Arms and Legs Hyperpigmentation

Areas of Hyperpigmentation on the arms and legs

There are no conditions which specifically give pigmentation localised to these areas other than sunexposure.Other photo disorders such as a phototoxic drug reaction with pigmentation would also be localised to these areas.An extravasated iron infusion will give localised hyperpigmentation at the extravasated site.On the lower legs hemosiderin pigmentation from broken down red blood cells from leaking varicose veins will give pigmentation around the ankles and shins known as a pigmented purpuric dermatosis.

SIGN DIP MEN  Overview of Hyperpigmentation

 

S-Squamous   Resolved lichen planus

 

I-Infective  Rarely leishmaniasis

 

G-Granulomatous   Sarcoidosis

 

N-Neoplastic  Melanoma metastases,Lung carcinoma(producing ACTH or MSH),Lymphoma

 

D-Drugs   Melasma, Fixed drug eruption,bleomycin,arsenic,gold and cyclophosphamide,Iron extravasation,Puva,Clofazimine,Busulphan,Melanotan

 

I-Immunological Scleroderma,lupus erythematosus and dermatomyositis

 

P-Physical  Erythema ab igne, Post sunburn,Post taumatic,Racial pigmentary demarcation lines,Phototoxic hyperpigmentation (Plants),Pigmented purpuric dermatosis,Vagabond’s disease

 

M-Metabolic  ,Porphyria cutanea tarda,Hemochromatosis,Renal and hepatic failure,Primary biliary cirrhosis,Amyloidosis,Nelson's syndrome,Wilson's disease

 

E-Endocrine   Hyperthyroidism,Pregnancy,Cushing's,Acromegally,Addison’s diseaseThyrotoxicosis,Pheochromocytoma

 

N-Nutritional  Pellagra,Malabsorption

 

Others   Racial

 

Associated Findings  Photosensitivity (Pellagra,Photodrug,Amiodarone)  Itch (Pellagra,Renal or Liver disease,Primary biliary cirrhosis) Hypertrichosis (Porphyria cutanea tarda,Cushing's syndrome)Skin Thickening (Scleroderma,Graft versus host disease,Diffuse morphea) Mouth pigmentation and palmar creases (Addison's disease)

 

Eyelids  Familial,nevoid,metabolic diseases such as ochronosis,chemical such as mercury ointments and psoralens and argyria,lichen planus,lichen aureus,melanoacanthoma and some endocrine diseases.

Reticulate Pigmentation  Dowling Degos(flexures),Zosteriform,Dyskeratosis congenita,Naegeli Franceschetti syndrome(neck axillae,keratoderma),Acropigmentations of Kitamura and Dohi

 

Localised hyperpigmentation  DAMN PIG PAPA

 

Drugs Fixed drug plus antimalarials,minocycline,cytotoxics,bleomycin(reticulate pigmentation),mercury and bismuth,psoralens,dithranol in psoriasis,

Autoimmune Scleroderma,lupus erythematosus,dermatomyositis,atrophoderma,

Metabolic Ochronosis,chloasma,gaucher's disease,kwashiorkor,pellagra,linea nigra,acanthosis nigricans,

Neoplastic Lymphoma,melanoma,mastocytosis,

P erythema dyschromicum perstans,post inflammatory hyperpigmentation,erythema ab igne, lichen planus,

Infective erythrasma,tinea nigra

Granulomatous leprosy,granuloma annulare,syphilis

P Parapsoriasis,A Amyloid,P Pigmented purpuric dermatosis,A acanthosis nigricans