By Gary M. White, MD

See also dyschromias.



General work up for diffuse pigmentation should include CBC, B12, AM cortisol, folate level, free T4, TSH, and alpha MSH.

Addison's Disease Note the pigmentation of the scars as well.
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Alpha-Msh Hypersecretion: Generalized skin hyperpigmentation, worse in the sun exposed areas may occur secondary to alpha MSH hypersecretion associated with ACTH deficiency [BJD 1992;126;286].

Bone Marrow Transplantation BJD 1996;134;325

Cronkite-Canada Syndrome Look for nail dystrophy here as well.
Cytostatic Drugs (e.g. bleomycin, busulfan)

Familial Progressive Hyperpigmentation

Folate Deficiency: Diffuse hyperpigmentation may develop in the setting of folate deficiency. For diagnosis, check CBC folate level and exclude other causes [AD 1976;112;562].

Gaucher's Disease: Diffuse hyperpigmentation with stripes on the shins.



Melanosis Diffusa Congenita: [AD 114;775]

Metastatic Melanoma
Neiman-Pick Disease

Pituitary Tumors [JAMA 1966;198;619]

Plasma Cell Dyscrasia With Polyneuropathy

Porphyria Cutanea Tarda


Variagate Porphyria

Vitamin B12 Deficiency: Generalized hyperpigmentation, mucosal hyperpigmenation, premature graying of the hair and glossitis have all been described in the setting of vitamin B12 deficiency.

WhippleÂ’ Disease


See also dyschromias.

Bronze Baby Syndrome

Carbon Baby Syndrome Progressive blackening of the skin since 4 months of age. Ped Derm 2014;Sept

Familial Progressive Hyperpigmentation

Melanosis Universalis Hereditaria

Diffuse Congenital Melanosis

Congenital Adrenal Hypoplasia Diffuse hyperpigmentation may occasionally develop in an infant or young child with CAH (primary adrenocortical failure caused by hypoplasia or atrophy of the adrenal glands at birth). The pigmentation has been reported at birth[1]. The corticotropin (ACTH) level is abnormally elevated. JAAD 1995;33;323(CP)

Progressive hyperpigmentation in a Taiwanese child due to an inborn error of vitamin B12 metabolism [BJD 2015;172;1111]. Hyperpigmentation can also result from vitamin B12 deficiency, although the associated hyperpigmentation is not usually diffuse.

HIV Hyperpigmentation

Diffuse hyperpigmentation, as well as pigmented macules of the face[, fingers, penis or toes may develop in HIV patients. Whether these changes are secondary to AZT or some other drug, adrenal insufficiency (e.g. from CMV infection), folate or B12 deficiency, elevated alpha melanocyte stimulating hormone or some other cause may not be clear.

Hyperpigmentation of the palms in a darkly pigmented patient taking zidovudine.


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