Erythema Dyschromicum Perstans Clinical Presentation

Updated: Mar 23, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Erythema dyschromicum perstans has a slow onset and is unlikely to resolve spontaneously. [15] The clinical course of childhood (prepubertal) may differ from that of adults; erythema dyschromicum perstans may be more likely to resolve within 2-3 years. A proposed clinical classification has been devised, dividing ashy dermatoses from erythema dyschromicum perstans with the former lacking erythematous borders, and having a third category for simulators such as lichen planus variants, and medication-induced melanodermas. [19]

Erythema dyschromicum perstans is an asymptomatic eruption of oval, polycyclic, or irregularly shaped, gray-blue hyperpigmented macules on the trunk, the arms, the face, and the neck. It begins as ash-colored macules, sometimes with an erythematous or elevated border (see the image below). No systemic symptoms or associations exist.

Erythema dyschromicum perstans may resolve in 2-3 years in prepubertal children, but it is more likely to persist in adults. [20]

Ash-colored, partially confluent, macular lesions Ash-colored, partially confluent, macular lesions over the patient's back. Reprint with permission from Cutis 1986; 37: 42-44.

Physical Examination

Erythema dyschromicum perstans has asymptomatic, gray-blue hyperpigmented patches of variable shape and size and an elevated erythematous border in the early stages (see the image below). The eruption is symmetrically distributed on the face, the trunk, and the upper extremities. The oral cavity and the genitals are spared. Dermatoscopic features are variable. Pigmentation on dermatoscopic examination is due to epidermal papillomatosis, and small brown dots correspond to pigmentary incontinence, two findings, which, when combined, may produce a “Wagyu beef–like” appearance. [21]

Close-up photograph shows ash-colored macular lesi Close-up photograph shows ash-colored macular lesions and lack of an inflammatory border. Reprint with permission from Cutis 1986; 37: 42-44.


No significant complications have been described in erythema dyschromicum perstans (EDP). See Medical Care for complications associated with clofazimine therapy.