Erythema Dyschromicum Perstans Differential Diagnoses

Updated: Mar 23, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Diagnostic Considerations

Also consider the following:

  • Lichen planus pigmentosus

  • Medication eruptions: Lichen planus–like drug eruption; [22] anti-PD-1 therapy; [23] hydroxyurea; [24] epidermal growth factor receptor inhibitor therapy [25]

  • Atrophic lichen planus

  • Pigmented contact dermatitis [26]

  • Tuberculoid leprosy

  • Chronic graft versus host disease [27]

Idiopathic eruptive macular pigmentation (IEMP) is a rare disease that can be distinguished by different clinical appearance of the macules: gray with an erythematous border and possibly confluent in erythema dyschromicum perstans, versus brownish and nonconfluent in IEMP. [28]

Drug reactions should be considered. Ashy dermatosis–like pigmentation has been described attributed to ethambutol. [29]

Pigmented contact dermatitis may appear as an epidermal melanosis characterized by erythema, papules, and pruritus, with little preexistent actual dermatitis, followed by hyperpigmentation from chemicals in fragrances or washing materials. [26]

However, one must put the differential diagnosis in context. Facial hyperpigmentation commonly evident in darker-skinned individuals is much more often melasma or postinflammatory hyperpigmentation than lichen planus pigmentosus or erythema dyschromicum perstans. [30, 31] Poikiloderma vasculare atrophicans may initially show features of erythema dyschromicum perstans. [32] A patient with both erythema dyschromicum perstans and vitiligo has been described. [33]

Differential Diagnoses