dermatologic disorders
Hyperpigmentation
Key Points
Common causes of focal hyperpigmentation include injury, inflammation, phytophotodermatitis, lentigines, melasma, freckles, café-au-lait macules, and acanthosis nigricans. Common causes of widespread hyperpigmentation include melasma, drugs, cancers, and other systemic disorders. Test patients who have widespread hyperpigmentation not caused by drugs for disorders such as primary biliary cholangitis, hemochromatosis, and Addison disease. Treat melasma initially with a combination ofhydroquinone2 to 4%,tretinoin0.05 to 1%, and a class V to VII topical corticosteroid. If lentigines are a cosmetic concern, treat with cryotherapy or laser. 