Erythema Dyschromicum Perstans Differential Diagnoses

Updated: Mar 18, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Diagnostic Considerations

Also consider the following:

  • Lichen planus pigmentosus

  • Lichen planus–like drug eruption [22] ; recently described on anti-PD-1 therapy [23]

  • Atrophic lichen planus

  • Pigmented contact dermatitis [24]

  • Tuberculoid leprosy

  • Chronic graft versus host disease [25]

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. [26]

Drug reactions should be considered. Ashy dermatosis–like pigmentation has been described attributed to ethambutol. [27]

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. [24]

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. [28, 29] Poikiloderma vasculare atrophicans may initially show features of erythema dyschromicum perstans. [30] A patient with both erythema dyschromicum perstans and vitiligo has been described. [31]

Differential Diagnoses