Symptoms and causes of skin dyschromia in adults and children. Dyschromia: pathology or natural skin change? ICD codes 10 l

However, the lack of a corresponding specialty “cosmetologist”, standardized Procedures and Rules for the provision of medical services, the presence of the type of medical activity “therapeutic cosmetology” and at the same time types of household cosmetology services intersecting according to OKUN (all-Russian classifier of services to the population) put cosmetology in an “uncertain” position.

Domestic cosmetology was in this state of “uncertainty” for almost 20 years, but from the moment cosmetology was introduced as a new medical specialty by the Order of the Ministry of Health and Social Development of Russia dated April 23, 2009 “On the nomenclature of specialties with higher and postgraduate medical and pharmaceutical education in the healthcare sector of the Russian Federation,” and then with the entry into force of the Order of the Ministry of Health and Social Development of Russia dated April 18, 2012 “On approval of the Procedure for providing medical care to the population in the field of cosmetology” and the Decree of the Government of the Russian Federation dated October 4, 2012 “On approval of the Rules for the provision of paid medical services by medical organizations”, the issue of registration of medical services and management primary documentation has become the most acute problem for clinics.

Currently, cosmetology (with the exception of a narrow group of services classified as household services in accordance with the Order of the Ministry of Labor of Russia dated December 22, 2014) is becoming a purely medical activity and is equal to any other types of medical services. Accordingly, the provision of medical cosmetology services must be carried out in compliance with all requirements, incl. maintaining primary medical documentation and reflecting unified diagnoses in it according to ICD-10.

Where and what diagnoses according to ICD-10 should a cosmetologist reflect?

The main document that is issued for any medical intervention or service, according to the Order of the Ministry of Health of Russia dated December 15, 2014 “On approval of unified forms of medical documentation used in medical organizations providing medical care in outpatient settings, and procedures for filling them out,” is a Medical Card patient (hereinafter referred to as MK) receiving medical care on an outpatient basis (form 025/u) (for persons under 18 years of age - form 112u). The same Order contains information on the rules for filling out the relevant sections of the IC, including stating that during the initial consultation a preliminary or final diagnosis must be indicated, which must be made in accordance with ICD-10.

What is the scope of professional authority of a cosmetologist?

According to clause 3 of the Order of the Ministry of Health and Social Development of Russia dated April 18, 2012 “On approval of the Procedure for providing medical care to the population in the field of cosmetology,” the area of ​​influence of cosmetology is limited to the integumentary tissues - the skin, its appendages, subcutaneous fatty tissue and superficial muscles. Guided by this fact and primary perception , diagnoses in cosmetology could be looked for in the sections of ICD-10 devoted to diseases of the skin, its appendages and subcutaneous fat. For several years, medical specialists did just that: cosmetologists used about 15 diagnoses from these sections, which, unfortunately, did not reflect the full breadth of problems that a cosmetologist faces in his professional activities.

Do topologies or techniques determine the ICD-10 diagnoses used?

It is important to understand that, along with conditions directly related to the group of diseases of the integumentary tissues and eliminated by cosmetological techniques, there are other diseases and conditions that constitute the scope of professional competence of a cosmetologist.

Firstly, these are diseases topologically manifested in the area of ​​integumentary tissues, but classified according to correction methods Procedures for the provision of medical services (relevant orders of the Ministry of Health of the Russian Federation) to other areas of medical specialties. Those. For these conditions, the cosmetologist does not provide medical interventions, but is limited to only consulting services. An example of such diseases are neoplasms of the skin, its appendages and subcutaneous tissue. Removal of benign neoplasms is permitted by the Order of the Ministry of Health in a cosmetology clinic, while the treatment of malignant neoplasms, including those located in the area of ​​integumentary tissues, is the area of ​​professional responsibility of the oncologist, and some skin infectious diseases that externally manifest themselves as neoplasms (molluscum contagiosum) are the area of ​​responsibility of the dermatologist. But the patient himself cannot determine the nature of the origin of the neoplasm, which constitutes an aesthetic problem for him, and therefore patients often turn to the cosmetology clinic to remove the tumors, unaware of their oncological or infectious nature. In this case, the cosmetologist’s task is to conduct a differential diagnosis during consultation and, in the case of a benign neoplasm, remove it using approved correction methods, followed by histological control. And if you suspect a malignant or infectious nature of the neoplasm, refer the patient to the appropriate specialist by filling out form 057/у. But in any of these cases, the cosmetologist is required to fill out medical documentation indicating the preliminary and final diagnosis in accordance with ICD-10.

Secondly, these are diseases topologically assigned to other (non-cosmetology) sections of ICD-10, but according to the methods of correcting their manifestations, they form the scope of professional competencies of a cosmetologist. An example of such conditions are generalized vascular diseases, reflected in various sections of ICD-10, relating to various areas of medical knowledge (including phlebology, vascular diseases), but having external manifestations in the integumentary tissues and, in connection with this, making up an aesthetic component for the patient problem. In the arsenal of a cosmetologist, there are currently a number of techniques, primarily hardware (photo and laser systems), that can effectively eliminate such vascular manifestations. Naturally, when receiving such patients and filling out the primary medical documentation, the cosmetologist must establish an appropriate diagnosis, which is not classified in ICD-10 as a disease of the skin and its appendages, but in terms of the area of ​​manifestation and the method of correction, it constitutes the area of ​​professional responsibility of cosmetology.

Accordingly, in the work of a cosmetologist, to fill out medical documentation, diagnoses should and can be used that are classified in ICD-10 not only to sections directly topologically classified as cosmetology, but also from any field of medicine that has manifestations in the “area of ​​responsibility” of the cosmetologist, regardless of whether the cosmetologist independently provides treatment or refers the patient to specialists of other medical professions.

Part of the difficulty in determining diagnoses within the competence of a cosmetologist lies in the mixed classification system used in ICD-10, where diagnoses are grouped into sections both by areas of medical knowledge and by topological features, correction methods, histological features and disease progression . Therefore, the development of a simple methodology for selecting diagnoses can both significantly facilitate the maintenance of medical records and improve the quality of work of a cosmetologist when carrying out differential diagnosis of diseases.

How to determine and select from an extensive list those ICD-10 diagnoses that are necessary for a cosmetologist in practice?

Understanding that at least at the level of consultation, a cosmetologist must make a judgment about any condition that brought the patient to a cosmetology clinic, and accordingly fill out the MK in order to establish the entire list of diagnoses and systematize them for the practical activities of a cosmetologist, one should understand what are the reasons for contacting patient to a cosmetology clinic.

The order of the Ministry of Health of Russia dated December 15, 2014 introduces the concept of “treatment” into the practice of a doctor - the reason that prompted the patient to go to the clinic. To date, we have identified a little more than 20 such causes in cosmetology, ranging from age-related changes to “defectology” associated with the elimination of benign formations, treatment of post-acne, hypertrichosis, removal of age spots, etc. The most common diseases, the elimination of external manifestations of which cosmetology deals with, are contained in 6 sections of ICD-10. Each potential reason for a patient's visit corresponds to several diagnoses. There are about 150 of them in total. For the patient, the cosmetologist is obliged to operate with all of them with varying degrees of accuracy. Having systematized and grouped the diagnoses from ICD-10 in this way, we received a convenient tool to help practitioners.

Accuracy of diagnosis and practice of a cosmetologist?

Another important point: diagnoses in ICD-10, depending on the section, have a complex, sometimes three-level, classification system. Since cosmetology services are not etiotropic in nature, that is, they eliminate not the cause of the disease, but the consequences of its manifestations, a detailed diagnosis in cosmetology is not always mandatory. For example, in ICD-10 there are several diagnoses of hypertrichosis, but for choosing a method of cosmetic correction (laser or photoepilation) precise diagnosis is redundant, so a cosmetologist can indicate a general diagnosis when filling out primary medical documentation.

As a rule, in all sections of ICD-10 there is subsection 09, which contains diagnoses with unknown causes or topology. Therefore, in order to protect yourself from incorrect diagnosis and reduce the financial burden on the patient (additional studies will cost him significant amounts, but their results will not affect the cosmetologist’s work in any way), it is recommended to use general diagnoses.

