Hyperpigmentation generalised

Generalised hyperpigmentation is always worrying. It can be a feature of underlying malignancy particularly ACTH producing carcinoma of the lung or from an underlying melanoma. Also consider Addison's disease with pigmentation of the skin creases and inside the mouth.Drug induced hyperpigmentation is another thought particularly from some chemotherapy drugs. Metabolic disorders such as hemochromatosis and porphyria cutanea tarda can also give marked generalised hyperpigmentation but in PCT it is accentuated in sun exposed areas.

Generalised hyperpigmetation is summarised in the overview below.

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,Puva

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 dermatosis,A acanthosis nigricans