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
- Section Editor
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — General Dermatology
- Professor of Dermatology and Public Health
- University of Colorado School of Medicine
- Colorado School of Public Health
- Chief, Dermatology Service
- US Department of Veterans Affairs
- Eastern Colorado Health Care System
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?
- Vanderhooft SL, Francis JS, Pagon RA, et al. Prevalence of hypopigmented macules in a healthy population. J Pediatr 1996; 129:355.
- Pagnoni A, Kligman AM, Sadiq I, Stoudemayer T. Hypopigmented macules of photodamaged skin and their treatment with topical tretinoin. Acta Derm Venereol 1999; 79:305.
- Drenkard C, Villa AR, Reyes E, et al. Vasculitis in systemic lupus erythematosus. Lupus 1997; 6:235.
- Stern RS, Shear NH. Cutaneous reactions to drugs and biological modifiers. In: Cutaneous Medicine and Surgery, Arndt KA, LeBoit PE, Robinson JK, Wintroub BU (Eds), W.B. Saunders, Philadelphia 1996. Vol 1, p.412.
- González E, González S. Drug photosensitivity, idiopathic photodermatoses, and sunscreens. J Am Acad Dermatol 1996; 35:871.
- Jimbow K. Vitiligo. Therapeutic advances. Dermatol Clin 1998; 16:399.
- Leung AK, Feingold M. Pityriasis alba. Am J Dis Child 1986; 140:379.
- Galan EB, Janniger CK. Pityriasis alba. Cutis 1998; 61:11.
- Lin RL, Janniger CK. Pityriasis alba. Cutis 2005; 76:21.
- Blessmann Weber M, Sponchiado de Avila LG, Albaneze R, et al. Pityriasis alba: a study of pathogenic factors. J Eur Acad Dermatol Venereol 2002; 16:463.
- Urano-Suehisa S, Tagami H. Functional and morphological analysis of the horny layer of pityriasis alba. Acta Derm Venereol 1985; 65:164.
- Eczematous eruptions in childhood. In: Hurwitz Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence, 3rd ed, Paller AS, Mancini AJ (Eds), WB Saunders, Philadelphia 2006. p.49.
- Jóźwiak S, Schwartz RA, Janniger CK, et al. Skin lesions in children with tuberous sclerosis complex: their prevalence, natural course, and diagnostic significance. Int J Dermatol 1998; 37:911.
- Miura Y, Tajima S, Ishibashi A, Hata Y. Multiple anemic macules on the arms: a variant form of nevus anemicus? Dermatology 2000; 201:180.
- Choe YB, Park KC, Cho KH. A case of hypopigmented mycosis fungoides. J Dermatol 2000; 27:543.
- Sarkar R, Kaur I, Das A, Sharma VK. Macular lesions in leprosy: a clinical, bacteriological and histopathological study. J Dermatol 1999; 26:569.
- Pandya AG, Guevara IL. Disorders of hyperpigmentation. Dermatol Clin 2000; 18:91.
- Beleznay K, Humphrey S, Au S. Erythema ab igne. CMAJ 2010; 182:E228.
- Arnold AW, Itin PH. Laptop computer-induced erythema ab igne in a child and review of the literature. Pediatrics 2010; 126:e1227.
- Adams BB. Heated car seat-induced erythema ab igne. Arch Dermatol 2012; 148:265.
- Ratnam KV, Su WP, Peters MS. Purpura simplex (inflammatory purpura without vasculitis): a clinicopathologic study of 174 cases. J Am Acad Dermatol 1991; 25:642.
- Rocamora V, Puig L, Romaní J, de Moragas JM. Amelanotic lentigo maligna melanoma: report of a case and review of the literature. Cutis 1999; 64:53.
- Geria AN, Tajirian AL, Kihiczak G, Schwartz RA. Minocycline-induced skin pigmentation: an update. Acta Dermatovenerol Croat 2009; 17:123.
- Alto WA, Clarcq L. Cutaneous and systemic manifestations of mastocytosis. Am Fam Physician 1999; 59:3047.
- Pollack CV Jr, Pender ES. Recognizing an index case of type 1 neurofibromatosis. Am Fam Physician 1992; 45:623.
- Wang AS, Barr KL, Jagdeo J. Shiitake mushroom-induced flagellate erythema: A striking case and review of the literature. Dermatol Online J 2013; 19:5.
- Todkill D, Taibjee S, Borg A, Gee BC. Flagellate erythema due to bleomycin. Br J Haematol 2008; 142:857.
- 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