Differential Diagnosis for a 13-year-old Male with Black Healed Lesions
Single Most Likely Diagnosis
- Trauma or Injury: Given the description of black healed lesions, a common and likely explanation could be previous injuries or traumas that have healed, leaving behind pigmentation changes. This is a frequent occurrence in active adolescents.
Other Likely Diagnoses
- Vitiligo: Although it presents with depigmented patches, in some cases, especially if the patient has a darker skin tone, the contrast between the affected and unaffected skin might appear as "black" healed lesions due to the hyperpigmentation of the surrounding skin.
- Fixed Drug Eruption: This condition can cause lesions that heal with hyperpigmentation, which might appear black, especially in individuals with darker skin tones.
- Insect Bites or Allergic Reactions: Repeated exposure to allergens or insect bites can lead to hyperpigmented lesions that might fit the description.
Do Not Miss Diagnoses
- Malignant Melanoma: Although rare in adolescents, any pigmented lesion, especially those with irregular borders, color variation, or diameter larger than 6mm (the ABCDE rule), warrants a thorough examination to rule out melanoma.
- Sickle Cell Ulcers: In patients with sickle cell disease, ulcers can occur and heal with hyperpigmentation. Given the potential severity of sickle cell disease, it's crucial not to miss this diagnosis.
Rare Diagnoses
- Erythema Dyschromicum Perstans: A rare condition characterized by the gradual appearance of hyperpigmented macules that can be mistaken for healed lesions.
- Incontinentia Pigmenti: A genetic disorder that can cause hyperpigmented lesions, although it typically presents with a more complex set of skin manifestations and is associated with other systemic findings.
- Dyskeratosis Congenita: A rare genetic disorder that can cause skin hyperpigmentation among other symptoms like nail dystrophy and oral leukoplakia.