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Pigmentation of the skin (differential diagnosis)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Causes of diffuse hyperpigmentation include:

  • congenital:
    • familial or racial

  • irradiation, especially UV light

  • endocrine:
    • chronic primary hypoadrenalism
    • Cushing's syndrome with high ACTH - not adrenal adenoma
    • acromegaly
    • oestrogens, pregnancy

  • systemic disease:
    • chronic renal failure
    • cachexia e.g. TB or malignancy
    • primary biliary cirrhosis
    • haemochromatosis
    • malabsorption - e.g. Whipples disease, coeliac disease

  • drug-induced:
    • cytotoxic drugs - busulphan, bleomycin and cyclophosphamide may cause generalized brown pigmentation
    • phenothiazines e.g. chlorpromazine - bluish pigmentation on light exposed skin
    • arsenic

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