroderma – Circumscribed hypopigmentation with perifollicular pigment retention.
  • Medication – Particularly high-potency topical and intralesional corticosteroids.
Differentials for depigmented lesions include:
  • Vitiligo – Pigment loss is total.
  • Discoid lupus erythematosus – Pigment loss, often in the center of lesions with a rim of hyperpigmentation; associated with cutaneous atrophy / scarring.

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 09/12/2011
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Post-inflammatory hypopigmentation - Skin in Child
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Post-inflammatory hypopigmentation : Hypopigmented patch
Clinical image of Post-inflammatory hypopigmentation
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