The most difficult, from the point of view of selecting a diagnosis, despite all the obviousness of their manifestations, are the reasons associated with the correction of age-related changes - wrinkles, dry skin, decreased skin turgor. From the point of view of clinical conventional medicine, these conditions correspond to the age norm, and the process of natural aging is not considered an independent disease. Therefore, these age-related changes are not reflected in detail in ICD-10. But it is precisely such conditions and desires to “eliminate age-related changes” that make up the majority of visits to a cosmetology clinic. All of these conditions, characterized as “anti-aging techniques,” include general diagnoses such as degenerative changes in the dermis.

Summary

Thus, a cosmetologist uses diagnoses from various fields of medicine in his work. Conventionally, they can be divided into 2 large groups according to the volume of services provided by the cosmetologist: advisory (i.e., which the cosmetologist uses to consult and redirect the patient to another specialist) and manipulative (those that the cosmetologist uses directly to provide services in the “cosmetology” profile). .

An example of the selection of ICD-10 diagnoses for a disease not classified as diseases of the skin and its appendages, but with cosmetological correction methods (“manipulation” group)

An example of the selection of ICD-10 diagnoses for a disease that manifests itself in the area of ​​the skin and its appendages, but with correction methods by other medical specialties (“consultative” group)

An example of using ICD-10 diagnoses for an unspecified diagnosis

To provide hair removal services, it is recommended to use code L68.9 (Hypertrichosis, unspecified), and if a neoplasm is suspected of being malignant and the patient is referred to an oncologist, code D48.9 (Neoplastic neoplasm of unspecified or unknown nature, unspecified) is recommended.

A large number of different microbes live on the surface of human skin, for example, epidermal streptococci. They do not harm a healthy body with good immunity.

If the integrity of the outer skin is damaged (microtraumas, cuts, eczema), these bacteria can penetrate into the deeper layers and cause inflammation, which is called streptoderma.

The disease most often develops in people with weakened or deficient immune defenses. Young children, as well as adults with serious chronic diseases, are especially susceptible.

Why this pathology occurs, how it manifests itself and is treated – let’s try to figure it out.

What kind of disease is this

In dermatology, streptoderma refers to a whole group of infectious skin diseases caused by streptococcus. These include streptococcal seizures, simple face, chronic diffuse pyoderma, erysipelas, vulgar ecthyma. The first form is the most typical and common.

Streptoderma occurs more often in children than in adults due to an insufficiently perfect immune system and thinner and more delicate skin.

This disease is contagious, it can be transmitted between people through direct contact (kissing, handshakes) or through shared objects. Outbreaks of the disease often occur in closed communities (boarding schools, military units, colonies).

The following factors may predispose to the development of the disease:

• weakening of the body's immune defense (stress, fatigue, intoxication, moving to another climate zone, etc.);
• the presence of concomitant infectious (herpes, chicken pox) or chronic diseases in the body (diabetes, psoriasis, eczema, atopic dermatitis);
• malnutrition or starvation (deficiency of protein, vitamins and microelements);
• work in hazardous industries;
• severe contamination and damage to the skin (microcracks, abrasions, scratches, insect bites);
• neglect of the rules of personal hygiene or excessive cleanliness;
• exposure to low (frostbite) or high (burns) temperatures;
• (excessive sweating);
• circulatory disorders (varicose veins).

ICD-10 code

To analyze the general morbidity situation in different countries, as well as to monitor the frequency and prevalence of diseases and other health-related problems, the International Standard Classification (ICD) was created. All doctors need it in their daily work.

Every decade, the World Health Organization reviews the classification to bring it into line with the current state of knowledge. Currently, the ICD is in its 10th edition, in which each disease has its own code, understandable to doctors all over the world.

According to ICD-10, streptoderma refers to other local infections of the skin and subcutaneous tissue, designated by the code L08. This section has a code for pyoderma L08.1 (generic term) and for specified infectious lesions L08.8.

For cases where it is necessary to identify the pathogen, an additional code is used; for streptococci it is suitable B95(B95.1 to B95.5). The most common form of streptoderma is impetigo, it has its own code L01. In case of co-infection, additional coding is used individually in each specific case.

How does streptoderma begin?

The incubation period (the time from the moment of infection to the initial manifestations of the disease) averages a week. Streptoderma usually begins acutely with the appearance of pink spots on the skin, which soon become covered with a blistering rash, accompanied by severe itching.

This is how the disease begins: photo

The presence of blisters with purulent contents is a distinctive feature of streptoderma from dermatitis. The vesicles soon burst, leaving behind erosions covered with honey-colored crusts.

Skin lesions can quickly spread to adjacent and distant areas if the patient scratches the rash.

Streptoderma in adults on the face (cheeks, nasolabial triangle, forehead) can be combined with damage to the skin folds under the breasts, under the armpits. In children The most common form of infection is the common form of infection, affecting the face, neck, back, hands, lower extremities, which is accompanied by a violation of the general condition due to the development of intoxication (fever, swollen lymph nodes, lethargy, refusal to eat).

Symptoms and treatment in adults and children will differ depending on the type of streptococcal skin lesion.

Types of streptoderma

Depending on the predominant symptoms, two forms of streptoderma are distinguished:

1. getting wet– blisters with purulent contents, erosions and crusts successively appear on the surface of the skin, from under which a liquid substance is released.
2. Dry– peeling and pink spots are present on the face and neck without the formation of blisters and maceration (wet loosening and swelling of the epidermis).

Depending on the depth of skin damage, it happens:

• superficial process (affects only the epidermis) – impetigo, seizures, lichen simplex of the facial skin;
• deep inflammation (spreads to the underlying layers of the skin) - streptococcal cellulitis, ecthyma, ulcerative version of pyoderma.

Impetigo

This is the most common form of the disease in adults. The rash appears suddenly and goes through all stages of development: papules (tubercles), vesicles (bubbles), small erosive defects, yellow-gray crusts.

Impetigo usually affects the lateral surfaces of the nose, the area above the upper lip, the chin, the spaces behind the ears, the hands, and large folds of the body (in obese patients). Patients are always bothered by severe itching. When combing elements, the process quickly spreads along the periphery.

After the rash disappears (after about 5-7 days), unstable hyperpigmentation may remain at the site of inflammation.

With the bullous (vesicular) form of impetigo, dense blisters appear on the extremities, which grow slowly, accompanied by severe itching and dry skin.

Seizures

This is the name given to erosions in the form of cracks and crusts in the corners of the mouth. They appear in children as a complication after chickenpox or herpes; in adults they more often occur when using dishes after a sick person.

A predisposing factor in the development of this pathology is increased salivation in certain diseases, incorrect dentures, as well as insufficiency of B vitamins.

Lichen simplex of the face

This is dry streptoderma, which manifests itself on the face as local peeling and large pinkish spots with scales on the surface.

This type of disease occurs mainly in boys and young men. After treatment and cessation of peeling, depigmentation may temporarily remain on the skin.

Ecthyma

This is a lesion of the deep layers of the skin, in which an abscess with serous-purulent fluid appears; it is characterized by a tendency to peripheral growth and rapid increase in size.

Soon after formation, the abscess dries into a yellow-green crust; unlike impetigo, it does not separate, but adheres tightly to the skin.

When the crust is removed, a painful deep ulcer with jagged edges and pus inside is formed. Such elements take a long time to heal, and scar formation almost always occurs. Most often, ecthyma is located on the skin of the legs and thighs.

Treatment

It is necessary to treat streptoderma in order to avoid the disease becoming chronic, which can cause periodic relapses with any weakening of the body’s defenses.

In most cases, home treatment is effective. You should not try to remove crusts from the surface of the body yourself. Only a doctor can do this.

• treat the lesion (dried crust) with 3% hydrogen peroxide;
• dry with sterile material (bandage, napkin);
• lubricate the skin around the problem area (within a radius of at least 2 cm) with a solution of brilliant green, iodine, furacillin, salicylic or chloramphenicol alcohol;
• ointment with an antibacterial substance (for example, erythromycin) is applied to the inflamed area under or without a bandage, depending on the location.

An oral antibiotic may be required for severe, widespread forms of infection, such as in young children. Until the rash disappears, you should not take baths or use a washcloth.

At chronic course It is advisable to undergo an examination to determine the cause of the disease (diabetes, vascular problems, etc.) and prescribe treatment from specialists in the profile of the identified pathology, as well as obtain advice from an immunologist.

