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Erythema Dyschromicum Perstans Differential Diagnoses

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
Updated: Jun 07, 2016

Diagnostic Considerations

Also consider the following:

  • Lichen planus pigmentosus
  • Lichen planus–like drug eruption [19]
  • Atrophic lichen planus
  • Pigmented contact dermatitis [20]
  • Tuberculoid leprosy

Idiopathic eruptive macular pigmentation (IEMP) is a rare disease that can be distinguished by different clinical appearance of the macules: gray with an erythematous border and possibly confluent in erythema dyschromicum perstans, versus brownish and nonconfluent in IEMP.[21]

Drug reactions should be considered. Ashy dermatosis–like pigmentation has been described attributed to ethambutol.[22]

Pigmented contact dermatitis may appear as an epidermal melanosis characterized by erythema, papules, and pruritus, with little preexistent actual dermatitis, followed by hyperpigmentation from chemicals in fragrances or washing materials.[20]

However, one must put the differential diagnosis in context. Facial hyperpigmentation commonly evident in darker-skinned individuals is much more often melasma or postinflammatory hyperpigmentation than lichen planus pigmentosus or erythema dyschromicum perstans.[23, 24] Poikiloderma vasculare atrophicans may initially show features of erythema dyschromicum perstans.[25]

Differential Diagnoses

Contributor Information and Disclosures

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.


Santiago A Centurion, MD Dermatologist, Dermatology Associates of Central NJ

Santiago A Centurion, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, American Society of Dermatopathology, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: XOMA; Biogen/IDEC; Novartis; Janssen Biotech, Abbvie, CSL pharma<br/>Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor and intermittent author; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; for: Celgene; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Shyam Verma, MBBS, DVD, FAAD Clinical Associate Professor, Department of Dermatology, University of Virginia School of Medicine; Adjunct Associate Professor, Department of Dermatology, State University of New York at Stonybrook School of Medicine; Adjunct Associate Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Shyam Verma, MBBS, DVD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Ash-colored, partially confluent, macular lesions over the patient's back. Reprint with permission from Cutis 1986; 37: 42-44.
Close-up photograph shows ash-colored macular lesions and lack of an inflammatory border. Reprint with permission from Cutis 1986; 37: 42-44.
Photomicrograph of a lesion on the patient's back shows slight basilar vacuolar change, extensive pigment incontinence, dilatation of dermal lymphatics, and lack of inflammation (hematoxylin & eosin, original magnification X24.8). Reprint with permission from Cutis 1986; 37: 42-44.
Higher-power photograph shows slight vacuolar basilar change, marked dilatation of intradermal lymphatics, incontinence of melanin pigment, and lack of inflammation (hematoxylin & eosin, original magnification X238). Reprint with permission from Cutis 1986; 37: 42-44.
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