Flexures Hypopigmentation

Hypopigmentation in the flexures

 

Vitiligo will commonly start in the flexures particularly the axillae and genital areas.Atrophy is sometimes mistaken for hypopigmentation.Conditions such as pseudoxanthoma elasticum may occur in the axillae in these circumstances.Lichen sclerosus and morphea are often seen under the breasts.The latter will feel firm to touch and the former will look pale with skin atrophy.In white people who are tanned pityriasis versicolor will appear hypopigmented in these areas.

Management  Check carefully for the other features of PXE and scrape for microcopy and culture for pityriasis versicolor.

SIGN DIP MEN   Overview of Hypopigmentation

 

S-Squamous    Healing areas of eczema and psoriasis,Pityriasis alba,Pityriasis versicolor,Post discoid lupus erythematosus scarring,Tinea corporis,

 

I-Infective    Pityriasis versicolor,Tuberculoid Leprosy,Pinta,Syphilis,Post herpes zoster

 

G-Granulomatous   Sarcoidosis,

 

N-Neoplastic    Morpheic Basal cell skin cancer,Epidermodysplasia verruciformis,

 

D-Drugs     Phenols,

 

I-Immunological    Vitiligo,Halo nevi,Localised Morphea,Lichen sclerosus,Scleroderma,

 

P-Physical     Following liquid nitrogen,Post traumatic in dark skin,Idiopathic guttate hypomelanosis,Chronic radiodermatitis,

 

M-Metabolic

 

E-Endocrine

 

N-Nutritional

 

Other Localised congenital depigmentation  Nemonic is (WANT A DIP) of colour.

Wardenberg's,Alezandreni,nevus anaemicus,nevus depigmentosus,Tuberous sclerosus,Dyskeratosis congenita,Incontinentia pigmenti achromicans,Piebaldism.

 

Others- Genetic Albinism,Piebaldism,Klein Wardenburg syndrome,Voigt-Koyanagi syndrome,Ashleaf macules of Tuberous sclerosus,Nevus depigmentosus,Nevus anemicus,