You can get rid of streptoderma if you pay attention to the symptoms in time and do not try to treat yourself.

Video

Skin dyschromia is quite common. It is diagnosed in people of any age, including newborns and older children. Most deviations do not affect a person’s general well-being, but can lead to psychological discomfort if the defect is noticeable to others. Depending on the cause, the color of the epidermis is restored on its own or requires conservative (or even surgical) correction. Treatment tactics are selected taking into account the underlying disease.

Dyschromia is a general concept that includes conditions in which the skin changes its natural color due to an excess or lack of pigment. Such changes can be congenital or occur later.

According to the International Classification of Diseases (ICD-10), the pathology is assigned code L81, which denotes other pigmentation disorders.

The main substance that affects skin color is melanin. This is a pigment produced by special cells - melanocytes, which are located in the epidermis and dermis, retina, and inner ear. The main function of pigment cells is to protect the skin from the toxic effects of ultraviolet radiation.

Other pigments that affect the coloring of the skin include:

• yellow-orange (carotene, vitamin A);
• red (oxygenated hemoglobin);
• blue (reduced iron protein);
• melanoid is a breakdown product of melanin.

Dyschromia is divided into:

• hyperchromic - increased pigmentation;
• hypochromic - decreased intensity of skin color.

In addition to pigments, many diseases lead to changes in skin color:

• red (hypertension, erythrocytosis, tuberculosis, sinusitis);
• earthy (thyroid dysfunction, cancer, sepsis, AIDS);
• pale (peptic ulcer, heart defects, oncology, endometriosis);
• blue (methemoglobinemia, cardiac or pulmonary dysfunction, chronic bronchitis);
• yellow - liver dysfunction;
• bronze (adrenal or hypothalamic-pituitary system insufficiency).

A change in skin color that persists for a long time is a reason to consult a doctor and undergo an examination.

The main sign indicating dyschromia is a change in skin color, namely:

• uneven lightening or darkening of the skin;
• the appearance of clearly defined or blurry spots of various shades;
• pigmentation disorder throughout the body or localized symmetrically, for example, on the right and left arm.

Some deviations are asymptomatic and manifest only visual signs.

Others are accompanied by local discomfort:

• redness;
• peeling;
• itching;
• soreness;
• swelling;
• suppuration;
• bleeding.

Still others cause a general deterioration in well-being:

• weakness and decreased ability to work;
• asthenia, insomnia and irritability;
• dizziness, headaches;
• loss of appetite, weight loss or opposite symptoms;
• dyspeptic disorders.

The reasons that provoke dyschromia are different.

Albinism

The congenital absence of pigment is called albinism. It can be partial or complete. The defects are caused by a genetic mutation and discolor the epidermis while still in the womb. When a baby is born, abnormalities are immediately visible.

The characteristic color of the epidermis remains forever and cannot be treated.

Vitiligo

This pathology is characterized by focal lightening. Unlike albinism, pathology appears in children after 5 years of age and adults. Younger children rarely get sick. The likelihood of developing vitiligo in a newborn or infant is minimal.

The spots are localized throughout the body or in a specific anatomical area, for example, only on the face or hands. Less commonly, large areas are affected.

Lightened lesions are colored milky or creamy. Sometimes they are pinkish and bluish.

The exact cause of the appearance is unknown. Presumable provoking factors are genetic predisposition or a malfunction of the immune system.

Treatment of vitiligo is lengthy and expensive, but with a properly selected regimen, the prognosis is favorable.

This is the name for spots of regular shape, localized on the face, shoulders, and hands. They appear less frequently on other parts of the body. People with blond or red hair are prone to freckles.

Ephelides often appear in early childhood, sometimes in newborns. In winter they fade and become almost invisible. When exposed to ultraviolet light, they turn bright orange or brown.

Freckles remain with a person for life. If desired, they can be lightened by a cosmetologist or using lightening creams. But you won’t be able to get rid of them forever.

Chloasma and lentigo

These two pathologies refer to acquired pigment spots. This is the same hyperpigmentation that worries women so much. Chloasma and lentigo look like flat, dark, irregularly shaped lesions with clear boundaries. Typical localization is open areas of the body - face, shoulders, limbs. Why such defects occur is not known exactly, but doctors suggest that the predisposing factors are:

• excess ultraviolet radiation;
• natural photoaging;
• hormonal changes;
• diseases of the liver and adrenal glands;
• use of cosmetics with oxidized components.

Chloasma often appears in pregnant women. Adolescents are diagnosed with juvenile lentigo. In childhood, the likelihood of such defects occurring is minimal.

Initially, chloasma and lentigo are benign formations, but under the influence of unfavorable factors they can (very rarely!) degenerate into cancer. According to statistics, lentigo becomes malignant more often.

After eliminating the provoking factor, the spots disappear on their own or lighten, but remain for life. Treatment is required if the patient considers them to be a serious cosmetic defect or if there are alarming symptoms in the hyperpigmented area.

In the vast majority of cases, such pigmentation does not cause any discomfort other than psychological, since many women are very concerned about such a cosmetic defect.

These are pigmented formations that consist of nevus cells. They differ in color, structure and occur in people of any age.

Most moles are benign and rarely develop into cancer. Dangerous varieties are considered:

• Dubreuil's melanosis;
• giant;
• dysplastic;
• blue nevus.

Signs of a good mole:

• symmetry;
• uniform color;
• size not exceeding 6 mm;
• no discomfort.

The opposite symptoms are considered dangerous and require consultation with a dermatologist.

Nevi are removed if cancer is suspected or at the request of the patient.

Melanoma

This is an aggressive type of skin cancer consisting of degenerated pigment cells. It often occurs in hyperpigmented areas where there are moles and dark spots. Pigmentless forms are rare.

At an early stage, the disease manifests itself as discomfort in the area of ​​the darkened area - pain, itching, inflammation. As it progresses, general symptoms appear, indicating involvement of the lymphatic system in the pathological process. The patient develops weakness and signs of intoxication.

The exact reasons for the degeneration of a benign spot are unknown. The most common theories include:

• influence of ultraviolet radiation;
• genetic predisposition;
• mechanical damage.

Treatment of melanoma is surgical. Early stages are well treated, but in later stages the prognosis is unfavorable.

Sometimes dyschromia occurs as a consequence of skin diseases, such as pityriasis alba, pityriasis versicolor or rosea. Discoloration is caused by toxins produced by fungal pathogens. After reducing the concentration of these substances, the spots gradually restore color. Many such cases are described on forums dedicated to skin diseases.

Other likely causes of lightening or darkening of the epidermis include:

1. Injuries (burns, cuts, bites), which leave scars that do not contain pigment cells.
2. Abuse of foods or vitamin complexes containing carotene.
3. Poor patency of the biliary tract, excess bilirubin turns the skin yellow.

A short-term change in skin color may be associated with food eaten the day before, the use of certain medications, or activation of the immune system. To find out the cause, you need to consult a doctor.

Features of dyschromia during gestation

Gestation is the period from the first day of the last menstrual period until the cutting of the umbilical cord.

With the onset of pregnancy, a woman’s body undergoes powerful hormonal and physical changes. During this period, all cells and internal organs begin to work differently. Melanocytes try to protect the body of the unborn baby from the toxic effects of UV rays, so they accumulate in certain places, where chloasma and other age spots subsequently form. The adrenal glands play an important role in this process.

Skin defects often appear in the second trimester. Common localization:

• face;
• breast;
• nipples;
• belly (vertical strip from navel to pubis).

Most spots disappear 1 to 2 weeks after birth, but some persist.

If signs of skin dyschromia appear in a child or adult, it is recommended to visit a dermatologist who will examine the pathological area, collect anamnesis and give a referral for tests.

The general examination scheme includes:

• general blood test, urine test and biochemistry;
• dermatoscopy;
• examination using a Wood's lamp.

The further algorithm depends on the suspected cause. You may need to consult other specialists - oncologist, gastroenterologist, immunologist, hepatologist.

The treatment regimen is selected taking into account the examination results. To restore pigmentation use:

• medications (tablets, injections, ointments);
• physiotherapy;
• phototherapy;
• minimally invasive procedures (laser, cryodestruction);
• cosmetic creams and serums with toning or brightening effects;
• folk recipes;
• surgical methods (excision of suspicious areas, transplantation).

