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Overview of Pigmentation Disorders

by Peter C. Schalock, MD

Pigmentation disorders involve hypopigmentation, depigmentation, or hyperpigmentation. Areas may be focal or diffuse. In hypopigmentation, pigment is decreased, whereas in depigmentation, pigment is completely lost, leaving white skin.

Focal hypopigmentation is most commonly a consequence of

  • Injury

  • Inflammatory dermatoses (eg, atopic dermatitis [see Atopic Dermatitis (Eczema)], psoriasis [see Psoriasis])

  • Burns

  • Chemical exposure (especially to hydroquinones and phenols)

Focal hypopigmentation or depigmentation is also a feature of vitiligo (which may involve large areas of skin), leprosy, nutritional deficiencies (kwashiorkor), and genetic conditions (eg, tuberous sclerosis, piebaldism, Waardenburg syndrome).

Diffuse hypopigmentation or depigmentation is most often caused by

Hyperpigmentation (see Hyperpigmentation) typically occurs after inflammation due to various causes. This postinflammatory hyperpigmentation is usually focal in distribution. Hyperpigmentation may also be caused by a systemic disorder, drug, or cancer; distribution is usually more diffuse.

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