Approach to the patient with macular skin lesions
- Beth G Goldstein, MD
Beth G Goldstein, MD
- Adjunct Clinical Assistant Professor
- Department of Dermatology
- University of North Carolina at Chapel Hill
- Adam O Goldstein, MD, MPH
Adam O Goldstein, MD, MPH
- Department of Family Medicine
- University of North Carolina at Chapel Hill
Macules are nonpalpable lesions that vary in pigmentation from the surrounding skin. Macules are not raised or atrophic; clinicians must consider other salient features to assist in developing a reasonable differential diagnosis. Often, clinicians state that a dermatologic lesion is "macular-papular," when in fact the lesion's morphology is papules and plaques, not macules. Definitions of dermatologic lesions can be found separately. (See "Approach to dermatologic diagnosis".)
Relatively few dermatologic disorders account for the majority of conditions presenting with only macules. Thus, the presence of these lesions can aid in forming an accurate diagnosis (table 1). One to two isolated macules in young children are often not pathologic; in adults, such lesions may occur frequently as a result of sun exposure [1,2].
The presence of macules should raise the following questions:
●What is the distribution of the lesion?
●Is there erythema, hypo- or hyperpigmentation?
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- ERYTHEMATOUS MACULES
- PHOTODISTRIBUTED MACULAR ERUPTIONS
- Systemic lupus erythematosus
- Drug-induced photosensitivity reactions
- Porphyria cutanea tarda
- Polymorphous light eruption
- HYPOPIGMENTED MACULES
- Tinea versicolor
- Halo nevus
- Pityriasis alba
- HYPERPIGMENTED MACULES
- Postinflammatory hyperpigmentation
- Solar purpura (senile purpura)
- Erythema ab igne
- Solar lentigo
- Schamberg's disease
- Fixed drug eruption
- INFORMATION FOR PATIENTS