Self-treatment is usually ineffective and sometimes very dangerous.

Preventive measures and life prognosis

It is not always possible to prevent dyschromia. To reduce the likelihood, medical professionals recommend:

1. Avoid prolonged exposure to the sun, use creams that protect the skin from tanning.
2. Give up bad habits and low-quality products.
3. Strengthen immunity.
4. Be less nervous.
5. Exercise.
6. Take medications only with the permission of your doctor.
7. Go to the hospital if something bothers you.

In the absence of serious diseases, dyschromia is not dangerous. If there are any, then the prognosis is difficult to predict. Many pathologies are successfully treated at an early stage (including melanoma). When the first signs appear, it is recommended to go to the doctor and not experiment with your own body.

Skin dyschromia is not a separate disease, but a group of pathologies that affect the color of the skin. The reasons are different - poor nutrition, autoimmune processes, etc. To clarify the diagnosis, it is recommended to visit a dermatologist or therapist, who will tell you what to do next. Most dyschromia, which manifests itself as lightening or darkening of the skin, is harmless, but cases vary.

Skin dyschromia is a condition in which the natural color of the skin is modified. The phenomenon is common and in most cases does not constitute a pathological disorder. Discomfort from dyschromia is aesthetic and psychological in nature.

Dyschromia is a pigmentation disorder caused by a different nature. The color of the skin is affected by 4 pigments - melanin, red and blue hemoglobin, carotene. Most often, the cause of altered skin color is dystrophy or an excess of melanin, a brown pigment.

Dyschromia is divided into:

• hyperpigmentation – the appearance of intensely colored areas (hyperchromia);
• hypochromia or achromia - the appearance of spots with weak or absent coloring;
• Pigment displacement is a phenomenon in which “colorless” foci are formed in hyperpigmented areas.

There are congenital and acquired forms of dyschromia. Congenital diseases include albinism, freckles, and pigmented birthmarks. Acquired - includes all other types of pigmentation and is divided into primary and secondary forms.

Primary ones develop as independent diseases and affect a long time (vitiligo, syphilitic leukoderma, chloasma). Secondary - arise as a result of previously suffered dermatological disorders and have a short-term effect (psoriasis, lichen planus).

The International Classification of Diseases, 10th revision (ICD10), considers dyschromia as a disease of the skin and subcutaneous tissue and classifies it as a pigmentation disorder. To identify the disease, a special ICD-10 code is used - L81.

Symptoms and causes in adults and children

The disease is recognized by a pigment disorder - a change in the color of the skin. The symptoms of dyschromia differ depending on the type of disease and the cause of its occurrence.

Vitiligo is a type of achromia. Light spots of different shapes and sizes appear on the human body.

The skin loses pigment, resulting in almost white formations. This is a fairly rare occurrence that does not cause physical discomfort.

Ephelides or freckles are small pigment spots that occur in people with fair skin (and most often with red hair). The formations have an even round shape, spread mainly over the face, less often over the chest, arms, and back.

Chloasma - brown spots with clear contours and irregular shape. Spread over the face, neck, chest, back. Such spots appear in pregnant women during the gestational period.

Lentigo is a “senile ripple”, a dark-colored formation that appears in older people. The process of lentigo formation is associated with the natural aging of the skin and exposure to ultraviolet radiation. Localized on the arms, back, shoulders.

Melanoma is a dangerous malignant tumor that affects the skin. Dark spots with uneven edges and unclear boundaries appear on the body. The formation is characterized by inclusions of other shades.

The causes of dyschromia are varied. The occurrence of disorders is influenced by certain factors of external influence or internal processes of the body:

• individual characteristics of the skin;
• sensitivity to ultraviolet radiation;
• skin aging process;
• lack of vitamins;
• dermatological diseases;
• abuse of UV radiation;
• allergic reactions of the body;
• oncology;
• hormonal changes in the body.

Regardless of the cause of pigmentation disorders in a child or an adult, at the first symptoms you should consult a doctor.

Features of dyschromia during gestation

Gestation is the period of gestation from conception to birth of the baby. At this stage, a woman’s body undergoes a number of hormonal and physiological changes. One of them is dyschromia chloasma.

The appearance of age spots during pregnancy is associated with the protective function of the body. To protect the fetus from exposure to negative external factors, an increased amount of melanin is produced. The pigment acts as a barrier against the influence of ultraviolet radiation.

Dyschromia appears in the second trimester of pregnancy and disappears 1-2 months after birth. These numbers are not fundamental and may differ for some women. Most often, dyschromia during gestation appears on the face, neck, chest (especially in the nipple area), abdomen and genital area. Pregnant women observe the appearance of a brown vertical stripe that starts a few centimeters above the navel and ends at the pubis. Its nature is associated with excessive production of melanin. This phenomenon passes quickly enough, leaving no trace.

A common phenomenon is skin dyschromia in a newborn baby. Immediately after birth, small yellow spots similar to freckles appear on the baby's body. This is a normal phenomenon associated with the adaptation of the newborn’s body to the environment. Such formations soon disappear on their own.

Cafe-au-lait spots in children located on the back, in the groin area or on the inside of the limbs may indicate a genetic disease - neurofibromatosis. If such symptoms occur, you should contact your pediatrician and undergo the necessary tests.

Diagnosis and treatment

The diagnostic examination begins in the physician's office. The doctor examines the area of ​​dyschromia, taking into account associated factors. Information about the patient’s age, pregnancy, and use of oral contraception is taken into account. To obtain a complete picture of a person’s condition, laboratory tests are required. If concomitant diseases are identified, the patient is referred for additional diagnostics to specialists.

Treatment of pigmentation disorders primarily comes down to eliminating the root cause of the disease. Sometimes, after identifying the underlying disease, dyschromia disappears. In other cases, additional actions are required. Elimination of symptoms includes drug therapy, the use of topical medications, and cosmetic procedures. In especially rare cases, when the extent of the affected skin is too wide, a transplant is performed.

Treatment methods are selected individually, depending on the nature of the disorders and the patient’s condition. The general approach includes prescribing vitamin complexes, using special creams to whiten or darken problem areas, as well as injections of drugs that synthesize melanin production. Procedural therapy involves the processes of eliminating pigments through mechanical action:

• dermabrasion;
• peeling;
• grinding;
• cryotherapy;
• phototherapy;
• laser exposure;
• mesotherapy.

To solve problem areas on the face, permanent makeup is used. To do this, special substances are injected under the skin to give the desired shade to the skin.

Preventive measures and life prognosis

To prevent pigmentary disorders, a person needs to pay attention to his own body and health in general. Providing the body with vitamins, using high-quality cosmetics, and moderate exposure to sunlight will help reduce the risk of dyschromia.

In cases where there are no dangerous diseases, pigmentary disorders do not affect a person’s physical quality of life. The need to solve the problem is associated with a psychological factor.

Any changes in the body’s usual state indicate the need to visit a doctor. Only after examination by the doctor will the patient receive accurate information about the nature of the disease and be able to take the necessary measures.

CLASS XII. DISEASES OF SKIN AND SUBcutaneous Fiber (L00-L99)

This class contains the following blocks:
L00-L04 Infections of the skin and subcutaneous tissue
L10-L14 Bullous disorders
L20-L30 Dermatitis and eczema
L40-L45 Papulosquamous disorders
L50-L54 Urticaria and erythema
L55-L59 Diseases of the skin and subcutaneous tissue associated with radiation
L60-L75 Skin appendage diseases
L80-L99 Other diseases of the skin and subcutaneous tissue

The following categories are marked with an asterisk:
L14*Bullous skin disorders in diseases classified elsewhere
L45* Papulosquamous disorders in diseases classified elsewhere

L54* Erythema in diseases classified elsewhere
L62* Changes in nails in diseases classified elsewhere
L86* Keratoderma in diseases classified elsewhere
L99* Other disorders of the skin and subcutaneous tissue in diseases classified elsewhere

INFECTIONS OF THE SKIN AND SUBCUTANEOUS FIBER (L00-L08)

If it is necessary to identify the infectious agent, use an additional code ( B95-B97).

