Pigmentation Problems for the Physician Assistant Exam - dummies

Pigmentation Problems for the Physician Assistant Exam

By Barry Schoenborn, Richard Snyder

Hyper- and hypo-pigmentation conditions will be covered on the Physician Assistant Exam (PANCE). There are a number of causes of pigmentation issues. For instance, adrenal insufficiency is a medical condition that can cause hyperpigmentation. Read on to get familiar with a few other pigmentation issues that are likely to be on the PANCE.

Acanthosis nigricans

Acanthosis nigricans is a velvety black hyperpigmentation of the skin that can occur under the axillary area, under inguinal areas, and in crevices and folds in other parts of the body. Causes are many. Three big causes of acanthosis nigricans are paraneoplastic phenomenon, Cushing’s syndrome, and diabetes. When you see acanthosis nigricans, the key is to look for and treat the underlying cause.


Melasma is a skin condition you often see in young women, particularly those who are pregnant or are taking estrogen/progesterone supplementation. Melasma has been called the “mask of pregnancy.” The cause of this skin condition isn’t known, but melasma is characterized by a macular discoloration of the facial area. This is usually a clinical diagnosis. The treatment is supportive.


If melasma is a problem of pigmentation of the skin, especially the face, then vitiligo is just the opposite. Here, you’re dealing with an autoimmune condition that causes portions of the skin, especially the extremities, not to be pigmented. Vitiligo can be associated with other autoimmune conditions. The treatment is steroids or photodynamic therapy.