Codes

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

• Hypopigmented flat warts – These are perceptibly raised.
• Hypopigmented seborrheic keratoses – Also perceptibly raised.
• Tinea versicolor – Typically scaly and limited to the upper trunk and shoulder.
• Pityriasis alba – Usually seen in atopic children; lesions are ill-defined.
• Pityriasis lichenoides chronica (PLC) – Usually seen in a younger patient population than IGH and found on sun-protected skin; in young patients with dark skin phototypes, PLC may present as hypopigmented macules, and PLC may resolve with guttate leukoderma.
• Leukodermic macules of Darier disease.
• Postinflammatory hypopigmentation – Can be distinguished by preceding history of dermatitis.
• Vitiligo – Lesions are depigmented, often acral, and coalesce to form larger depigmented patches.
• Leukoderma punctata – 0.5- to 1.5-mm achromic macules that follow psoralen plus UVA (PUVA) or UVB therapy.
• Lichen sclerosus – Shows a "tissue paper" atrophic appearance with telangiectasia; not confined to sun-exposed skin.
• Atrophie blanche – Favors the distal shins and ankles but is usually atrophic and surrounded by telangiectasia.

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References

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