Pigmentation of the skin normally varies according to racial origin (see Fitzpatrick phototypes) and the amount of sun exposure.Pigmentation disorders are often more troublesome in skin of colour.. Quadrichrome vitiligo features a fourth, dark-brown pigment, which surrounds hair follicles. The hypopigmented macules progress to full depigmentation. This is especially true of albinism. Differential diagnosis. Hypopigmented MF presents with hypopigmented macules and patches. For example, macules can be moles (which are hyperpigmented, or darker, relative to the skin) or vitiligo lesions (which are hypopigmented or depigmented, or lighter, relative to the skin). Some people with hypopigmentation are at a higher risk for skin cancer. Differential diagnosis Conditions to include in the differential diagnosis include the following. A well-defined, hypopigmented, irregularly shaped, confluent macules forming a patch that is usually found on the trunk; It presents at birth or early in childhood and persists in to adulthood remaining unchanged; Stroking, rubbing, or warming induces erythema of the adjacent normal skin 1 Frequency of the condition is much lower in … Erythema, scale, and papules within these macules and patches are variable. 1,2 The skin surrounding the lesions may be normal or mildly erythrocyanotic. BS consists of asymptomatic, small, irregular, hypopigmented macules characterized by a normal histological appearance, which are usually found in individuals aged 20-40 and more frequently in women than men. Lesions often occur on the head, neck, upper extremities, trunk, and buttocks. It is necessary to perform a clinical differential diagnosis of hypopigmented lesions, including vitiligo, idiopathic guttate hypomelanosis, tinea versicolor, and postinflammatory hypopigmentation. Nevus depigmentosus. When faced with a patient with hypopigmented macules, the differential diagnosis should include tinea versicolor, pityriasis alba, vitiligo, tuberculoid leprosy, and idiopathic guttate hypomelanosis. a. Introduction. The differential diagnosis is challenging as TFI resemble many other dermatologic conditions. Pigmenting pityriasis alba. The macules are well circumscribed and each has a central raised lesion. Case presentation A 7-year-old girl presents with a small number of hypopigmented macules on her back that have been present for about three months (Figure 1). The pigment cells or melanocytes are located at the base of the epidermis and produce the protein melanin.Melanin is carried by keratinocytes to the skin surface. The differential diagnosis of pityriasis alba includes the following: Postinflammatory pigment alteration. DISCUSSION. Lesions of pityriasis alba are usually bilateral and located on the face, arms, and neck. Hypochromic naevus (naevus depigmentosus). 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