Lancaster General Health Family Medicine Residency Program, Lancaster, PA, USA.
Mayville Family HealthCare, Mayville, MI, USA.
Am Fam Physician. 2017 Dec 15;96(12):797-804.
Pigmentation disorders are commonly diagnosed, evaluated, and treated in primary care practices. Typical hyperpigmentation disorders include postinflammatory hyperpigmentation, melasma, solar lentigines, ephelides (freckles), and café au lait macules. These conditions are generally benign but can be distressing to patients. Appropriate dermatologic history, skin examination, and skin biopsy, when appropriate, can help exclude melanoma and its precursors. In addition to addressing the underlying condition, hyperpigmentation is treated with topical agents, chemical peels, cryotherapy, light or laser therapy, or a combination of these methods. Café au lait macules are treated with surgical excision or laser therapy if treatment is desired. Hypopigmentation disorders include vitiligo, pityriasis alba, tinea versicolor, and postinflammatory hypopigmentation. Treatment of vitiligo depends on the distribution and extent of skin involvement, and includes topical corticosteroids and calcineurin inhibitors, ultraviolet A therapy (with or without psoralens), narrowband ultraviolet B therapy, and cosmetic coverage. Patients with stable, self-limited vitiligo may be candidates for surgical grafting techniques, whereas those with extensive disease may be candidates for depigmentation therapy to make skin tone appear more even. Other hypopigmentation disorders may improve or resolve with treatment of the underlying condition.
色素沉着障碍在初级保健实践中通常被诊断、评估和治疗。典型的色素沉着障碍包括炎症后色素沉着、黄褐斑、日光性雀斑、雀斑（雀斑）和咖啡牛奶斑。这些情况通常是良性的，但可能会令患者感到困扰。适当的皮肤科病史、皮肤检查和皮肤活检（如有必要）有助于排除黑色素瘤及其前体。除了治疗潜在疾病外，还可以使用局部药物、化学换肤、冷冻疗法、光或激光疗法或这些方法的组合来治疗色素沉着过度。如果需要治疗，咖啡牛奶斑可以通过手术切除或激光治疗。色素减退性疾病包括白癜风、特应性皮炎、花斑癣和炎症后色素减退。白癜风的治疗取决于皮肤受累的分布和范围，包括局部皮质类固醇和钙调磷酸酶抑制剂、紫外线 A 治疗（有或没有补骨脂素）、窄带紫外线 B 治疗和美容遮盖。稳定、自限性白癜风患者可能适合手术移植技术，而广泛疾病患者可能适合脱色治疗以使肤色更均匀。其他色素减退性疾病可能会随着基础疾病的治疗而改善或消退。
