Hands and Feet Hyperpigmentation

Hyperpigmentation of the hands and feet  would be unusual as a localised phenomenon.Addison's disease gives accentuation of the palmar flexures.Porphyria cutanea tarda will cause hyperpigmentation in sun exposed areas.Pellagra would also have to be considered but should cause scales and erosions.Rarely acanthosis nigricans is seen on the hands.Phytophotodermatitis from lime juice or other plant allergens may give spotty hyperpigmentation in sun exposed areas particularly on the back of the hands.Graphite under the skin will give a permanent tatoo like pigmentation.

Localised hyperpigmentation is usually freckling from sun exposure but Peutz Jegher syndrome will give excessive freckling on the dorsa of the hands as well as the lips.

SIGN DIP MEN  Overview of Hyperpigmentation

 

S-Squamous   Resolved lichen planus

 

I-Infective

 

G-Granulomatous

 

N-Neoplastic  Melanoma metastases,Lung carcinoma,Lymphoma

 

D-Drugs   Melasma, Fixed drug eruption,bleomycin,arsenic,gold and cyclophosphamide,PuvaClofazimine

 

I-Immunological Scleroderma,lupus erythematosus and dermatomyositis

 

P-Physical  Post sunburn,Post taumatic,Racial pigmentary demarcation lines,Phototoxic hyperpigmentation (Plants),Vagabond’s disease

 

M-Metabolic  Addison’s disease,Porphyria cutanea tarda,Hemochromatosis,Renal and hepatic failure,Amyloidosis

 

E-Endocrine   Hyperthyroidism,Pregnancy,Cushings,Acromegally,Thyrotoxicosis,Pheochromocytoma

 

N-Nutritional  Pellagra,Malabsorption

 

Others

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.

Autoimmune Scleroderma,lupus erythematosus,dermatomyositis,atrophoderma,

Metabolic Ochronosis,chloasma,gaucher's disease,

Neoplastic Lymphoma,melanoma,mastocytosis,

P erythema dyschromicum perstans,postinflammatory hyperpigmentation lichen planus,

Infective erythrasma,tinea nigra

Granulomatous leprosy,granuloma annulare,syphilis

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