Disorder	Description	Location	Etiology	Treatment*
Hyperpigmentation disorders
Postinflammatory hyperpigmentation	Irregular, darkly pigmented macules/patches	Previous sites of injury or inflammation	Trauma, inflammation	Triple combination therapy,† hydroquinone, retinoids, azelaic acid (Finacea), chemical peels, laser therapy
Melasma	Pigmented, well-defined macules; light brown, brown, or gray	Face (centrofacial 63%, malar 21%, mandibular 16%) or forearms	Pregnancy, oral contraceptives, phenytoin (Dilantin), idiopathic	Triple combination therapy,† chemical peels, light or laser therapy, sunscreen
Solar lentigines	1- to 3-cm well-circumscribed macules; light yellow to dark brown, variegated	Face, hands, forearms, chest, back, shins	Acute or chronic ultraviolet exposure	Triple combination therapy† with or without cryotherapy, hydroquinone, retinoids, chemical peels, cryotherapy, intense pulsed light, laser therapy
Ephelides	1- to 2-mm sharply defined macules, red or tan to light brown	Face, neck, chest, arms, legs	Childhood onset after sun exposure in susceptible individuals (skin types I or II)	Fades in winter months so treatment may be unnecessary; cryotherapy, hydroquinone, azelaic acid, chemical peels, laser therapy
Café au lait macules	1- to 20-cm tan to brown macules, epidermal, present at birth or early childhood	Most commonly trunk but may appear anywhere	Increased melanin in melanocytes/basal keratinocytes	Laser therapy, surgical excision
Hypopigmentation disorders
Vitiligo	Hypopigmented macules and patches; sharply defined; 5 to 50 mm; coalescent	Face, hands, forearms, neck, genitalia, body folds, periorificial; lip-tip pattern	Unknown, possibly immune-mediated	High-potency topical corticosteroids (class II and III), topical calcineurin inhibitors, narrowband ultraviolet B, psoralen and ultraviolet A, systemic corticosteroids
Pityriasis alba	Hypopigmented, irregular patches; fine scale; itchy	Face, head, neck, forearms	Possible association with atopic dermatitis aggravated by sunlight exposure	Sunscreen, topical corticosteroids, tacrolimus (Protopic) ointment
Tinea versicolor	Hypopigmented or pink plaques; may be hyperpigmented; fine scale	Neck, chest, back, abdomen, proximal extremities	Malassezia spp. infection	Topical antifungals, topical adapalene (Differin) gel
Postinflammatory hypopigmentation	Loss of pigment (variable), macules, patches	Varies	Tinea versicolor, atopic dermatitis, pityriasis alba, psoriasis, guttate parapsoriasis, dermabrasion, chemical peels, intralesional corticosteroid use	Treatment of underlying condition when applicable