Symptom Finder - Skin Pigmentation and Other Pigmentary Changes
SKIN PIGMENTATION AND OTHER PIGMENTARY CHANGES
To recall the causes of a diffuse pigmentation of the skin, one might simply visualize various organs of the body where a cause may originate.
The adrenal gland brings to mind Addison disease, the liver suggests hemochromatosis, the thyroid suggests hyperthyroidism, the uterus suggests pregnancy (more likely to cause chloasma), and the ovaries suggest the chloasma of menopause and melasma of chronic birth control use. The liver is also the cause of jaundice.The skin itself is the site of melanotic carcinoma, which in occasional cases causes a deeply pigmented skin, and tinea versicolor, which produces a patchy yellow-brown pigmented area over the trunk. Any dermatitis that takes a long time to heal may cause a patchy pigmentation. Cushing syndrome and ectopic adrenocorticotropic hormone (ACTH) production by a malignancy (especially a carcinoma of the lung) should be ruled out.
Other causes of patchy pigmentation are the café au lait spots of neurofibromatosis, stasis dermatitis from chronic thrombophlebitis and varicose veins, the pigmentation of the dorsal surfaces of the hands and face in pellagra, carcinoid syndrome, porphyria, and Gaucher disease.
Ochronosis produces a bluish black or bluish brown pigment of the sclera, ears, skin, and nails. Vitiligo (idiopathic type) suggests a patchy pigmentation but is really a depigmentation. Acanthosis nigricans characterized by pigmented lesions of the skin flexures, neck, and nipples is often associated with malignancies.
Approach to the Diagnosis
The workup for diffuse pigmentation involves ruling out hemochromatosis, hepatobiliary disease, and Addison disease with appropriate tests for these disorders and using the expertise of a dermatologist in the cases of patchy pigmentation.
Other Useful Tests
1. Wood lamp (tinea versicolor)
2. Serum electrolytes (Addison disease)
3. Serum cortisol (Addison disease)
4. Serum iron and iron-binding capacity (hemochromatosis)
5. Urine porphyrins and porphobilinogen (porphyria)
6. Urine melanin (melanoma)
7. Urine for homogentisic acid (ochronosis)
8. Free thyroxine (FT4) level (hyperthyroidism)
9. Serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels (menopause)
10. Skin biopsy
11. Serum ACTH (ectopic ACTH production
To recall the causes of a diffuse pigmentation of the skin, one might simply visualize various organs of the body where a cause may originate.
The adrenal gland brings to mind Addison disease, the liver suggests hemochromatosis, the thyroid suggests hyperthyroidism, the uterus suggests pregnancy (more likely to cause chloasma), and the ovaries suggest the chloasma of menopause and melasma of chronic birth control use. The liver is also the cause of jaundice.The skin itself is the site of melanotic carcinoma, which in occasional cases causes a deeply pigmented skin, and tinea versicolor, which produces a patchy yellow-brown pigmented area over the trunk. Any dermatitis that takes a long time to heal may cause a patchy pigmentation. Cushing syndrome and ectopic adrenocorticotropic hormone (ACTH) production by a malignancy (especially a carcinoma of the lung) should be ruled out.
Other causes of patchy pigmentation are the café au lait spots of neurofibromatosis, stasis dermatitis from chronic thrombophlebitis and varicose veins, the pigmentation of the dorsal surfaces of the hands and face in pellagra, carcinoid syndrome, porphyria, and Gaucher disease.
Ochronosis produces a bluish black or bluish brown pigment of the sclera, ears, skin, and nails. Vitiligo (idiopathic type) suggests a patchy pigmentation but is really a depigmentation. Acanthosis nigricans characterized by pigmented lesions of the skin flexures, neck, and nipples is often associated with malignancies.
Approach to the Diagnosis
The workup for diffuse pigmentation involves ruling out hemochromatosis, hepatobiliary disease, and Addison disease with appropriate tests for these disorders and using the expertise of a dermatologist in the cases of patchy pigmentation.
Other Useful Tests
1. Wood lamp (tinea versicolor)
2. Serum electrolytes (Addison disease)
3. Serum cortisol (Addison disease)
4. Serum iron and iron-binding capacity (hemochromatosis)
5. Urine porphyrins and porphobilinogen (porphyria)
6. Urine melanin (melanoma)
7. Urine for homogentisic acid (ochronosis)
8. Free thyroxine (FT4) level (hyperthyroidism)
9. Serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels (menopause)
10. Skin biopsy
11. Serum ACTH (ectopic ACTH production
