The macules are well circumscribed and each has a central raised lesion. Lesions of pityriasis alba are usually bilateral and located on the face, arms, and neck. Introduction. For example, macules can be moles (which are hyperpigmented, or darker, relative to the skin) or vitiligo lesions (which are hypopigmented or depigmented, or lighter, relative to the skin). Pigmenting pityriasis alba. The frequency of IGH increases with age. In these cases, the skin is more vulnerable to damage from ultraviolet rays. Lesions often occur on the head, neck, upper extremities, trunk, and buttocks. Obsessive compulsive disorder (OCD) – The obsessive thoughts and repetitive actions seen in OCD can appear BS consists of asymptomatic, small, irregular, hypopigmented macules characterized by a normal histological appearance, which are usually found in individuals aged 20-40 and more frequently in women than men. 1,2 The skin surrounding the lesions may be normal or mildly erythrocyanotic. Pigmentation of the skin normally varies according to racial origin (see Fitzpatrick phototypes) and the amount of sun exposure.Pigmentation disorders are often more troublesome in skin of colour.. Differential diagnosis Conditions to include in the differential diagnosis include the following. Idiopathic guttate hypomelanosis is a common but underreported condition in elderly patients that usually presents with small, discrete, asymptomatic, hypopigmented macules. Hypopigmented MF presents with hypopigmented macules and patches. Hypochromic naevus (naevus depigmentosus). This is especially true of albinism. Nevus depigmentosus. Differential diagnosis. Some people with hypopigmentation are at a higher risk for skin cancer. Quadrichrome vitiligo features a fourth, dark-brown pigment, which surrounds hair follicles. A well-defined, hypopigmented, irregularly shaped, confluent macules forming a patch that is usually found on the trunk; It presents at birth or early in childhood and persists in to adulthood remaining unchanged; Stroking, rubbing, or warming induces erythema of the adjacent normal skin DISCUSSION. ... hypopigmented macules in this 6-year-old child with pityriasis alba. Case presentation A 7-year-old girl presents with a small number of hypopigmented macules on her back that have been present for about three months (Figure 1). The differential diagnosis of pityriasis alba includes the following: Postinflammatory pigment alteration. The differential diagnosis is challenging as TFI resemble many other dermatologic conditions. The pigment cells or melanocytes are located at the base of the epidermis and produce the protein melanin.Melanin is carried by keratinocytes to the skin surface. 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