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Disorders of Pigmentation

»	Are some disorders of pigmentation markers for systemic disease?
»	How do you diagnose a pigmentation disorder?
»	What are the important elements of a skin examination of a patient with a pigmentation disorder?
»	What is a Wood’s lamp?
Leukoderma: partial or complete loss of skin pigmentation
»	Name some heritable forms of leukoderma.
»	Name the skin disorder that manifests with complete loss of skin pigmentation.
»	Describe the clinical appearance of the skin lesions in vitiligo.
»	When does vitiligo have its onset?
»	Do any factors influence the onset of vitiligo?
»	Is vitiligo treatable?
»	What is piebaldism?
»	What is albinism?
»	How does albinism differ from the other inherited leukodermas?
»	Can disorders of amino acid metabolism cause leukoderma?
»	How do chemicals cause skin depigmentation or skin hypopigmentation?
»	Can patients with nutritional disorders suffer from leukoderma?
»	What disorders should the clinician consider in a patient with hypopigmented macules and patches?
»	What is tuberous sclerosis?
»	What is nevus depigmentosus?
»	How does nevus depigmentosus compare to hypomelanosis of Ito?
»	Which infectious disorders can have associated leukoderma?
»	Describe the pigmentation changes seen with the treponematoses.
»	What cutaneous lesions are seen with Hansen’s disease?
»	Why is lesional skin of tinea versicolor frequently hypopigmented?
Melanoderma: abnormal darkening of the skin
»	What are lentigines? What heritable disorders manifest these?
»	Why is it important to identify patients with Peutz-Jeghers syndrome?
»	Describe the clinical manifestations of Moynahan’s syndrome.
»	Are there pigmentation disorders associated with neurofibromatosis?
»	Do any other disorders manifest with CALM?
»	What is Becker’s melanosis?
»	What is a nevus spilus?
»	Do any natural factors stimulate human epidermal pigmentation?
»	What drugs are used to stimulate skin pigmentation? How do they work?
»	Can other drugs cause increased skin pigmentation?
»	Can endocrine and metabolic disorders cause altered skin pigmentation?
»	Can forms of radiation other than ultraviolet radiation cause increased skin pigmentation?
Blue-gray dyspigmentation
»	Are there other types of dyspigmentation besides leukoderma and melanoderma?
»	Name the different types of hyperpigmentation due to excess numbers of derma melanocytes.
»	Differentiate a nevus of Ota from a nevus of Ito.
»	What types of hyperpigmentation are due to dermal melanin deposition?
»	How does erythema ab igne occur?
»	Are there any metabolic disorders associated with nonmelanin skin dyspigmentation?
»	What pigmentation disorders are associated with heavy-metal deposition in the dermis?
»	What drugs can deposit in the dermis and cause pigmentary changes?

Are there other types of dyspigmentation besides leukoderma and melanoderma?

Yes. Blue-gray skin discoloration can develop from melanin in dermal melanocytes, dermal melanin deposition, or nonmelanin dermal dyspigmentation (Table 18-2).

Table 18-2. Classification of Dermal Hyperpigmentation
	INCREASED MELANOCYTE NUMBER	INCREASED MELANIN	NONMELANIN PIGMENTS
	Genetic Mongolian spot Nevus of Ota Nevus of Ito	- - -	- - -
	Chemical or Drug - - - - - - - - -	Fixed drug eruption - - - - - - - -	Silver Mercury Bismuth Gold Antimalarials Phenothiazines Minocycline Amiodarone
	Endocrine or Metabolic - -	Chronic nutritional deficiency Melasma	- Ochronosis
	Physical -	Erythema ab igne	-
	Inflammation and Infection - - -	Macular amyloidosis Erythema dyschromicum perstans Postinflammatory hyperpigmentation	- - -