Differential Diagnosis for Brown Freckles on Palms
Single Most Likely Diagnosis
- Addison's disease: This condition, characterized by adrenal insufficiency, can lead to hyperpigmentation, including brown freckles on the palms and soles due to increased ACTH levels stimulating melanocortin receptors.
Other Likely Diagnoses
- Peutz-Jeghers syndrome: An autosomal dominant disorder that presents with mucocutaneous melanin deposits, leading to brown freckles on the lips, oral mucosa, and sometimes the palms.
- Carney complex: A rare genetic disorder that can cause spotty skin pigmentation, including on the palms, along with other systemic features like myxomas and endocrine disorders.
- Ephelides (freckles): While more common on sun-exposed areas, in some cases, freckles can appear on the palms, especially in individuals with a genetic predisposition and significant sun exposure.
Do Not Miss Diagnoses
- Acral lentiginous melanoma: A subtype of melanoma that can present as a brown freckle on the palms or soles. Early detection is crucial for treatment and survival.
- Secondary adrenal insufficiency: Though less common than primary adrenal insufficiency (Addison's disease), secondary causes (e.g., pituitary tumors) can also lead to hyperpigmentation.
Rare Diagnoses
- Laugier-Hunziker syndrome: A rare condition characterized by acquired hyperpigmentation of the skin and mucous membranes, which can include the palms.
- Dowling-Degos disease: A rare genetic disorder that affects the skin, leading to reticular pigmentation of the flexures and sometimes the palms.