Excluded: hordeolum ( H00.0)
infectious dermatitis ( L30.3)
local skin infections classified in class I,
such as:
erysipelas ( A46)
erysipeloid ( A26. -)
herpetic viral infection ( B00. -)
anogenital ( A60. -)
molluscum contagiosum ( B08.1)
mycoses ( B35-B49)
pediculosis, acariasis and other infestations ( B85-B89)
viral warts ( B07)
panniculitis:
NOS ( M79.3)
lupus ( L93.2)
neck and back ( M54.0)
recurrent [Weber-Christian] ( M35.6)
fissure of the lip commissure [jamming] (due to):
NOS ( K13.0)
candidiasis ( B37. -)
riboflavin deficiency ( E53.0)
pyogenic granuloma ( L98.0)
herpes zoster ( B02. -)

L00 Staphylococcal skin lesion syndrome in the form of burn-like blisters

Pemphigus of the newborn
Ritter's disease
Excluded: toxic epidermal necrolysis [Lyella] ( L51.2)

L01 Impetigo

Excluded: impetigo herpetiformis ( L40.1)
pemphigus of the newborn ( L00)

L01.0 Impetigo [caused by any organism] [any location]. Impetigo Bockhart
L01.1 Impetiginization of other dermatoses

L02 Skin abscess, boil and carbuncle

Included: boil
furunculosis
Excluded: areas of the anus and rectum ( K61. -)
genital organs (external):
female ( N76.4)
men's ( N48.2, N49. -)

L02.0 Skin abscess, boil and carbuncle of the face
Excluded: external ear ( H60.0)
century ( H00.0)
head [any part other than the face] ( L02.8)
lacrimal:
glands ( H04.0)
paths ( H04.3)
mouth ( K12.2)
nose ( J34.0)
eye sockets ( H05.0)
submandibular ( K12.2)
L02.1 Skin abscess, boil and carbuncle of the neck

L02.2 Skin abscess, boil and carbuncle of the trunk. Abdominal wall. Back [any part other than the gluteal]. Chest wall. Groin area. Crotch. Navel
Excluded: breast ( N61)
pelvic girdle ( L02.4)
omphalitis of the newborn ( P38)
L02.3 Skin abscess, boil and carbuncle of the buttock. Gluteal region
Excluded: pilonidal cyst with abscess ( L05.0)
L02.4 Skin abscess, boil and carbuncle of the limb
L02.8 Skin abscess, boil and carbuncle of other localizations
L02.9 Skin abscess, boil and carbuncle of unspecified localization. Furunculosis NOS

L03 Phlegmon

Included: acute lymphangitis
Excluded: phlegmon:
areas of the anus and rectum ( K61. -)
external auditory canal ( H60.1)
external genitalia:
female ( N76.4)
men's ( N48.2, N49. -)
century ( H00.0)
lacrimal apparatus ( H04.3)
mouth ( K12.2)
nose ( J34.0)
eosinophilic cellulitis [Velsa] ( L98.3)
febrile (acute) neutrophilic dermatosis [Svita] ( L98.2)
lymphangitis (chronic) (subacute) ( I89.1)

L03.0 Phlegmon of the fingers and toes
Nail infection. Onychia. Paronychia. Peronychia
L03.1 Phlegmon of other parts of the extremities
Armpit. Pelvic girdle. Shoulder
L03.2 Facial phlegmon
L03.3 Phlegmon of the trunk. Abdominal walls. Back [any part]. Chest wall. Groin. Crotch. Navel
Excluded: omphalitis of the newborn ( P38)
L03.8 Phlegmon of other localizations
Head [any part other than the face]. Scalp
L03.9 Cellulitis, unspecified

L04 Acute lymphadenitis

Includes: abscess (acute) of any lymph node,
acute lymphadenitis) except mesenteric
Excluded: swollen lymph nodes ( R59. -)
disease caused by human immunodeficiency virus
[HIV], manifested as a generalized
lymphadenopathy ( B23.1)
lymphadenitis:
NOS ( I88.9)
chronic or subacute, except mesenteric ( I88.1)
mesenteric nonspecific ( I88.0)

L04.0 Acute lymphadenitis of the face, head and neck
L04.1 Acute lymphadenitis of the trunk
L04.2 Acute lymphadenitis of the upper limb. Armpit. Shoulder
L04.3 Acute lymphadenitis of the lower limb. Pelvic girdle
L04.8 Acute lymphadenitis of other localizations
L04.9 Acute lymphadenitis, unspecified

L05 Pilonidal cyst

Includes: fistula - coccygeal or
sinus) pilonidal

L05.0 Pilonidal cyst with abscess
L05.9 Pilonidal cyst without abscesses. Pilonidal cyst NOS

L08 Other local infections of the skin and subcutaneous tissue

L08.0 Pyoderma
Dermatitis:
purulent
septic
pyogenic
Excludes: pyoderma gangrenous ( L88)
L08.1 Erythrasma
L08.8 Other specified local infections of the skin and subcutaneous tissue
L08.9 Local infection of skin and subcutaneous tissue, unspecified

BULLOUS DISORDERS (L10-L14)

Excludes: benign (chronic) familial pemphigus
[Hailey-Hailey disease] ( Q82.8)
syndrome of staphylococcal skin lesions in the form of burn-like blisters ( L00)
toxic epidermal necrolysis [Lyell's syndrome] ( L51.2)

L10 Pemphigus [pemphigus]

Excludes: pemphigus of the newborn ( L00)

L10.0 Pemphigus vulgare
L10.1 Pemphigus vegetans
L10.2 Pemphigus foliaceus
L10.3 Brazilian bladderwort
L10.4 Pemphigus is erythematous. Senir-Usher syndrome
L10.5 Drug-induced pemphigus
L10.8 Other types of pemphigus
L10.9 Pemphigus, unspecified

L11 Other acantholytic disorders

L11.0 Acquired keratosis follicularis
Excluded: keratosis follicularis (congenital) [Darrieu-White] ( Q82.8)
L11.1 Transient acantholytic dermatosis [Grover's]
L11.8 Other specified acantholytic changes
L11.9 Acantholytic changes, unspecified

L12 Pemphigoid

Excluded: pregnancy herpes ( O26.4)
impetigo herpetiformis ( L40.1)

L12.0 Bullous pemphigoid
L12.1 Scarring pemphigoid. Benign pemphigoid of the mucous membranes [Levera]
L12.2 Chronic bullous disease in children. Juvenile dermatitis herpetiformis
L12.3 Epidermolysis bullosa acquired
Excludes: epidermolysis bullosa (congenital) ( Q81. -)
L12.8 Other pemphigiodes
L12.9 Pemphigoid, unspecified

L13 Other bullous changes

L13.0 Dermatitis herpetiformis. Dühring's disease
L13.1 Subcorneal pustular dermatitis. Sneddon-Wilkinson disease
L13.8 Other specified bullous changes
L13.9 Bullous changes, unspecified

L14* Bullous skin disorders in diseases classified elsewhere

DERMATITIS AND ECZEMA (L20-L30)

NoteIn this block, the terms “dermatitis” and “eczema” are used interchangeably as synonyms.
Excluded: chronic (childhood) granulomatous disease ( D71)
dermatitis:
dry skin ( L85.3)
artificial ( L98.1)
gangrenous ( L88)
herpetiformis ( L13.0)
perioral ( L71.0)
stagnant ( I83.1 — I83.2 )
diseases of the skin and subcutaneous tissue associated with exposure to radiation ( L55-L59)

L20 Atopic dermatitis

Excluded: limited neurodermatitis ( L28.0)

L20.0 Scabies Beignets
L20.8 Other atopic dermatitis
Eczema:
flexion NEC
pediatric (acute) (chronic)
endogenous (allergic)
Neurodermatitis:
atopic (localized)
diffuse
L20.9 Atopic dermatitis, unspecified

L21 Seborrheic dermatitis

Excluded: infectious dermatitis ( L30.3)

L21.0 Seborrhea of ​​the head. "Baby's Cap"
L21.1 Seborrheic infantile dermatitis
L21.8 Other seborrheic dermatitis
L21.9 Seborrheic dermatitis, unspecified

