How do you describe an area of red hyperpigmentation on a patient's skin?

Describing Red Hyperpigmentation

An area of red hyperpigmentation should be described as "post-inflammatory erythema" or "erythema from a resolving lesion" when it represents residual redness following inflammation, distinguishing it from true hyperpigmentation which involves increased melanin deposition. 1

Key Terminology and Clinical Distinction

The term "red hyperpigmentation" is technically imprecise—true hyperpigmentation refers to increased melanin (brown/black pigment), while persistent redness represents either:

• Post-inflammatory erythema: Residual vascular changes and inflammation without increased melanin 1
• Erythema with hyperpigmentation: Mixed presentation where both redness and brown discoloration coexist 1

Structured Description Framework

When documenting red or erythematous areas, use this systematic approach:

Intensity Grading

Grade erythema intensity using a standardized scale 1:

• 0: No erythema
• 1: Light pink
• 2: Moderate pink
• 3: Dark pink
• 4: Bright red

Essential Descriptive Elements

Color characteristics 1:

• Specify if purely erythematous (red) versus mixed with brown/tan pigmentation
• Note any heterogeneous coloring patterns
• Document presence of telangiectasia (visible blood vessels) separately 1

Distribution and extent 1:

• Measure area of involvement (in cm² or percentage of anatomic region)
• Document whether localized, regional, or diffuse
• Note if borders are sharp or irregular 1

Associated features 1:

• Presence of scale, texture changes, or atrophy
• Any associated symptoms (burning, stinging, pruritus)
• Temporal relationship to prior inflammation or injury

Critical Clinical Pitfalls

Do not confuse post-inflammatory erythema with active inflammation 1—post-inflammatory erythema represents damage/residual change from resolved inflammation, not ongoing disease activity. This distinction affects treatment decisions.

In darker skin types (phototypes V-VI), erythema may be difficult to visualize 1—in these patients, focus more on:

• Hyperpigmentation (brown/black discoloration) rather than redness
• Patient-reported symptoms (burning, stinging)
• Consider Wood's lamp examination to differentiate epidermal from dermal pigmentation 2

Distinguish from concerning lesions 1:

• Document any irregular borders, diameter >6mm, or recent changes that might suggest melanoma
• Note if the area has inflammation (reddish tinge within a pigmented lesion), which can be a warning sign 1
• Persistent erythema with irregular pigmentation warrants closer evaluation or biopsy 1

Documentation in Medical Records

Use precise terminology 1, 3:

• "Post-inflammatory erythema" for residual redness after inflammation
• "Post-inflammatory hyperpigmentation with erythema" when both brown pigment and redness coexist
• "Persistent erythema" for ongoing redness without clear inflammatory cause 1
• Avoid vague terms like "red hyperpigmentation"—specify whether melanin deposition is present

Always document 1, 2:

• Size (in cm or mm)
• Location (anatomic site)
• Intensity (using grading scale)
• Borders (sharp vs. irregular)
• Associated symptoms
• Duration and evolution over time