Pigmentary Changes Following Inflammation Of The Skin

Postinflammatory hypomelanosis (psoriasis) The hypomelanotic lesions correspond

exactly to the antecedent eruption. There is some residual psoriasis within the lesions.

Postinflammatory hypomelanosis is always related

to loss of melanin. It is a special feature of pityriasis
versicolor (Fig. 13-13, see also Section 25), in
which the hypopigmentation may also remain for
weeks after the active infection has disappeared.
_ Hypomelanosis is not uncommonly seen in atopic
dermatitis, psoriasis (Fig. 13-14), guttate parapsoriasis,
and pityriasis lichenoides chronica.
_ It may also be present in cutaneous lupus
erythematosus (Fig. 13-15), alopecia mucinosa,
mycosis fungoides, lichen striatus, seborrheic
dermatitis, and leprosy.
_ Hypomelanosis may follow dermabrasion and
chemical peels; in these conditions there is
a “transfer block,” in which melanosomes are
present in melanocytes but are not transferred
to keratinocytes, resulting in hypomelanosis. The
lesions are usually not chalk white, as in vitiligo,
but “off” white and have indiscrete margins.
_ A common type of hypopigmentation is associated
with pityriasis alba (Fig. 13-16). This is a
macular hypopigmentation mostly on the face of
children, off-white with a powdery scale. Relatively
indistinct margins under Wood light and scaling
distinguish this eczematous dermatitis from
vitiligo. It is self-limited.
_ Hypomelanosis not uncommonly follows intralesional
glucocorticoid injections; but when the
injections are stopped, a normal pigmentation
develops in the areas.
_ Depending on the associated disorder, postinflammatory
hypomelanosis may respond to oral PUVA photochemotherapy.

Pityriasis versicolor A. Hypopigmented, sharply marginated, scaling macules on the back

of an individual with skin phototype III. Gentle abrasion of the surface will accentuate the scaling.
This type of
hypomelanosis can remain long after the eruption has been treated and the primary process is
resolved. B.
Pityriasis versicolor in African skin. Lesions are perifollicular on the chest and coalesce to large
confluent patches
on the neck where the fine scaling can best be seen.