L22 Diaper dermatitis

Diaper:
erythema
rash
Psoriasis-like diaper rash

L23 Allergic contact dermatitis

Included: allergic contact eczema
Excludes: allergy NOS ( T78.4)
dermatitis:
NOS ( L30.9)
contact BDU ( L25.9)
diaper ( L22)
L27. -)
century ( H01.1)
simple irritable contact ( L24. -)
perioral ( L71.0)
eczema of the outer ear ( H60.5)
diseases of the skin and subcutaneous tissue associated with exposure to radiation ( L55-L59)

L23.0 Allergic contact dermatitis caused by metals. Chrome. Nickel
L23.1 Allergic contact dermatitis caused by adhesives
L23.2 Allergic contact dermatitis caused by cosmetics
L23.3 Allergic contact dermatitis caused by drugs in contact with the skin
If it is necessary to identify the drug, use an additional code for external causes (class XX).
T88.7)
L27.0-L27.1)
L23.4 Allergic contact dermatitis caused by dyes
L23.5 Allergic contact dermatitis caused by other chemicals
With cement. Insecticides. Plastic. Rubber

L23.6 Allergic contact dermatitis caused by food contact with skin
L27.2)
L23.7 Allergic contact dermatitis caused by plants other than food
L23.8 Allergic contact dermatitis caused by other substances
L23.9 Allergic contact dermatitis, cause not specified. Allergic contact eczema NOS

L24 Simple irritant contact dermatitis

Included: simple irritant contact eczema
Excludes: allergy NOS ( T78.4)
dermatitis:
NOS ( L30.9)
allergic contact ( L23. -)
contact BDU ( L25.9)
diaper ( L22)
caused by substances taken orally ( L27. -)
century ( H01.1)
perioral ( L71.0)
eczema of the outer ear ( H60.5)
diseases of the skin and subcutaneous tissue associated
with exposure to radiation ( L55-L59)

L24.0 Simple irritant contact dermatitis caused by detergents
L24.1 Simple irritant contact dermatitis caused by oils and lubricants
L24.2 Simple irritant contact dermatitis caused by solvents
Solvents:
chlorine-containing)
cyclohexane)
ethereal)
glycolic) group
hydrocarbon)
ketone)
L24.3 Simple irritant contact dermatitis caused by cosmetics
L24.4 Irritant contact dermatitis caused by drugs in contact with the skin
If it is necessary to identify the drug, use an additional code for external causes (class XX).
Excludes: drug-induced allergy NOS ( T88.7)
drug-induced dermatitis ( L27.0-L27.1)
L24.5 Simple irritant contact dermatitis caused by other chemicals
With cement. Insecticides
L24.6 Simple irritant contact dermatitis caused by food contact with skin
Excluded: dermatitis caused by food eaten ( L27.2)
L24.7 Simple irritant contact dermatitis caused by plants other than food
L24.8 Simple irritant contact dermatitis caused by other substances. Dyes
L24.9 Simple irritant contact dermatitis, cause unspecified. Irritant contact eczema NOS

L25 Contact dermatitis, unspecified

Included: contact eczema, unspecified
Excludes: allergy NOS ( T78.4)
dermatitis:
NOS ( L30.9)
allergic contact ( L23. -)
caused by substances taken orally ( L27. -)
century ( H01.1)
simple irritable contact ( L24. -)
perioral ( L71.0)
eczema of the outer ear ( H60.5)
lesions of the skin and subcutaneous tissue associated
with exposure to radiation ( L55-L59)

L25.0 Unspecified contact dermatitis caused by cosmetics
L25.1 Unspecified contact dermatitis caused by drugs in contact with skin
If it is necessary to identify the drug, use an additional code for external causes (class XX).
Excludes: drug-induced allergy NOS ( T88.7)
drug-induced dermatitis ( L27.0-L27.1)
L25.2 Unspecified contact dermatitis caused by dyes
L25.3 Unspecified contact dermatitis caused by other chemicals. With cement. Insecticides
L25.4 Unspecified contact dermatitis caused by food in contact with skin
Excluded: contact dermatitis caused by food eaten ( L27.2)
L25.5 Unspecified contact dermatitis caused by plants other than food
L25.8 Unspecified contact dermatitis caused by other substances
L25.9 Unspecified contact dermatitis, cause not specified
Contact:
dermatitis (occupational) NOS
eczema (occupational) NOS

L26 Exfoliative dermatitis

Pitiriaz Gebra
Excludes: Ritter's disease ( L00)

L27 Dermatitis caused by ingested substances

Excluded: unfavorable:
drug exposure NOS ( T88.7)
reaction to food, excluding dermatitis ( T78.0-T78.1)
allergic reaction NOS ( T78.4)
contact dermatitis ( L23-l25)
medicinal:
photoallergic reaction ( L56.1)
phototoxic reaction ( L56.0)
urticaria ( L50. -)

L27.0 Generalized skin rash caused by drugs and medications
If it is necessary to identify the drug, use an additional code for external causes (class XX).
L27.1 Localized skin rash caused by drugs and medications
If it is necessary to identify the drug, use an additional code for external causes (class XX).
L27.2 Dermatitis caused by food eaten
Excluded: dermatitis caused by food in contact with skin ( L23.6, L24.6, L25.4)
L27.8 Dermatitis caused by other substances ingested
L27.9 Dermatitis due to unspecified substances ingested

L28 Simple chronic lichen and prurigo

L28.0 Simple chronic lichen. Limited neurodermatitis. Ringworm NOS
L28.1 Prurigo nodular
L28.2 Another pruritus
Pruritus:
NOS
Gebras
mitis
Urticaria papular

L29 Itching

Excluded: neurotic scratching of the skin ( L98.1)
psychogenic itching ( F45.8)

L29.0 Itching of the anus
L29.1 Itching of the scrotum
L29.2 Itching of the vulva
L29.3 Anogenital itching, unspecified
L29.8 Another itch
L29.9 Unspecified itching. Itching NOS

L30 Other dermatitis

Excluded: dermatitis:
contact ( L23-L25)
dry skin ( L85.3)
small plaque parapsoriasis ( L41.3)
stasis dermatitis ( I83.1-I83.2)

L30.0 Coin eczema
L30.1 Dyshidrosis [pompholyx]
L30.2 Skin autosensitization. Candida. Dermatophytosis. Eczematous
L30.3 Infectious dermatitis
Infectious eczema
L30.4 Erythematous diaper rash
L30.5 Pityriasis white
L30.8 Other specified dermatitis
L30.9 Dermatitis, unspecified
Eczema NOS

PAPULOSQUAMOUS DISORDERS (L40-L45)

L40 Psoriasis

L40.0 Psoriasis vulgaris. Coin psoriasis. Plaque
L40.1 Generalized pustular psoriasis. Impetigo herpetiformis. Zumbusch's disease
L40.2 Acrodermatitis persistent [Allopo]
L40.3 Palmar and plantar pustulosis
L40.4 Guttate psoriasis
L40.5+ Arthropathic psoriasis ( M07.0-M07.3*, M09.0*)
L40.8 Other psoriasis. Flexor inverse psoriasis
L40.9 Psoriasis, unspecified

L41 Parapsoriasis

Excludes: atrophic vascular poikiloderma ( L94.5)

L41.0 Pityriasis lichenoid and smallpox-like acute. Mucha-Habermann disease
L41.1 Pityriasis lichenoid chronic
L41.2 Lymphomatoid papulosis
L41.3 Small plaque parapsoriasis
L41.4 Large plaque parapsoriasis
L41.5 Reticular parapsoriasis
L41.8 Other parapsoriasis
L41.9 Parapsoriasis, unspecified

L42 Pityriasis rosea [Gibera]

L43 Lichen ruber flatus

Excluded: lichen planus pilaris ( L66.1)

L43.0 Lichen hypertrophic red flat
L43.1 Lichen planus bullosa
L43.2 Lichenoid reaction to a drug
If it is necessary to identify the drug, use an additional code for external causes (class XX).
L43.3 Lichen planus subacute (active). Tropical lichen planus
L43.8 Other lichen planus
L43.9 Lichen planus, unspecified

L44 Other papulosquamous changes

L44.0 Pityriasis red hair pityriasis
L44.1 Lichen brilliant
L44.2 Lichen linear
L44.3 Ringworm red moniliform
L44.4 Infantile papular acrodermatitis [Gianotti-Crosti syndrome]
L44.8 Other specified papulosquamous changes
L44.9 Papulosquamous changes, unspecified

