Changes in pigmentation

Cafe-au-lait spot

This lesion is typically a tan or light brown macule or patch that's slightly but uniformly pigmented with a somewhat irregular border. A small (0.5 to 1.5 cm in diameter) lesion is usually of no consequence, but six or more larger lesions suggest neurofibromatosis. (In this photo, the small, darker macules are unrelated.)

Tinea versicolor

A common superficial fungal infection of the skin, tinea versicolor causes hypopigmented, slightly scaling macules on the trunk, neck, and upper arms. They're easier to see in darker skin and in some people are more obvious after tanning. In lighter skin, macules may look pink or tan instead of pale.

Vitiligo

In this condition, which may be hereditary, melanocytes (cells that produce melanin) die or stop forming melanin. Depigmented patches of milky-white skin appear in various regions, typically the face, hands, feet, and extensor surfaces and may coalesce into extensive areas as shown here.In these photos,the brown skin is normal and the pale areas are vitiligo.

Source of photos: Tinea Versicolor-Ostler HB, Mailbach HI, Hoke AW, Schwab IR. Diseases of the Eye and Skin: A Color Atlas. Philadelphia, Lippincott Williams & Wilkins; Vitiligo, Erythema-Goodheart HP. Goodheart's Photoguide of Common Skin Disorders: Diagnosis and Management, 2nd ed. Philadelphia, Lippincott Williams & Wilkins, 2003; Heliotrope-Hall JC. Sauer's Manual of Skin Diseases, 8th ed. Philadelphia, Lippincott Williams & Wilkins, 2000.

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Cyanosis

The bluish color of these toenails and toes indicates cyanosis. In this photo, the patient's normally pink fingernails and fingers are provided for contrast. Impaired venous return in the lower extremity caused this example of peripheral cyanosis. Cyanosis, especially when slight, may be hard to distinguish from normal skin color.

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Jaundice

The diffusely yellow skin color in this photo is characteristic of jaundice. Note the contrast in color with the examiner's hand. The discoloration is most easily seen in the sclera, as shown here, and may also be visible in mucous membranes. Possible causes include liver disease and hemolysis of red blood cells.

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Carotenemia

In these photos, you see how the yellowish palm of a patient with carotenemia contrasts with a normally pink palm. Unlike jaundice, carotenemia doesn't affect the sclerae, which remain white, or mucous membranes. The cause is a high serum level of carotene usually associated with a diet high in carrots and other yellow vegetables and fruits. Although carotenemia isn't harmful, you should follow up by assessing the patient's dietary intake.

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Erythema

The red hue of increased blood flow gives the patient the "slapped cheeks" appearance characteristic of erythema infectiosum (fifth disease). Caused by human parvovirus B19, this infection is more common in children, but it can also affect adults.1

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Heliotrope

Dermatomyositis, a collagen vascular disease, causes this characteristic rash: a red-purple edematous discoloration of the upper eyelids.

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Source: Bickley LS. Bates' Guide to Physical Examination and History Taking. 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:174-175,

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