Post-inflammatory Hypopigmentation of Skin

Authored by , Reviewed by Dr Doug McKechnie | Last edited | Meets Patient’s editorial guidelines

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Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find one of our health articles more useful.

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Treatment of almost all medical conditions has been affected by the COVID-19 pandemic. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. Please visit https://www.nice.org.uk/covid-19 to see if there is temporary guidance issued by NICE in relation to the management of this condition, which may vary from the information given below.

Post-inflammatory hypopigmentation presents as poorly defined whitening of the skin, which is irregular in outline. Often the loss of pigment is partial rather than complete.[1] The surface is usually normal but scaling may be present if the underlying cause is scaly (such as eczema or psoriasis).

Partial loss of pigment may follow any inflammatory skin reaction but this is most noticeable in those with darker skin.[2] Scarring conditions such as thermal burns, discoid lupus and lichen planus will cause white atrophic hypopigmented areas.[1] Post-inflammatory hypopigmentation is a recognised hazard of laser therapy.[3]

The differential diagnosis of post-inflammatory hypopigmentation includes:

  • Vitiligo - this is normally well defined, geographic in shape and there is complete loss of pigment.
  • Pityriasis versicolor - this is made up of coalescing oval/round macules which may be slightly scaly.
  • Pityriasis alba - this is seen on the face of children as slightly scaly, poorly defined macules and patches. It is common in children with dark skin but is seen on lighter skins in the summer. It is assumed to be a mild form of eczema with hypopigmentation.
  • Hypopigmented mycosis fungoides - a slow progressive cutaneous T-cell lymphoma.[6]
  • Naevus depigmentosus - a congenital non-progressive hypopigmented macule or patch that is stable in its relative size and distribution throughout life.[7]
  • Nummular eczema.[8]
  • Idiopathic guttate hypomelanosis - this causes widespread hypopigmented macules on the arms and legs of middle-aged women and elderly men and women.[9]

It may be possible to make the diagnosis on clinical grounds, based on the appearance, size, site and distribution of lesions, the age of the patient and the sex of the patient.

However, skin scraping for mycology and/or biopsy for histopathology may be necessary.[10] Laser scanning microscopy may be helpful in diagnosing post-inflammatory hypopigmentation disorders and may offer an alternative to invasive methods.[11]

Treatment of the underlying condition is the mainstay of management. With sun exposure the white areas should eventually repigment unless scarring has occurred.[10] A 308 nm excimer laser has been used to stimulate pigmentation in resistant cases, but regular treatment is needed to maintained results.[12, 10]

Creams are available that can be used to camouflage the lighter patches. They are different to skin creams used for make-up because they are designed to last longer and provide heavier masking. They are available on prescription but not all local authorities will allow them to be prescribed.

Depigmentation often resolves spontaneously after weeks or months but may persist on occasion.[5]

Referral may be needed in cases of diagnostic difficulty with post-inflammatory hypopigmentation.

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Further reading and references

  • Drivenes JL, Berg-Jensen M, Bygum A; A phototoxic drug reaction due to topical NSAIDs. Clin Case Rep. 2022 Jan 2010(1):e05251. doi: 10.1002/ccr3.5251. eCollection 2022 Jan.

  • Vachiramon V; A concise approach to childhood hypopigmentation. J Cutan Aesthet Surg. 2013 Apr6(2):73-4.

  • Furlan FC, Sanches JA; Hypopigmented mycosis fungoides: a review of its clinical features and pathophysiology. An Bras Dermatol. 2013 Nov-Dec88(6):954-60. doi: 10.1590/abd1806-4841.20132336.

  1. Pigmentation disorders; DermNet NZ

  2. Skin of colour - clinical variations; Primary Care Dermatology Society (PCDS), July 2021

  3. Choi CW, Kim HJ, Lee HJ, et al; Treatment of nevus of Ota using low fluence Q-switched Nd:YAG laser. Int J Dermatol. 2013 Jul 8. doi: 10.1111/ijd.12085.

  4. Tey HL; A practical classification of childhood hypopigmentation disorders. Acta Derm Venereol. 201090(1):6-11. doi: 10.2340/00015555-0794.

  5. Hill JP, Batchelor JM; An approach to hypopigmentation. BMJ. 2017 Jan 12356:i6534. doi: 10.1136/bmj.i6534.

  6. Zhang JA, Yu JB; Hypopigmented mycosis fungoides in a chinese woman. Indian J Dermatol. 2013 Mar58(2):161. doi: 10.4103/0019-5154.108093.

  7. Lee DJ, Kang HY; Is spontaneous disappearance of nevus depigmentosus possible? Ann Dermatol. 2012 Feb24(1):109-11. doi: 10.5021/ad.2012.24.1.109. Epub 2012 Feb 2.

  8. Nummular Eczema; American Osteopathic College of Dermatology

  9. Kim SK, Kim EH, Kang HY, et al; Comprehensive understanding of idiopathic guttate hypomelanosis: clinical and histopathological correlation. Int J Dermatol. 2010 Feb49(2):162-6. doi: 10.1111/j.1365-4632.2009.04209.x.

  10. Gutierrez P, Gandhi K, Amakiri N, et al; Vulvar lesion mimicking vitiligo: A case report. Case Rep Womens Health. 2020 Jun 2227:e00234. doi: 10.1016/j.crwh.2020.e00234. eCollection 2020 Jul.

  11. Xiang W, Xu A, Xu J, et al; In vivo confocal laser scanning microscopy of hypopigmented macules: a preliminary comparison of confocal images in vitiligo, nevus depigmentosus and postinflammatory hypopigmentation. Lasers Med Sci. 2010 Jul25(4):551-8. doi: 10.1007/s10103-010-0764-2. Epub 2010 Feb 24.

  12. Kreeshan FC, Madan V; Idiopathic Guttate Hypomelanosis Treated with 308-nm Excimer Light and Topical Bimatoprost. J Cutan Aesthet Surg. 2021 Jan-Mar14(1):115-117. doi: 10.4103/JCAS.JCAS_112_20.

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