Autoimmune associations with vitiligo

• Thyroid disease • Myasthenia gravis

• Pernicious anaemia • Alopecia areata

• Hypoparathyroidism • Halo naevus

• Diabetes lichen sclerosus

Agyria (silver salts in skin)

Melasma

Acanthosis nigricans

Agyria (silver salts in skin)

Melasma

Carcinoma left upper zone

Drugs

Chlorpromazine, other phenothiazines, and minocycline may cause an increased pigmentation in areas exposed to the sun. Phenytoin can cause local hyperpigmentation of the face and neck.

Inflammatory reactions

Postinflammatory pigmentation is common, often after acute eczema, fixed drug eruptions, or lichen planus. Areas of lichenification from rubbing the skin are usually darkened.

Malabsorption and deficiency states

In malabsorption syndromes, pellagra, and scurvy there is commonly increased skin pigmentation.

Congenital conditions

There is clearly a marked variation in pigmentation and in the number of freckles in normal individuals. There may be localised well defined pigmented areas in neurofibromatosis with "cafe au lait" patches. Increased pigmentation with a blue tinge occurs over the lumbosacral region in the condition known as Mongolian blue spot.

Peutz-Jeghers syndrome is described under the section "The gut and the skin", below. There are pigmented macules associated with intestinal polyposis in the oral mucosa, lips, and face.

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