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Postinflammatory hypopigmentation in Child
Other Resources UpToDate PubMed

Postinflammatory hypopigmentation in Child

Contributors: Elyse M. Love MD, Steven M. Nwe DO, Oyetewa Oyerinde MD, Callyn Iwuala BA, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Postinflammatory hypopigmentation is the presence of partial or total loss of pigmentation that occurs after resolution of cutaneous inflammation or after trauma.

Postinflammatory hypopigmentation can occur in patients of all ages, sexes, and skin types, and is more visibly pronounced in those with darker skin phototypes. It can be seen as a sequela of many inflammatory skin diseases (atopic dermatitis, seborrheic dermatitis, psoriasis, lichen striatus, pityriasis lichenoides chronica, lichen planus, sarcoidosis, discoid lupus erythematosus), infections (zoster, pityriasis versicolor, impetigo), procedures (chemical peels, laser, dermabrasion), and burns.

Time to resolution of hypopigmentation is dependent on the underlying cause and severity of inflammation, ranging from a few weeks in minimally hypopigmented lesions to several years in depigmented lesions (eg, discoid lupus erythematosus and burns).

Related topic: Drug-induced hypopigmentation

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

Differential diagnosis 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; potassium hydroxide (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.
  • Eruptive hypomelanosis – Acute onset of symmetric, monomorphic, hypopigmented macules with or without fine scaling. Usually preceded by viral prodrome and spontaneously resolves within 2-8 weeks.
  • Medication – Particularly high-potency topical and intralesional corticosteroids.
  • Chronic arsenic exposure – Hypopigmented lesions resemble idiopathic guttate hypomelanosis presentation but are scattered on a hyperpigmented base.
  • Lichen striatus
Differential diagnosis for depigmented lesions include:

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Last Reviewed:12/12/2019
Last Updated:12/12/2019
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Patient Information for Postinflammatory hypopigmentation in Child
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Contributors: Medical staff writer

Overview

Postinflammatory hypopigmentation is a loss of skin color (pigmentation) after your skin heals from an injury. The pigment-producing cells (melanocytes) are damaged or destroyed in the healing process.

Who’s At Risk

Anyone can experience pigment loss, but it is often more prominent in darker-skinned people due to the contrast with their normal skin color. It can occur with any skin injury (burns, cuts, or surgery) or with many skin disorders (acne, eczema, chickenpox, seborrheic dermatitis, and others). Some medications may cause skin lightening in dark-skinned people (eg, strong cortisone creams or benzoyl peroxide products).

Signs & Symptoms

One or more areas of white or lighter areas of skin. The size, shape, and area(s) affected depend upon the cause.

Self-Care Guidelines

Stop any creams or lotions with benzoyl peroxide or strong cortisone. If there are only a few areas and you have no underlying skin problem, no treatment is needed. In mild cases, the skin restores pigment on its own.

When to Seek Medical Care

Seek medical care if you have multiple unexplained, lighter skin areas; if you have a single lighter skin area with no history of previous injury; or if you have a lighter skin area that is numb or has lost sensation or feeling.

Seek medical care if you have any skin condition that leaves multiple lighter skin spots.

Treatments

This will depend upon the diagnosis and cause, and you might need to have a portion of skin taken and checked under a microscope (biopsy) to determine what is causing the discoloration.


References


Bolognia, Jean L., ed. Dermatology, pp.947-973. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.819, 2141. New York: McGraw-Hill, 2003.
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Postinflammatory hypopigmentation in Child
A medical illustration showing key findings of Postinflammatory hypopigmentation
Clinical image of Postinflammatory hypopigmentation - imageId=95540. Click to open in gallery.  caption: 'A close-up of an oval white patch.'
A close-up of an oval white patch.
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