ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferencesInformation for PatientsView all Images (12)
Post-inflammatory hypopigmentation - Skin in Adult
Print
Other Resources UpToDate PubMed

Post-inflammatory hypopigmentation - Skin in Adult

Print Patient Handout Images (12)
Contributors: Steven M. Nwe DO, Jeffrey D. Bernhard MD, Paul Kelly MD, Lowell A. Goldsmith MD, MPH, Lynn McKinley-Grant MD, Aída Lugo-Somolinos MD
Other Resources UpToDate PubMed

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

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Differentials for hypopigmented lesions include:
  • Pityriasis alba – Scaly, oval, ill-defined macules and patches with mild hypopigmentation; more common in children.
  • Sarcoidosis – Histology will reveal dermal noncaseating granulomas.
  • 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.
  • Infundibulomatosis
  • Hypopigmented lesions in extramammary Paget's disease
  • Medication – Particularly high-potency topical and intralesional corticosteroids.
Differentials for depigmented lesions include:

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

References

Subscription Required

Last Updated: 09/07/2011
Copyright © 2019 VisualDx®. All rights reserved.
Post-inflammatory hypopigmentation - Skin in Adult
Print 12 Images
View all Images (12)
(with subscription)
Post-inflammatory hypopigmentation : Hypopigmented patch
Clinical image of Post-inflammatory hypopigmentation
Copyright © 2019 VisualDx®. All rights reserved.