L45* Papulosquamous disorders in diseases classified elsewhere

URTIA AND ERYTHEMA (L50-L54)

Excluded: Lyme disease ( A69.2)
rosacea ( L71. -)

L50 Urticaria

Excludes: allergic contact dermatitis ( L23. -)
angioedema ( T78.3)
hereditary vascular edema ( E88.0)
Quincke's edema ( T78.3)
hives:
giant ( T78.3)
newborn ( P83.8)
papular ( L28.2)
pigment ( Q82.2)
whey ( T80.6)
solar ( L56.3)

L50.0 Allergic urticaria
L50.1 Idiopathic urticaria
L50.2 Hives caused by exposure to low or high temperatures
L50.3 Dermatographic urticaria
L50.4 Vibration urticaria
L50.5 Cholinergic urticaria
L50.6 Contact urticaria
L50.8 Other hives
Hives:
chronic
periodic recurring
L50.9 Urticaria, unspecified

L51 Erythema multiforme

L51.0 Nonbullous erythema multiforme
L51.1 Bullous erythema multiforme. Stevens-Johnson syndrome
L51.2 Toxic epidermal necrolysis [Lyella]
L51.8 Other erythema multiforme
L51.9 Erythema multiforme, unspecified

L52 Erythema nodosum

L53 Other erythematous conditions

Excluded: erythema:
burn ( L59.0)
arising from contact with the skin of external agents ( L23-L25)
diaper rash ( L30.4)

L53.0 Erythema toxicum
If it is necessary to identify a toxic substance, use an additional external cause code (Class XX).
Excludes: neonatal erythema toxicum ( P83.1)
L53.1 Erythema annular centrifugal
L53.2 Erythema marginal
L53.3 Other chronic patterned erythema
L53.8 Other specified erythematous conditions
L53.9 Erythematous condition, unspecified. Erythema NOS. Erythroderma

L54* Erythema in diseases classified elsewhere

L54.0* Erythema marginal in acute articular rheumatism ( I00+)
L54.8* Erythema in other diseases classified elsewhere

DISEASES OF THE SKIN AND SUBcutaneous Fiber,
RADIATION EXPOSURE RELATED (L55-L59)

L55 Sunburn

L55.0 First degree sunburn
L55.1 Second degree sunburn
L55.2 Third degree sunburn
L55.8 Another sunburn
L55.9 Sunburn, unspecified

L56 Other acute skin changes caused by ultraviolet radiation

L56.0 Drug phototoxic reaction
If it is necessary to identify the drug, use an additional code for external causes (class XX).
L56.1 Drug photoallergic reaction
If it is necessary to identify the drug, use an additional code for external causes (class XX).
L56.2 Photocontact dermatitis
L56.3 Solar urticaria
L56.4 Polymorphic light eruption
L56.8 Other specified acute skin changes caused by ultraviolet radiation
L56.9 Acute skin change caused by ultraviolet radiation, unspecified

L57 Skin changes caused by chronic exposure to non-ionizing radiation

L57.0 Actinic (photochemical) keratosis
Keratosis:
NOS
senile
solar
L57.1 Actinic reticuloid
L57.2 Diamond-shaped skin on the back of the head (neck)
L57.3 Poikiloderma Siwatt
L57.4 Senile atrophy (flabbiness) of the skin. Senile elastosis
L57.5 Actinic [photochemical] granuloma
L57.8 Other skin changes caused by chronic exposure to non-ionizing radiation
Farmer's leather. Sailor's skin. Solar dermatitis
L57.9 Skin change caused by chronic exposure to non-ionizing radiation, unspecified

L58 Radiation radiation dermatitis

L58.0 Acute radiation dermatitis
L58.1 Chronic radiation dermatitis
L58.9 Radiation dermatitis, unspecified

L59 Other diseases of the skin and subcutaneous tissue associated with radiation

L59.0 Burn erythema [ab igne dermatitis]
L59.8 Other specified diseases of the skin and subcutaneous tissue associated with radiation
L59.9 Radiation-associated skin and subcutaneous tissue disease, unspecified

DISEASES OF SKIN APPENDIXES (L60-L75)

Excluded: congenital defects of the external integument ( Q84. -)

L60 Nail diseases

Excluded: clubbed nails ( R68.3)
onychia and paronychia ( L03.0)

L60.0 Ingrown nail
L60.1 Onycholysis
L60.2 Onychogryphosis
L60.3 Nail dystrophy
L60.4 Bo Lines
L60.5 Yellow nail syndrome
L60.8 Other nail diseases
L60.9 Nail disease, unspecified

L62* Changes in nails in diseases classified elsewhere

L62.0* Clubbed nail with pachydermoperiostosis ( M89.4+)
L62.8* Nail changes in other diseases classified elsewhere

L63 Alopecia areata

L63.0 Alopecia total
L63.1 Alopecia universalis
L63.2 Area baldness (ribbon form)
L63.8 Other alopecia areata
L63.9 Alopecia areata, unspecified

L64 Androgenetic alopecia

Included: male type baldness

L64.0 Drug-induced androgenetic alopecia
If it is necessary to identify the drug, use an additional code for external causes (class XX).
L64.8 Other androgenetic alopecia
L64.9 Androgenetic alopecia, unspecified

L65 Other non-scarring hair loss

Excluded: trichotillomania ( F63.3)

L65.0 Telogen hair loss
L65.1 Anagen hair loss. Regenerating miasma
L65.2 Alopecia mucinosa
L65.8 Other specified non-scarring hair loss
L65.9 Non-scarring hair loss, unspecified

L66 Scarring alopecia

L66.0 Alopecia macular cicatricial
L66.1 Lichen planus pilaris. Follicular lichen planus
L66.2 Folliculitis leading to baldness
L66.3 Perifolliculitis of the head abscess
L66.4 Folliculitis reticularis cicatricial erythematous
L66.8 Other scarring alopecias
L66.9 Scarring alopecia, unspecified

L67 Abnormalities of hair and hair shaft color

Excluded: Knotty hair ( Q84.1)
beaded hair ( Q84.1)
telogen hair loss ( L65.0)

L67.0 Trichorrhexis nodosum
L67.1 Changes in hair color. Gray hair. Graying (premature). Hair heterochromia
Poliosis:
NOS
limited acquired
L67.8 Other abnormalities in hair color and hair shaft. Hair fragility
L67.9 Abnormality of hair and hair shaft color, unspecified

L68 Hypertrichosis

Included: excessive hairiness
Excluded: congenital hypertrichosis ( Q84.2)
resistant vellus hair ( Q84.2)

L68.0 Hirsutism
L68.1 Acquired vellus hair hypertrichosis
If it is necessary to identify the drug that caused the disorder, use an additional external cause code (class XX).
L68.2 Localized hypertrichosis
L68.3 Polytrichy
L68.8 Other hypertrichosis
L68.9 Hypertrichosis, unspecified

L70 Acne

Excluded: keloid acne ( L73.0)

L70.0 Common acne [acne vulgaris]
L70.1 Globular acne
L70.2 Acne pox. Necrotic miliary acne
L70.3 Tropical eels
L70.4 Baby acne
L70.5 Acne excoriee des jeunes filles
L70.8 Other acne
L70.9 Acne, unspecified

L71 Rosacea

L71.0 Perioral dermatitis
If it is necessary to identify the drug that caused the lesion, use an additional external cause code (class XX).
L71.1 Rhinophyma
L71.8 Another type of rosacea
L71.9 Rosacea unspecified

L72 Follicular cysts of the skin and subcutaneous tissue

L72.0 Epidermal cyst
L72.1 Trichodermal cyst. Hair cyst. Sebaceous cyst
L72.2 Styatocystoma multiple
L72.8 Other follicular cysts of the skin and subcutaneous tissue
L72.9 Follicular cyst of skin and subcutaneous tissue, unspecified

L73 Other diseases of hair follicles

L73.0 Acne keloids
L73.1 Pseudofolliculitis of beard hair
L73.2 Hidradenitis suppurativa
L73.8 Other specified follicular diseases. Sycosis of the beard
L73.9 Hair follicle disease, unspecified

L74 Diseases of merocrine [eccrine] sweat glands

Excluded: hyperhidrosis ( R61. -)

