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Approach to the patient with macular skin lesions

Beth G Goldstein, MD
Adam O Goldstein, MD, MPH
Section Editor
Robert P Dellavalle, MD, PhD, MSPH
Deputy Editor
Rosamaria Corona, MD, DSc


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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Literature review current through: Nov 2017. | This topic last updated: Jun 12, 2017.
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