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Author: Dr Daniel Mazzoni, Junior Medical Officer, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. January 2020.
Idiopathic eruptive macular hyperpigmentation is a rare benign pigmentary disorder of the first two decades of life characterised by asymptomatic hyperpigmented macules with a predilection for the upper body regions . It is classified as a variant of acquired dermal macular hyperpigmentation.
Idiopathic eruptive macular hyperpigmentation can occur in any age group and affects both sexes. However most reported cases develop in children and adolescents .
The cause of idiopathic eruptive macular hyperpigmentation is unknown. The hypermelanosis occurs sporadically in the absence of preceding illness, inflammation, sun exposure, or medication . It has not been reported to be familial .
Hormones have been hypothesised to play a role in rare cases that have worsened during pregnancy .
Idiopathic eruptive macular hyperpigmentation is characterised by multiple discrete asymptomatic brown-grey-black small macules or larger patches.
Idiopathic eruptive macular hyperpigmentation is not influenced by exposure to ultraviolet (UV) radiation .
Histopathological evaluation of a skin biopsy shows:
Diagnostic criteria were proposed by Sanz de Galeano :
Suggested modifications have included clinical features of possible slightly raised plaques resembling acanthosis nigricans, and involvement of the face, and histology described as an epidermal hypermelanosis with or without papillomatosis in the absence of dermal inflammation .
A global consensus statement published in 2019 adds a further criterion that the pigmented macules have not appeared after a known episode such as a viral exanthem, pityriasis rosea, drug eruption, etc .
Idiopathic eruptive macular hyperpigmentation can be clinically misdiagnosed as one of the following conditions.
Treatment of idiopathic eruptive macular hyperpigmentation is not required because lesions are asymptomatic and resolve spontaneously within several months to years. Once cleared, there are no residual changes or scarring . Recurrence has not been reported.
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