Systemic Scleroderma Skin Involvement: Hyperpigmentation and Hypopigmentation

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Drug-Induced: Minocycline
Drug-Induced: Plaquenil
Salt and Pepper Appearance
Ultraviolet Light Therapy

Overview of Hyper- and Hypopigmentaion in Scleroderma

Systemic sclerosis (SSc) such as limited or diffuse scleroderma, can cause hyperpigmentation (darkening) and hypopigmention (lightening) of the skin, usually in the areas which have been affected by skin hardening. (Also see Overview of Skin Involvement, What is Scleroderma? and Types of Scleroderma)

Some medications, such as plaquenil and minocycline, can cause permanent dark skin plaques, which resemble black and blue marks similar to morphea scleroderma.

Cosmetically, pigmentation differences can be covered up with corrective cosmetics, such as Dermablend.

Drug-Induced Hyperpigmentation caused by Minocycline (Minocin) Antibiotic

Hyperpigmentation associated with minocycline therapy. In one study, hyperpigmentation occurred in 41% of patients with rheumatoid arthritis who had been taking minocycline for more than 3 months (median onset 12 months). Expired Article, Canadian Medical Association Journal. (Also see Minocycline)

Drug-Induced Hyperpigmentation caused by Plaquenil (Hydroxychloroquine)

Plaquenil (Hydroxycholoroquine) Side Effects. Dermatologic side effects have included mucocutaneous hyperpigmentation, nonlight-sensitive psoriasis, bleaching of hair, alopecia, pruritus, photosensitivity, and skin eruptions such as urticarial, morbilliform, lichenoid, maculopapular, purpuric, erythema annulare centrifugum, Stevens-Johnson syndrome, acute generalized exanthematous pustulosis, and exfoliative dermatitis.

Salt and Pepper Hypopigmentation and Hyperpigmentation in Systemic Sclerosis (SSc)

Criteria for Diagnosis of Scleroderma. A "salt and pepper" pattern of hyperpigmentation (excess pigmentation of the skin) and hypopigmentation (reduced pigmentation of the skin) is common. MediFocus Health. (Also see Overview of Skin Involvement, What is Scleroderma? and Types of Scleroderma)

Clinical utility of hypo– and hyperpigmentation of skin in diffuse cutaneous systemic sclerosis (dcSSc). Our study demonstrates strong association of "salt and pepper" skin with dcSSc (69%), increased risk of pruritus and contractures. PubMed, Int J Rheum Dis, 03/06/2017.

Ultraviolet Light Therapy for Morphea Scleroderma

Ultraviolet Light Therapy Is as Beneficial for Darker Skin as Lighter Skin. An analysis of more than 100 patients has confirmed for the first time that darker-skinned patients benefit as those with lighter skin when given light therapy for morphea and related diseases. Newswise. UT Southwestern Medical Center. (Also see Morphea Treatments)

Go to Skin Involvement: Sclerodactyly

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