Disorders of Pigmentations - Hypopigmentation and Hyperpigmentation - Differential Diagnosis Algorithm



HYPOPIGMENTATION

Diffuse Congenital - Generalized hypopigmentation of hair, eyes, skin

 • Phenylketonuria

 • Albinism

 • Piebaldism

Diffuse Acquired 

 • Vitiligo

Localized Congenital 

 • Tuberous sclerosis (white "ash leaf" macules)

Localized Acquired

 • Tinea versicolor (can also be hyperpigmented)

 • Pityriasis alba

 • Vitiligo

 • Post-inflammatory hypopigmentation

HYPERPIGMENTATION

Diffuse:

 • Tanning

 • Adverse cutaneous drug eruption

 • Addison's disease

 • Hemochromatosis

 • Porphyria cutanea tarda

Congenital:

 • Café au lait macules (neurofibromatosis or McCune Albright syndrome)

 • Congenital melanocytic nevi

Acquired:

 • Freckles (ephelides)

 • Lentigines

 • Melasma

 • Tinea versicolor (more commonly hypopigmented)

 • Post-Inflammatory hyperpigmentation



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