L74.0 Miliaria rubra
L74.1 Miliaria crystalline
L74.2 Prickly heat is deep. Tropical anhidrosis
L74.3 Miliaria unspecified
L74.4 Anhidrosis. Hypohidrosis
L74.8 Other diseases of merocrine sweat glands
L74.9 Merocrine sweating disorder, unspecified. Sweat gland damage NOS

L75 Diseases of apocrine sweat glands

Excludes: dyshidrosis [pompholyx] ( L30.1)
hidradenitis suppurativa ( L73.2)

L75.0 Bromhidrosis
L75.1 Chromhidrosis
L75.2 Apocrine heat rash. Fox-Fordyce disease
L75.8 Other diseases of the apocrine sweat glands
L75.9 Affection of apocrine sweat glands, unspecified

OTHER DISEASES OF THE SKIN AND SUBcutaneous Fiber (L80-L99)

L80 Vitiligo

L81 Other pigmentation disorders

Excludes: birthmark NOS ( Q82.5)
nevus - see Alphabetical index
Peutz-Jigers syndrome (Touraine) ( Q85.8)

L81.0 Post-inflammatory hyperpigmentation
L81.1 Chloasma
L81.2 Freckles
L81.3 Coffee stains
L81.4 Other melanin hyperpigmentation. Lentigo
L81.5 Leucoderma, not elsewhere classified
L81.6 Other disorders associated with decreased melanin production
L81.7 Pigmented red dermatosis. Angioma creeping
L81.8 Other specified pigmentation disorders. Iron pigmentation. Tattoo pigmentation
L81.9 Unspecified pigmentation disorder

L82 Seborrheic keratosis

Black papular dermatosis
Leser-Trélat disease

L83 Acanthosis nigricans

Confluent and reticulate papillomatosis

L84 Corns and calluses

Callus
Wedge-shaped callus (clavus)

L85 Other epidermal thickenings

Excluded: hypertrophic skin conditions ( L91. -)

L85.0 Acquired ichthyosis
Excluded: congenital ichthyosis ( Q80. -)
L85.1 Acquired keratosis [keratoderma] palmoplantar
Excluded: hereditary palmoplantar keratosis ( Q82.8)
L85.2 Keratosis punctate (palmar-plantar)
L85.3 Skin xerosis. Dry skin dermatitis
L85.8 Other specified epidermal thickenings. Cutaneous horn
L85.9 Epidermal thickening, unspecified

L86* Keratoderma in diseases classified elsewhere

Follicular keratosis) due to insufficiency
Xeroderma) vitamin A ( E50.8+)

L87 Transepidermal perforated changes

Excluded: granuloma annulare (perforated) ( L92.0)

L87.0 Keratosis follicular and parafollicular, penetrating the skin [Kierle disease]
Hyperkeratosis follicular penetrating
L87.1 Reactive perforating collagenosis
L87.2 Creeping perforating elastosis
L87.8 Other transepidermal perforation disorders
L87.9 Transepidermal perforation disorders, unspecified

L88 Pyoderma gangrenous

Gangrenous dermatitis
Necrotic pyoderma

L89 Decubital ulcer

Bedsore
Ulcer caused by plaster cast
Ulcer caused by compression
Excluded: decubital (trophic) cervical ulcer ( N86)

L90 Atrophic skin lesions

L90.0 Lichen sclerosis and atrophic
L90.1 Anetoderma Schwenninger-Buzzi
L90.2 Anetoderma Jadassohn-Pellisari
L90.3 Pasini-Pierini atrophoderma
L90.4 Acrodermatitis chronic atrophic
L90.5 Scar conditions and skin fibrosis. Soldered scar (skin). Scar. Disfigurement caused by a scar. Tripe NOS
Excluded: hypertrophic scar ( L91.0)
keloid scar ( L91.0)
L90.6 Atrophic stripes (striae)
L90.8 Other atrophic skin changes
L90.9 Atrophic skin change, unspecified

L91 Hypertrophic skin changes

L91.0 Keloid scar. Hypertrophic scar. Keloid
Excluded: acne keloids ( L73.0)
scar NOS ( L90.5)
L91.8 Other hypertrophic skin changes
L91.9 Hypertrophic skin change, unspecified

L92 Granulomatous changes in the skin and subcutaneous tissue

Excludes: actinic [photochemical] granuloma ( L57.5)

L92.0 Granuloma annular. Perforated granuloma annulare
L92.1 Necrobiosis lipoidica, not elsewhere classified
Excluded: associated with diabetes mellitus ( E10-E14)
L92.2 Facial granuloma [eosinophilic granuloma of the skin]
L92.3 Granuloma of the skin and subcutaneous tissue caused by a foreign body
L92.8 Other granulomatous changes of the skin and subcutaneous tissue
L92.9 Granulomatous change of skin and subcutaneous tissue, unspecified

L93 Lupus erythematosus

Excluded: lupus:
ulcerative ( A18.4)
ordinary ( A18.4)
scleroderma ( M34. -)
systemic lupus erythematosus ( M32. -)
If it is necessary to identify the drug that caused the lesion, use an additional external cause code (class XX).
L93.0 Discoid lupus erythematosus. Lupus erythematosus NOS
L93.1 Subacute cutaneous lupus erythematosus
L93.2 Other limited lupus erythematosus. Lupus erythematosus deep. Lupus panniculitis

L94 Other localized connective tissue changes

Excluded: systemic connective tissue diseases ( M30-M36)

L94.0 Localized scleroderma. Limited scleroderma
L94.1 Linear scleroderma
L94.2 Calcification of the skin
L94.3 Sclerodactyly
L94.4 Gottron's papules
L94.5 Poikiloderma vascular atrophic
L94.6 Anyum [spontaneous dactylolysis]
L94.8 Other specified localized connective tissue changes
L94.9 Localized connective tissue change, unspecified

L95 Vasculitis limited to the skin, not elsewhere classified

Excluded: creeping angioma ( L81.7)
Henoch-Schönlein purpura ( D69.0)
hypersensitivity angiitis ( M31.0)
panniculitis:
NOS ( M79.3)
lupus ( L93.2)
neck and back ( M54.0)
recurrent (Weber-Christian) ( M35.6)
polyarteritis nodosa ( M30.0)
rheumatoid vasculitis ( M05.2)
serum sickness ( T80.6)
urticaria ( L50. -)
Wegener's granulomatosis ( M31.3)

L95.0 Vasculitis with marbled skin. White atrophy (plaque)
L95.1 Erythema sublime persistent
L95.8 Other vasculitides limited to the skin
L95.9 Vasculitis limited to skin, unspecified

L97 Ulcer of lower extremity, not elsewhere classified

L89)
gangrene ( R02)
skin infections ( L00-L08)
A00-B99
varicose ulcer ( I83.0 , I83.2 )

L98 Other diseases of the skin and subcutaneous tissue, not elsewhere classified

L98.0 Pyogenic granuloma
L98.1 Artificial [artificial] dermatitis. Neurotic scratching of the skin
L98.2 Feverish neutrophilic dermatosis Sweet
L98.3 Wells' eosinophilic cellulitis
L98.4 Chronic skin ulcer, not elsewhere classified. Chronic skin ulcer NOS
Tropical ulcer NOS. Skin ulcer NOS
Excluded: decubital ulcer ( L89)
gangrene ( R02)
skin infections ( L00-L08)
specific infections classified under headings A00-B99
ulcer of the lower extremity NEC ( L97)
varicose ulcer ( I83.0 , I83.2 )
L98.5 Mucinosis of the skin. Focal mucinosis. Lichen myxedema
Excluded: focal mucinosis of the oral cavity ( K13.7)
myxedema ( E03.9)
L98.6 Other infiltrative diseases of the skin and subcutaneous tissue
Excluded: hyalinosis of the skin and mucous membranes ( E78.8)
L98.8 Other specified diseases of the skin and subcutaneous tissue
L98.9 Lesion of the skin and subcutaneous tissue, unspecified

L99* Other lesions of the skin and subcutaneous tissue in diseases classified elsewhere

L99.0* Cutaneous amyloidosis ( E85. -+)
Nodular amyloidosis. Patchy amyloidosis
L99.8* Other specified changes in the skin and subcutaneous tissue in diseases classified in other headings
Syphilitic:
alopecia ( A51.3+)
leucoderma ( A51.3+, A52.7+)