Patients with Addison disease have diffuse hyperpigmentation as well as hyperpigmentation on extensor surfaces (here the elbows) as in the top left panel. In the top right panel, hyperpigmentation of the palmar creases is visible in a patient with Addison disease. In the bottom left panel, hyperpigmented macules of the gums are visible in this patient with Addison disease. Some patients with Addison disease have vitiligo and hyperpigmentation, as seen in the bottom right panel.