Differential Diagnosis for Darkened Areas of Skin on Face in a 37-year-old African American
Single Most Likely Diagnosis
- Melasma: This condition is characterized by patches of discoloration, typically on the face, and is common in African American women, especially those with a history of hormonal contraceptive use or pregnancy. The darkened areas are usually symmetrical and found on the cheeks, forehead, and chin.
Other Likely Diagnoses
- Post-inflammatory Hyperpigmentation (PIH): This condition occurs after inflammation or injury to the skin, leading to an increase in melanin production. It's common in darker skin types and can be caused by acne, eczema, or other skin conditions.
- Dermatosis Papulosa Nigra (DPN): A benign condition that causes small, dark bumps on the face, particularly on the cheeks and forehead. It's more common in African Americans and can be mistaken for melanoma or other skin cancers.
- Acne-induced Hyperpigmentation: Acne can cause inflammation, leading to post-inflammatory hyperpigmentation, which can result in darkened areas of skin on the face.
Do Not Miss Diagnoses
- Malignant Melanoma: Although less common in African Americans, melanoma can still occur and is often more aggressive. It's crucial to rule out melanoma, especially if there's a new or changing lesion.
- Sarcoidosis: A systemic disease that can cause skin lesions, including darkened areas on the face. It's essential to consider sarcoidosis, especially if there are other systemic symptoms.
Rare Diagnoses
- Erythromelanosis Follicularis Faciei: A rare condition that causes reddish-brown pigmentation on the face, typically on the cheeks and forehead.
- Berloque Dermatitis: A rare condition caused by perfume or fragrance allergy, leading to hyperpigmentation on the face and neck.
- Addison's Disease: A rare endocrine disorder that can cause hyperpigmentation, particularly in sun-exposed areas, including the face.